{ "dataset": "HCPCS Level II codes 2026", "source": "Centers for Medicare & Medicaid Services (CMS) HCPCS Level II release", "count": 8677, "codes": [ { "code": "A0021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "September 10, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "A0030", "longDescription": "Ambulance service, outside state per mile, transport (medicaid only)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Outside state ambulance serv", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noninterest escort in non er", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interest escort in non er", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation; taxi", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonemergency transport taxi", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation and bus, intra or inter state carrier", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonemergency transport bus", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noner transport mini-bus", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0130", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation: wheelchair van", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noner transport wheelch van", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "September 10, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation and air travel (private or commercial) intra or inter state", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonemergency transport air", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation: per mile - case worker or social worker", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noner transport case worker", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transportation ancillary: parking fees, tolls, other", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transport parking fees/tolls", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0180", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation: ancillary: lodging-recipient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noner transport lodgng recip", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0190", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation: ancillary: meals-recipient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noner transport meals recip", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0200", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation: ancillary: lodging escort", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noner transport lodgng escrt", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0210", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation: ancillary: meals-escort", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noner transport meals escort", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ambulance service, neonatal transport, base rate, emergency transport, one way", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neonatal emergency transport", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "A0425", "longDescription": "Bls mileage (per mile)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Basic life support mileage", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0382", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Bls routine disposable supplies", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Basic support routine suppls", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0384", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bls defibrillation supplies", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "A0425", "longDescription": "Als mileage (per mile)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Advanced life support mileag", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Als defibrillation supplies", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Als specialized service disposable supplies; iv drug therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Als iv drug therapy supplies", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Als specialized service disposable supplies; esophageal intubation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Als esophageal intub suppls", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Als routine disposable supplies", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Als routine disposble suppls", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ambulance waiting time (als or bls), one half (1/2) hour increments", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ambulance waiting 1/2 hr", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0422", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ambulance 02 life sustaining", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "I = Not payable by Medicare", "longDescription": "Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Extra ambulance attendant", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ground mileage, per statute mile", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Ground mileage", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0426", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Als 1", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Als1-emergency", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulance service, basic life support, non-emergency transport, (bls)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Bls", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0429", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulance service, basic life support, emergency transport (bls-emergency)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Bls-emergency", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulance service, conventional air services, transport, one way (fixed wing)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Fixed wing air transport", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0431", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulance service, conventional air services, transport, one way (rotary wing)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rotary wing air transport", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0432", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Pi volunteer ambulance co", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0433", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Advanced life support, level 2 (als 2)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Als 2", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0434", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Specialty care transport (sct)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Specialty care transport", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Fixed wing air mileage, per statute mile", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Fixed wing air mileage", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0436", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Rotary wing air mileage, per statute mile", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rotary wing air mileage", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0888", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noncovered ambulance mileage", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0998", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ambulance response and treatment, no transport", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ambulance response/treatment", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A0999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Unlisted ambulance service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Unlisted ambulance service", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "A2001", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Innovamatrix ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Innovamatrix ac, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2002", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Mirragen advanced wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Mirragen adv wnd mat per sq", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Xcellistem, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Xcellistem, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2005", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Microlyte matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Microlyte matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2006", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Novosorb synpath dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Novosorb synpath per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2007", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Restrata, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Restrata, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2008", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Theragenesis, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Theragenesis, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2009", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Symphony, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Symphony, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2010", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Apis, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Apis, per square centimeter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2011", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Supra sdrm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Supra sdrm, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2012", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Suprathel, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Suprathel, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2013", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Innovamatrix fs, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Innovamatrix fs, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2014", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Omeza collagen matrix or omeza complete matrix, per 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Omeza collag compl 100 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2015", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Phoenix wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Phoenix wnd mtrx, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2016", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Permeaderm b, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Permeaderm b, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Permeaderm glove, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Permeaderm glove, each", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2018", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Permeaderm c, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Permeaderm c, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2019", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Kerecis omega3 marigen shield, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Kerecis marigen shld sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Ac5 advanced wound system (ac5)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ac5 wound system", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2021", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Neomatrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neomatrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2022", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Innovaburn or innovamatrix xl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Innovabrn/innovamatx xl sqcm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Innovamatrix pd, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Innovamatrix pd, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2024", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Resolve matrix or xenopatch, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Resolve or xenopatch sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2025", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Miro3d, per cubic centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Miro3d per cubic cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Restrata minimatrix, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Restrata minimatrix, 5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2027", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Matriderm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Matriderm per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Micromatrix flex, per mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Micromatrix flex per mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2029", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Mirotract wound matrix sheet, per cubic centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Mirotract matrix sheet", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Miro3d fibers, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Miro3d fibers, per mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2031", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Mirodry wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Mirodry, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2032", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Myriad matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Myriad matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Myriad morcells, 4 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Myriad morcells, 4 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2034", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Foundation drs solo, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Found drs solo, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Corplex p or theracor p or allacor p, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Corpl p therac p allac p mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2036", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Cohealyx collagen dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cohealyx col dml mx pr sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2037", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "G4derm plus/suprello, per milliliter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "G4derm plus/suprello, pr ml", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2038", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Marigen pacto, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Marigen pacto, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2039", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Innovamatrix fd, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Innovamatrix fd, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2040", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Microlyte painguard, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Microlyte painguard pr sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2041", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Foundation drs+ duo, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Foundation drs+ duo pr sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2042", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Foundation drs+ solo, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Foundation drs+ solo, sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2043", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Biobrane, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Biobrane, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2044", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Biobrane glove, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Biobrane glove, each", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A2045", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Novashield or novogen wound matrix, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Novashield/novogen pr sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A4100", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Non-sheet form skin substitute, fda cleared as a device, not otherwise specified (list in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Nosht skin sub fda clrd nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "A4206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Syringe with needle, sterile, 1 cc or less, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1 cc sterile syringe&needle", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Syringe with needle, sterile 2 cc, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 cc sterile syringe&needle", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Syringe with needle, sterile 3 cc, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "3 cc sterile syringe&needle", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Syringe with needle, sterile 5 cc or greater, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "5+ cc sterile syringe&needle", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Needle-free injection device, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonneedle injection device", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Supplies for self-administered injections", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supp for self-adm injections", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Non-coring needle or stylet with or without catheter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Non coring needle or stylet", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Syringe, sterile, 20 cc or greater, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "20+ cc syringe only", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Needle, sterile, any size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sterile needle", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sterile water, saline and/or dextrose, diluent/flush, 10 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Sterile water/saline, 10 ml", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95) P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sterile water/saline, 500 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Sterile water/saline, 500 ml", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95) P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sterile saline or water, metered dose dispenser, 10 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sterile saline or water", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95) P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 03, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Refill kit for implantable infusion pump", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Infusion pump refill kit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Supp non-insulin inf cath/wk", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Infusion supplies with pump", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Infusion supplies w/o pump", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Supplies for maintenance of insulin infusion catheter, per week", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Supply insulin inf cath/wk", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Supplies for external insulin infusion pump, syringe type cartridge, sterile, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Sup/ext insulin inf pump syr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4226", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "September 15, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Weekly supply maint cgs pump", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion set for external insulin pump, non needle cannula type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Infus insulin pump non needl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion set for external insulin pump, needle type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Infusion insulin pump needle", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4232", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "I = Not payable by Medicare", "longDescription": "Syringe with needle for external insulin pump, sterile, 3 cc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Syringe w/needle insulin 3cc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4233", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Alkalin batt for glucose mon", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4234", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "J-cell batt for glucose mon", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Lithium batt for glucose mon", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4236", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Silvr oxide batt glucose mon", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4238", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Adju cgm supply allowance", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Non-adju cgm supply allow", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Alcohol or peroxide, per pint", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol or peroxide per pint", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Alcohol wipes, per box", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol wipes per box", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Betadine or phisohex solution, per pint", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Betadine/phisohex solution", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Betadine or iodine swabs/wipes, per box", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Betadine/iodine swabs/wipes", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Chlorhexidine containing antiseptic, 1 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chlorhexidine antisept", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Urine test or reagent strips or tablets (100 tablets or strips)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Urine reagent strips/tablets", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Blood ketone test or reagent strip, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Blood ketone test or strip", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4253", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Blood glucose/reagent strips", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platforms for home blood glucose monitor, 50 per box", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Glucose monitor platforms", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4256", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Normal, low and high calibrator solution / chips", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Calibrator solution/chips", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement lens shield cartridge for use with laser skin piercing device, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Replace lensshield cartridge", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4258", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Spring-powered device for lancet, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Lancet device each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lancets, per box of 100", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Lancets per box", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Cervical cap for contraceptive use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cervical cap contraceptive", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Temporary, absorbable lacrimal duct implant, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Temporary tear duct plug", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4263", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Permanent, long term, non-dissolvable lacrimal duct implant, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Permanent tear duct plug", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4264", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "I = Not payable by Medicare", "longDescription": "Permanent implantable contraceptive intratubal occlusion device(s) and delivery system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intratubal occlusion device", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Paraffin, per pound", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Paraffin", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diaphragm for contraceptive use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diaphragm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4267", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Contraceptive supply, condom, male, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Male condom", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4268", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Contraceptive supply, condom, female, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Female condom", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4269", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Contraceptive supply, spermicide (e.g., foam, gel), each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spermicide", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Disposable endoscope sheath, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disposable endoscope sheath", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Home lancing/test cartridges", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Adhesive skin support attachment for use with external breast prosthesis, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Brst prsths adhsv attchmnt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tubing for breast pump, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replacement breastpump tube", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4282", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Adapter for breast pump, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replacement breastpump adpt", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4283", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Cap for breast pump bottle, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replacement breastpump cap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4284", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Breast shield and splash protector for use with breast pump, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replcmnt breast pump shield", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Polycarbonate bottle for use with breast pump, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replcmnt breast pump bottle", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4286", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Locking ring for breast pump, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replcmnt breastpump lok ring", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4287", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Disposable collection and storage bag for breast milk, any size, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Disp col sto bag breast milk", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4288", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Valve for breast pump, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Replacement breastpump valve", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Sacral nerve stimulation test lead, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sacral nerve stim test lead", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4295", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intermittent urinary catheter; straight tip, hydrophilic coating, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Straigh tip hydrophilic cath", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4296", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Coude tip hydrophilic cath", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4297", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intermittent urinary catheter; hydrophilic coating, with insertion supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Hydrophilic coat insert sup", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cath impl vasc access portal", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implantable access syst perc", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Disposable drug delivery system, flow rate of 50 ml or greater per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Drug delivery system >=50 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Disposable drug delivery system, flow rate of less than 50 ml per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Drug delivery system <=50 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion tray without drainage bag and without catheter (accessories only)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Insert tray w/o bag/cath", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath w/o bag 2-way silicone", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Catheter w/bag 3-way", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4314", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath w/drainage 2-way latex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath w/drainage 2-way silcne", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath w/drainage 3-way", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4318", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Female external urinary collection cup, with or without ring attachment, per day", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Fem urinary cup w/wo attch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1992", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Irrigation tray with bulb or piston syringe, any purpose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Irrigation tray", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Therapeutic agent for urinary catheter irrigation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath therapeutic irrig agent", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4322", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Irrigation syringe, bulb or piston, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Irrigation syringe", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Male external catheter with integral collection chamber, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Male external catheter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Female external urinary collection device; meatal cup, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Fem urinary collect dev cup", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Female external urinary collection device; pouch, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Fem urinary collect pouch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Perianal fecal collection pouch with adhesive, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Stool collection pouch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4331", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Extension drainage tubing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4332", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lubricant, individual sterile packet, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Lube sterile packet", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4333", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Urinary catheter anchoring device, adhesive skin attachment, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary cath anchor device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4334", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Urinary catheter anchoring device, leg strap, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary cath leg strap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4335", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Incontinence supply; miscellaneous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Incontinence supply", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4336", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Incontinence supply, urethral insert, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urethral insert", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4337", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Incontinence supply, rectal insert, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Incontinent rectal insert", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4338", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Indwelling catheter latex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Indwelling catheter special", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Iduc valve pat inst repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Iduc valve sply repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4344", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1983", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Indwelling catheter, foley type, two-way, all silicone or polyurethane, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath indw foley 2 way silicn", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4346", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1983", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Indwelling catheter; foley type, three way for continuous irrigation, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath indw foley 3 way", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4349", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Male external catheter, with or without adhesive, disposable, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Disposable male external cat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4351", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Straight tip urine catheter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4352", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Coude tip urinary catheter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intermittent urinary catheter, with insertion supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Intermittent urinary cath", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion tray with drainage bag but without catheter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Cath insertion tray w/bag", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Bladder irrigation tubing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4356", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "External urethral clamp or compression device (not to be used for catheter clamp), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ext ureth clmp or compr dvc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Bedside drainage bag", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary leg or abdomen bag", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Disposable external urethral clamp or compression device, with pad and/or pouch, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Disposable ext urethral dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy faceplate, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy face plate", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4362", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Skin barrier; solid, 4 x 4 or equivalent; each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Solid skin barrier", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4363", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy clamp, any type, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy clamp, replacement", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adhesive, liquid or equal, any type, per oz", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Adhesive, liquid or equal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4366", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy vent, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy vent", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4367", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy belt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy belt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4368", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy filter, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy filter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4369", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, liquid (spray, brush, etc.), per oz", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Skin barrier liquid per oz", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4371", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, powder, per oz", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Skin barrier powder per oz", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Skin barrier solid 4x4 equiv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4373", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Skin barrier with flange", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4375", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, with faceplate attached, plastic, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drainable plastic pch w fcpl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4376", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, with faceplate attached, rubber, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drainable rubber pch w fcplt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4377", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, for use on faceplate, plastic, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drainable plstic pch w/o fp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4378", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, for use on faceplate, rubber, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drainable rubber pch w/o fp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4379", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, with faceplate attached, plastic, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary plastic pouch w fcpl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, with faceplate attached, rubber, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary rubber pouch w fcplt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4381", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, for use on faceplate, plastic, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary plastic pouch w/o fp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4382", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, for use on faceplate, heavy plastic, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary hvy plstc pch w/o fp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4383", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, for use on faceplate, rubber, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary rubber pouch w/o fp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4384", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy faceplate equivalent, silicone ring, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy faceplt/silicone ring", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4385", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost skn barrier sld ext wear", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4387", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost clsd pouch w att st barr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4388", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drainable pch w ex wear barr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4389", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drainable pch w st wear barr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drainable pch ex wear convex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4391", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary pouch w ex wear barr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary pouch w st wear barr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4393", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urine pch w ex wear bar conv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy pouch liq deodorant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4395", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy deodorant for use in ostomy pouch, solid, per tablet", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy pouch solid deodorant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy belt with peristomal hernia support", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Peristomal hernia supprt blt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Irrigation supply; sleeve, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Irrigation supply sleeve", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy irrigation supply; bag, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy irrigation bag", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy irrigation supply; cone/catheter, with or without brush", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy irrig cone/cath w brs", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy irrigation set", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy irrigation set", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lubricant, per ounce", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Lubricant per ounce", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy ring, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy ring each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, non-pectin based, paste, per ounce", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Nonpectin based ostomy paste", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4406", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, pectin-based, paste, per ounce", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Pectin based ostomy paste", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4407", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ext wear ost skn barr <=4sq\"", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4408", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ext wear ost skn barr >4sq\"", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4409", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost skn barr convex <=4 sq i", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost skn barr extnd >4 sq", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost skn barr extnd =4sq", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4412", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pouch drain high output", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4413", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "2 pc drainable ost pouch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4414", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost sknbar w/o conv<=4 sq in", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4415", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost skn barr w/o conv >4 sqi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4416", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, closed, with barrier attached, with filter (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch clsd w barrier/filtr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4417", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch w bar/bltinconv/fltr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4418", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, closed; without barrier attached, with filter (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch clsd w/o bar w filtr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4419", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch for bar w flange/flt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch clsd for bar w lk fl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4421", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy supply; miscellaneous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ostomy supply misc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4422", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pouch absorbent material", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4423", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch for bar w lk fl/fltr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch drain w bar & filter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch drain for barrier fl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4426", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch drain 2 piece system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch drain/barr lk flng/f", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urine ost pouch w faucet/tap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4429", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urine ost pouch w bltinconv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost urine pch w b/bltin conv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4431", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch urine w barrier/tapv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4432", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Os pch urine w bar/fange/tap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4433", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urine ost pch bar w lock fln", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4434", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ost pch urine w lock flng/ft", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "1pc ost pch drain hgh output", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4436", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Irrigation supply; sleeve, reusable, per month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Irr supply sleev reus per mo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4437", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Irrigation supply; sleeve, disposable, per month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Irr supply sleev disp per mo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4438", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Adhesive clip ext ens contr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tape, non-waterproof, per 18 square inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Non-waterproof tape", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tape, waterproof, per 18 square inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Waterproof tape", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4453", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Rectal catheter with or without balloon, for use with any type transanal irrigation system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Rec cath any transanal, each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adhesive remover or solvent (for tape, cement or other adhesive), per ounce", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Adhesive remover per ounce", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4456", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adhesive remover, wipes, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Adhesive remover, wipes", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4457", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Enema tube, with or without adapter, any type, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Enema tube any type repl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4458", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Enema bag with tubing, reusable", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reusable enema bag", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4459", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Transanal irrigation, any", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4461", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical dressing holder, non-reusable, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Surgicl dress hold non-reuse", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4463", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical dressing holder, reusable, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Surgical dress holder reuse", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Non-elastic binder for extremity", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-elastic extremity binder", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4466", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "M = Non-covered by Medicare", "crossReferenceCode": "A4467", "longDescription": "Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Elastic garment/covering", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4467", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Belt, strap, sleeve, garment, or covering, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Belt strap sleev grmnt cover", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4468", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Exsufflation belt, includes all supplies and accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Exsuff belt incl all sup acc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gravlee jet washer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gravlee jet washer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4479", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic transanal irrigation system, includes electronic pump, water reservoir, tubing, and accessories, without catheter, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electro pump enema, reusable", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Vabra aspirator", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vabra aspirator", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4481", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tracheostoma filter, any type, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostoma filter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4483", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Moisture exchanger, disposable, for use with invasive mechanical ventilation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Moisture exchanger", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Surgical stockings above knee length, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Above knee surgical stocking", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4495", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Surgical stockings thigh length, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Thigh length surg stocking", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Surgical stockings below knee length, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Below knee surgical stocking", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Surgical stockings full length, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Full length surg stocking", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Incontinence garment, any type, (e.g., brief, diaper), each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Incontinence garment anytype", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trans elec nerv periph nerv", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Monthly supplies for use of device coded at e0733", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Monthly supp use with e0733", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Supp ext up limb tremor stim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply trans elec nerve stim", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4544", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Electrode for external lower extremity nerve stimulator for restless legs syndrome", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Electro nerve stimulator rls", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Suppl accessor tibial stim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Surgical trays", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgical trays", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4553", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Non-disposable underpads, all sizes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nondisp underpads, all sizes", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4554", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Disposable underpads, all sizes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disposable underpads", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ca tx e-stim electr/transduc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4556", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Electrodes, (e.g., apnea monitor), per pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Electrodes, pair", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4557", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Lead wires, (e.g., apnea monitor), per pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Lead wires, pair", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Conductive gel or paste", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4559", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Coupling gel or paste, for use with ultrasound device, per oz", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Coupling gel or paste", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Neuromuscular electrical stimulator (nmes), disposable, replacement only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nmes disposable", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Pessary, reusable, rubber, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pessary reusable rub anytype", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Pessary, reusable, non rubber, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pessary reusable nonrubber", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Vag inser rectal control sys", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4564", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Pessary, disposable, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Pessary, disposable any type", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1983", "coverageCode": "C = Carrier judgment", "longDescription": "Slings", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Slings", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4566", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "I = Not payable by Medicare", "longDescription": "Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Should sling/vest/abrestrain", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Splint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Splint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Topical hyperbaric oxygen chamber, disposable", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hyperbaric o2 chamber disps", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4580", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cast supplies (e.g., plaster)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cast supplies (plaster)", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4590", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "I = Not payable by Medicare", "longDescription": "Special casting material (e.g., fiberglass)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Special casting material", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4593", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controller", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Neuromod sti sys adj rehab", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "A4594", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Neuromod adj rehab mouthpie", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Tens suppl 2 lead per month", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Cranial electrotherapy stimulation (ces) system supplies and accessories, per month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Ces system monthly supp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Sleeve for intermittent limb compression device, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sleeve, inter limb comp dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Lithium ion battery, rechargeable, for non-prosthetic use, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Lith ion non prosth recharge", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replace lithium battery 1.5v", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Tubing with integrated heating element for use with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tubing with heating element", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheal suction catheter, closed system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Trach suction cath close sys", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Oxygen probe for use with oximeter device, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxygen probe used w oximeter", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Transtracheal oxygen catheter, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transtracheal oxygen cath", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Battery, heavy duty; replacement for patient owned ventilator", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Heavy duty battery", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Battery cables; replacement for patient-owned ventilator", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Battery cables", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Battery charger; replacement for patient-owned ventilator", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Battery charger", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4614", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Peak expiratory flow rate meter, hand held", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Hand-held pefr meter", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cannula, nasal", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cannula nasal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tubing (oxygen), per foot", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tubing (oxygen) per foot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4617", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mouth piece", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mouth piece", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4618", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breathing circuits", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Breathing circuits", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4619", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Face tent", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Face tent", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Variable concentration mask", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Variable concentration mask", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4623", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tracheostomy, inner cannula", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostomy inner cannula", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheal suction catheter, any type other than closed system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tracheal suction tube", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tracheostomy care kit for new tracheostomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Trach care kit for new trach", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tracheostomy cleaning brush, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostomy cleaning brush", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spacer bag/reservoir", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Oral and/or oropharyngeal suction catheter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Oropharyngeal suction cath", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tracheostomy care kit for established tracheostomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostomy care kit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl bat t.e.n.s. own by pt", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4633", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement bulb/lamp for ultraviolet light therapy system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Uvl replacement bulb", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement bulb for therapeutic light box, tabletop model", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replacement bulb th lightbox", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4635", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Underarm pad, crutch, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Underarm crutch pad", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Replacement, handgrip, cane, crutch, or walker, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Handgrip for cane etc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Replacement, tip, cane, crutch, walker, each.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl tip cane/crutch/walker", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for patient-owned ear pulse generator, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl batt pulse gen sys", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A4639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement pad for infrared heating pad system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Infrared ht sys replcmnt pad", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4640", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Replacement pad for use with medically necessary alternating pressure pad owned by patient", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Alternating pressure pad", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A4641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Radiopharmaceutical, diagnostic, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Radiopharm dx agent noc", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A4642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "In111 satumomab", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A4648", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Tissue marker, implantable, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Implantable tissue marker", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4649", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical supply; miscellaneous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Surgical supplies", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A4650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Implantable radiation dosimeter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Implant radiation dosimeter", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A4651", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Calibrated microcapillary tube, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calibrated microcap tube", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Microcapillary tube sealant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Microcapillary tube sealant", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4653", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Peritoneal dialysis catheter anchoring device, belt, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pd catheter anchor belt", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4657", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Syringe, with or without needle, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Syringe w/wo needle", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sphygmomanometer/blood pressure apparatus with cuff and stethoscope", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sphyg/bp app w cuff and stet", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4663", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood pressure cuff only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysis blood pressure cuff", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Automatic blood pressure monitor", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Automatic bp monitor, dial", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4671", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Disposable cycler set used with cycler dialysis machine, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disposable cycler set", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4672", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Drainage extension line, sterile, for dialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Drainage ext line, dialysis", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4673", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Extension line with easy lock connectors, used with dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ext line w easy lock connect", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4674", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chem/antisept solution, 8oz", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Activated carbon filter for hemodialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Activated carbon filter, ea", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4690", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialyzer, each", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4706", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bicarbonate concentrate, solution, for hemodialysis, per gallon", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bicarbonate conc sol per gal", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4707", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bicarbonate concentrate, powder, for hemodialysis, per packet", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bicarbonate conc pow per pac", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4708", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Acetate concentrate solution, for hemodialysis, per gallon", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acetate conc sol per gallon", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4709", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Acid concentrate, solution, for hemodialysis, per gallon", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acid conc sol per gallon", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4714", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Treated water per gallon", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4719", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "\"y set\" tubing for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "\"y set\" tubing", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysat sol fld vol > 249cc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysat sol fld vol > 999cc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4722", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialys sol fld vol > 1999cc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4723", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialys sol fld vol > 2999cc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4724", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialys sol fld vol > 3999cc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialys sol fld vol > 4999cc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4726", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialys sol fld vol > 5999cc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4728", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Dialysate solution, non-dextrose containing, 500 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysate solution, non-dex", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fistula cannulation set for hemodialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fistula cannulation set, ea", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4736", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Topical anesthetic, for dialysis, per gram", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Topical anesthetic, per gram", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4737", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injectable anesthetic, for dialysis, per 10 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj anesthetic per 10 ml", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Shunt accessory, for hemodialysis, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shunt accessory", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood tubing, arterial or venous, for hemodialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Art or venous blood tubing", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood tubing, arterial and venous combined, for hemodialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comb art/venous blood tubing", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate solution test kit, for peritoneal dialysis, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysate sol test kit, each", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4765", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate concentrate, powder, additive for peritoneal dialysis, per packet", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysate conc pow per pack", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4766", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysate conc sol add 10 ml", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood collection tube, vacuum, for dialysis, per 50", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Blood collection tube/vacuum", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4771", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Serum clotting time tube, for dialysis, per 50", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Serum clotting time tube", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4772", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood glucose test strips, for dialysis, per 50", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Blood glucose test strips", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4773", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Occult blood test strips, for dialysis, per 50", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Occult blood test strips", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4774", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ammonia test strips, for dialysis, per 50", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ammonia test strips", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4802", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Protamine sulfate, for hemodialysis, per 50 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Protamine sulfate per 50 mg", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4860", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Disposable catheter tips for peritoneal dialysis, per 10", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disposable catheter tips", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4870", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Plumbing and/or electrical work for home hemodialysis equipment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Plumb/elec wk hm hemo equip", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contracts, repair and maintenance, for hemodialysis equipment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Repair/maint cont hemo equip", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4911", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Drain bag/bottle, for dialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Drain bag/bottle", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4913", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Miscellaneous dialysis supplies, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Misc dialysis supplies noc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4918", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Venous pressure clamp, for hemodialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Venous pressure clamp", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4927", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gloves, non-sterile, per 100", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-sterile gloves", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4928", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Surgical mask, per 20", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surgical mask", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4929", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tourniquet for dialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tourniquet for dialysis, ea", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gloves, sterile, per pair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sterile, gloves per pair", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4931", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Oral thermometer, reusable, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reusable oral thermometer", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "A4932", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Rectal thermometer, reusable, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reusable rectal thermometer", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A5051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, closed; with barrier attached (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Pouch clsd w barr attached", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, closed; without barrier attached (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Clsd ostomy pouch w/o barr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, closed; for use on faceplate, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Clsd ostomy pouch faceplate", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, closed; for use on barrier with flange (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Clsd ostomy pouch w/flange", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stoma cap", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Stoma cap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "1 pc ost pouch w filter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "1 pc ost pou w built-in conv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "C = Carrier judgment", "longDescription": "Ostomy pouch, drainable; with barrier attached, (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Pouch drainable w barrier at", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable; without barrier attached (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drnble ostomy pouch w/o barr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5063", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Drain ostomy pouch w/flange", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary; with barrier attached (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary pouch w/barrier", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5072", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary; without barrier attached (1 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary pouch w/o barrier", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy pouch, urinary; for use on barrier with flange (2 piece), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary pouch on barr w/flng", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stoma plug or seal, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Stoma plug or seal, any type", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5082", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Continent device; catheter for continent stoma", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Continent stoma catheter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Continent device, stoma absorptive cover for continent stoma", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Stoma absorptive cover", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5093", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ostomy accessory; convex insert", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Ostomy accessory convex inse", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bedside drainage bottle with or without tubing, rigid or expandable, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Bedside drain btl w/wo tube", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Urinary suspensory with leg bag, with or without tube, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary suspensory", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Urinary leg bag", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Leg strap; latex, replacement only, per set", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Latex leg strap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Leg strap; foam or fabric, replacement only, per set", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Foam/fabric leg strap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Skin barrier, wipes or swabs, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Skin barrier, wipe or swab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Skin barrier; solid, 6 x 6 or equivalent, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Solid skin barrier 6x6", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Skin barrier; solid, 8 x 8 or equivalent, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Solid skin barrier 8x8", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adhesive or non-adhesive; disk or foam pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Disk/foam pad +or- adhesive", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Appliance cleaner, incontinence and ostomy appliances, per 16 oz.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Appliance cleaner", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous catheter/tube anchoring device, adhesive skin attachment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Percutaneous catheter anchor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A5500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Diab shoe for density insert", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Diabetic custom molded shoe", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Diabetic shoe w/roller/rockr", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Diabetic shoe with wedge", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Diab shoe w/metatarsal bar", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Diabetic shoe w/off set heel", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Modification diabetic shoe", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Diabetic deluxe shoe", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Compression form shoe insert", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multi den insert direct form", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multi den insert custom mold", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A5514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mult den insert dir carv/cam", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "A6000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wound warming wound cover", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A6010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen based wound filler, dry form, sterile, per gram of collagen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Collagen based wound filler", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen based wound filler, gel/paste, per gram of collagen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Collagen gel/paste wound fil", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen dressing, sterile, size 16 sq. in. or less, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Collagen dressing <=16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Collagen drsg>16<=48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen dressing, sterile, size more than 48 sq. in., each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Collagen dressing >48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen dressing wound filler, sterile, per 6 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Collagen dsg wound filler", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Silicone gel sheet, each", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A6154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wound pouch, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Wound pouch each", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6196", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Alginate dressing <=16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Alginate drsg >16 <=48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6198", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Alginate dressing > 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Alginate drsg wound filler", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Composite drsg <= 16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Composite drsg >16<=48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Composite drsg > 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact layer, sterile, 16 sq. in. or less, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Contact layer <= 16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Contact layer >16<= 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact layer, sterile, more than 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Contact layer > 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Foam drsg <=16 sq in w/o bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Foam drg >16<=48 sq in w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Foam drg > 48 sq in w/o brdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Foam drg <=16 sq in w/border", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Foam drg >16<=48 sq in w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Foam drg > 48 sq in w/border", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foam dressing, wound filler, sterile, per gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Foam dressing wound filler", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Non-sterile gauze<=16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Non-sterile gauze>16<=48 sq", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Non-sterile gauze > 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Gauze <= 16 sq in w/border", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Gauze >16 <=48 sq in w/bordr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Gauze > 48 sq in w/border", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Gauze <=16 in no w/sal w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Gauze >16<=48 no w/sal w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Gauze > 48 in no w/sal w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6228", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Gauze <= 16 sq in water/sal", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6229", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Gauze >16<=48 sq in watr/sal", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Gauze > 48 sq in water/salne", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel dsg<=16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6232", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel dsg>16<=48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6233", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel dressing >48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6234", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrocolld drg <=16 w/o bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrocolld drg >16<=48 w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6236", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrocolld drg > 48 in w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6237", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrocolld drg <=16 in w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6238", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrocolld drg >16<=48 w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Hydrocolld drg > 48 in w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound filler, paste, sterile, per ounce", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrocolld drg filler paste", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6241", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocolloid dressing, wound filler, dry form, sterile, per gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrocolloid drg filler dry", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6242", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel drg <=16 in w/o bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel drg >16<=48 w/o bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel drg >48 in w/o bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel drg <= 16 in w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel drg >16<=48 in w/b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel drg > 48 sq in w/b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrogel dressing, wound filler, gel, per fluid ounce", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Hydrogel drsg gel filler", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Skin sealants, protectants, moisturizers, ointments, any type, any size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Skin seal protect moisturizr", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\n9 = Other medical items or services", "year": "2026" }, { "code": "A6251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Absorpt drg <=16 sq in w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Absorpt drg >16 <=48 w/o bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6253", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Absorpt drg > 48 sq in w/o b", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6254", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Absorpt drg <=16 sq in w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Absorpt drg >16<=48 in w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6256", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Absorpt drg > 48 sq in w/bdr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transparent film, sterile, 16 sq. in. or less, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Transparent film <= 16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6258", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Transparent film >16<=48 in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transparent film, sterile, more than 48 sq. in., each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Transparent film > 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wound cleansers, any type, any size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wound cleanser any type/size", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wound filler, gel/paste, per fluid ounce, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Wound filler gel/paste /oz", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wound filler, dry form, per gram, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Wound filler dry form / gram", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Impreg gauze no h20/sal/yard", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Sterile gauze <= 16 sq in", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6403", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Sterile gauze>16 <= 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Sterile gauze > 48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6407", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Packing strips, non-impreg", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Eye pad, sterile, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Sterile eye pad", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Eye pad, non-sterile, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Non-sterile eye pad", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6412", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Eye patch, occlusive, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Occlusive eye patch", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6413", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Adhesive bandage, first-aid type, any size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adhesive bandage, first-aid", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A6441", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Pad band w>=3\" <5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Conform band n/s w<3\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6443", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Conform band n/s w>=3\"<5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6444", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Conform band n/s w>=5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6445", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Conform band s w <3\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6446", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Conform band s w>=3\" <5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6447", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Conform band s w >=5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6448", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Light compression bandage, elastic, knitted/woven, width less than three inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Lt compres band <3\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6449", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Lt compres band >=3\" <5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Lt compres band >=5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6451", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Mod compres band w>=3\"<5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "High compres band w>=3\"<5\"yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6453", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Self-adher band w <3\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6454", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Self-adher band w>=3\" <5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Self-adher band >=5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6456", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Zinc paste band w >=3\"<5\"/yd", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6457", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Tubular dressing with or without elastic, any width, per linear yard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Tubular dressing", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Synthetic drsg <= 16 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6461", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Synthetic drsg >16<=48 sq in", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, bodysuit (head to foot), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compres burngarment bodysuit", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, chin strap, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compres burngarment chinstrp", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, facial hood, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compres burngarment facehood", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, glove to wrist, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Cmprsburngarment glove-wrist", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, glove to elbow, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Cmprsburngarment glove-elbow", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, glove to axilla, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Cmprsburngrmnt glove-axilla", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, foot to knee length, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Cmprs burngarment foot-knee", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, foot to thigh length, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Cmprs burngarment foot-thigh", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compres burn garment jacket", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compres burn garment leotard", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, lower trunk including leg openings (panty), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compres burn garment panty", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compression burn garment, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compres burn garment, noc", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Compression burn mask, face and/or neck, plastic or equal, custom fabricated", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Compress burn mask face/neck", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A6515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, full leg, each, custom", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w str fu le cu", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, foot, each, custom", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w strap foo cu", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, below knee, each, custom", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w strap bn cus", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, arm, each, custom", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w strap arm cu", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6519", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, not otherwise specified, for nighttime use, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com garm noc night use", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, glove, padded, for nighttime use, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garmnt glove nghttime", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, glove, padded, for nighttime use, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garmnt glove nght cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, arm, padded, for nighttime use, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garment arm nighttime", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, arm, padded, for nighttime use, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garment arm nght custm", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, lower leg and foot, padded, for nighttime use, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garmnt lwr leg/ft nght", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garm lwrleg/ft ngt cus", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, full leg and foot, padded, for nighttime use, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garmt full leg/ft nght", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6527", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G garmt full leg/ft nght cus", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6528", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, bra, for nighttime use, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garment bra nighttime", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6529", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, bra, for nighttime use, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garmt bra night custm", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, below knee, 18-30 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Compression stocking bk18-30", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compress stking bk30-40 surg", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6532", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Compress stking bk40-50 surg", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6533", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, thigh length, 18-30 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking thighlngth 18-30", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6534", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, thigh length, 30-40 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking thighlngth 30-40", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, thigh length, 40 mmhg or greater, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking thighlngth 40+", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6536", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, full length/chap style, 18-30 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking full lngth 18-30", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6537", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, full length/chap style, 30-40 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking full lngth 30-40", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6538", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, full length/chap style, 40 mmhg or greater, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking full lngth 40+", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6539", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, waist length, 18-30 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking waistlngth 18-30", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, waist length, 30-40 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking waistlngth 30-40", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, waist length, 40 mmhg or greater, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking waistlngth 40+", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6544", "actionCode": "F = Change in administrative data field of procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, garter belt", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gc stocking garter belt", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "35 = Surgical dressings (price subject to floors and ceilings)", "shortDescription": "Grad com non-elastic bk surg", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6548", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Accessory to custom gradient compression garment, silicone band, any size", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Acces cust grad silic band", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6549", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, not otherwise specified, for daytime use, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com garm noc day use", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Neg pres wound ther drsg set", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A6552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, below knee, 30-40 mmhg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com stocking bk 30-40", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6553", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, below knee, 30-40 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com stcking bk 30-40 custm", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6554", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, below knee, 40 mmhg or greater, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com stocking bk 40+", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, below knee, 40 mmhg or greater, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com stcking bk 40+ custm", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6556", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, thigh length, 18-30 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com stcking thgh18-30 cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6557", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, thigh length, 30-40 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment 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"coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G stckng full/chap18-30 cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G stckng full/chap30-40 cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G stockng full/chap 40+ cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, waist length, 18-30 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com stckng waist18-30 cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, waist length, 30-40 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com stckng waist30-40 cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6564", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, waist length, 40 mmhg or greater, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com stckng waist 40+ cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression gauntlet, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad comp gauntlet custom", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6566", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, neck/head, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com garment neck/head", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6567", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, neck/head, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garment neck/head cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6568", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, torso and shoulder, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garment torso/shldr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6569", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, torso/shoulder, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garmnt torso/shdr cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, genital region, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com garment genital", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6571", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, genital region, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com garment genital custm", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6572", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, toe caps, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com garment toe caps", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6573", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression garment, toe caps, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com garmnt toe cap cust", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6574", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression arm sleeve and glove combination, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Custom gradient sleev/glov", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression arm sleeve and glove combination, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gradient comp sleev/glov", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6576", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression arm sleeve, custom, medium weight, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Custom grad com sleeve med", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6577", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression arm sleeve, custom, heavy weight, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Custom grad cm sleeve heavy", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6578", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression arm sleeve, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gradient comp sleeve", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6579", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression glove, custom, medium weight, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Custom grad com glove med", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression glove, custom, heavy weight, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Custom grad com glove heavy", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6581", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression glove, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gradient comp glove", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6582", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression gauntlet, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Gradient comp gauntlet", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6583", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, below knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w straps bk", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6584", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w straps", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6585", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, above knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w straps ak", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6586", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, full leg, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w strap fu leg", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6587", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, foot, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w straps foot", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6588", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, arm, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w strap arm", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6589", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient pressure wrap with adjustable straps, bra, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w straps bra", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "External urinary catheters; disposable, with wicking material, for use with suction pump, per month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Urinary cath disp suc pump", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A6591", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "External urinary catheter; non-disposable, for use with suction pump, per month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Urinary cath suc pump", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A6593", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Accessory for gradient compression garment or wrap with adjustable straps, not-otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com accessory gmt_wrap", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6594", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G comp bandge liner lwr extr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G comp bandge liner upr extr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G comp bandge conform gauze", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandage roll, elastic long stretch, linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G comp bandage long stretch", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6598", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G comp bandage med stretch", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G comp bandage short stretch", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandge hgh dn foam sht", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, high density foam pad, any size or shape, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandge hgh dn foam pad", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandge hgh dn foamroll", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandge low dn foamchnl", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandge low dn foam flt", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, padded foam, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandage padded foam", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, padded textile, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandage padded textile", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandage tub protct lyr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com bandage tub protct pad", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression bandaging supply, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G compression bandaging", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression stocking, below knee, 18-30 mmhg, custom, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "G com stcking bk 18-30 custm", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A6611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gradient compression wrap with adjustable straps, above knee, each, custom", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "40 = Lymphedema Compression Treatment Items", "shortDescription": "Grad com wrap w strap ak cus", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "A7000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Canister, disposable, used with suction pump, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Disposable canister for pump", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Canister, non-disposable, used with suction pump, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nondisposable pump canister", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Tubing, used with suction pump, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tubing used w suction pump", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Administration set, with small volume nonfiltered pneumatic nebulizer, disposable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer administration set", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Small volume nonfiltered pneumatic nebulizer, disposable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Disposable nebulizer sml vol", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nondisposable nebulizer set", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Administration set, with small volume filtered pneumatic nebulizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Filtered nebulizer admin set", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Large volume nebulizer, disposable, unfilled, used with aerosol compressor", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Lg vol nebulizer disposable", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Large volume nebulizer, disposable, prefilled, used with aerosol compressor", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Disposable nebulizer prefill", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer reservoir bottle", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Corrugated tubing, disposable, used with large volume nebulizer, 100 feet", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Disposable corrugated tubing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Nondispos corrugated tubing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Water collection device, used with large volume nebulizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer water collec devic", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Filter, disposable, used with aerosol compressor or ultrasonic generator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Disposable compressor filter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Filter, nondisposable, used with aerosol compressor or ultrasonic generator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Compressor nondispos filter", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Aerosol mask, used with dme nebulizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Aerosol mask used w nebulize", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Dome and mouthpiece, used with small volume ultrasonic nebulizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer dome & mouthpiece", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer not used w oxygen", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Water, distilled, used with large volume nebulizer, 1000 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Water distilled w/nebulizer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Interface for cough stimulating device, includes all components, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Interface, cough stim device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "A7021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Supplies and accessories for lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (e.g., handset, nebulizer kit, biofilter)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Suppl and access lung expan", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A7023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mech allergen parti barrier", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A7025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Replace chest compress vest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replace chst cmprss sys hose", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Combination oral/nasal mask, used with continuous positive airway pressure device, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Combination oral/nasal mask", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Oral cushion for combination oral/nasal mask, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl oral cushion combo mask", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Nasal pillows for combination oral/nasal mask, replacement only, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl nasal pillow comb mask", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Full face mask used with positive airway pressure device, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Cpap full face mask", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Face mask interface, replacement for full face mask, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replacement facemask interfa", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Cushion for use on nasal mask interface, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replacement nasal cushion", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Pillow for use on nasal cannula type interface, replacement only, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replacement nasal pillows", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nasal application device", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Headgear used with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pos airway press headgear", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Chinstrap used with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pos airway press chinstrap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tubing used with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pos airway pressure tubing", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Filter, disposable, used with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pos airway pressure filter", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Filter, non disposable, used with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Filter, non disposable w pap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "One way chest drain valve", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "One way chest drain valve", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Water seal drainage container and tubing for use with implanted chest tube", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Water seal drain container", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Implanted pleural catheter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Implanted pleural catheter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Vacuum drainage bottle and tubing for use with implanted catheter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Vacuum drainagebottle/tubing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Oral interface used with positive airway pressure device, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pap oral interface", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Exhalation port with or without swivel used with accessories for positive airway devices, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl exhalation port for pap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Water chamber for humidifier, used with positive airway pressure device, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl water chamber, pap dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Oral interface used with respiratory suction pump, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Resp suction oral interface", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A7048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Vacuum drain bottle/tube kit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Expiratory positive airway pressure intranasal resistance valve", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Epap nasal valve", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A7501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tracheostoma valve, including diaphragm, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostoma valve w diaphra", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Replacement diaphragm/faceplate for tracheostoma valve, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Replacement diaphragm/fplate", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Hmes filter holder or cap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Filter for use in a tracheostoma heat and moisture exchange system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostoma hmes filter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Hmes or trach valve housing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Hmes/trachvalve adhesivedisk", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Integrated filter & holder", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Housing & integrated adhesiv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Heat & moisture exchange sys", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Trach/laryn tube non-cuffed", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Trach/laryn tube cuffed", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Trach/laryn tube stainless", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostomy shower protector, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostomy shower protect", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostoma stent/stud/button, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostoma stent/stud/bttn", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostomy mask, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostomy mask", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostomy tube collar/holder, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Tracheostomy tube collar", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A7527", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheostomy/laryngectomy tube plug/stop, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Trach/laryn tube plug/stop", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A8000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Helmet, protective, soft, prefabricated, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Soft protect helmet prefab", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A8001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Helmet, protective, hard, prefabricated, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Hard protect helmet prefab", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A8002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Helmet, protective, soft, custom fabricated, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "45 = Customized DME items", "shortDescription": "Soft protect helmet custom", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A8003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Helmet, protective, hard, custom fabricated, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "45 = Customized DME items", "shortDescription": "Hard protect helmet custom", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A8004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Soft interface for helmet, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl soft interface, helmet", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A8005", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "I = Not payable by Medicare", "longDescription": "Powered, cable driven grip assist glove, hand, finger, includes microprocessor, pressure sensors, all components and accessories, custom fitted", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Grip glove w microprocessor", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A8006", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "I = Not payable by Medicare", "longDescription": "Powered, cable driven grip assist glove, hand, finger, includes pressure sensors, glove replacement only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Grip glove replacement only", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-prescription drugs", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Misc/exper non-prescript dru", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Single vitamin/mineral/trace element, oral, per dose, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Single vitamin nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Multi-vitamin nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Artificial saliva, 1 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Artificial saliva, 1 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Artificial saliva, 30 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Artificial saliva", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oral mucoadhesive, any type (liquid, gel, paste, etc.), per 1 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oral mucoadhesive per 1 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lice treatment, topical", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9268", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Programmer for transient, orally ingested capsule", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Programmer orally ingest cap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9269", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Programable, transient, orally ingested capsule, for use with external programmer, per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Programable ingest capsule", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Non-covered item or service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-covered item or service", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wound suction, disposable, includes dressing, all accessories and components, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disp wound suct, drsg/access", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9273", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hot/cold botle/cap/col/wrap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A9274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ext amb insulin delivery sys", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Home glucose disposable monitor, includes test strips", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disp home glucose monitor", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9276", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disposable sensor, cgm sys", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9277", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "External transmitter, cgm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9278", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "External receiver, cgm sys", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9279", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Monitoring feature/devicenoc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Alert or alarm device, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alert device, noc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Reaching/grabbing device, any type, any length, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reaching/grabbing device", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A9282", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Wig, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wig any type", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9283", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Foot pressure off loading/supportive device, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot press off load supp dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A9284", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Spirometer, non-electronic, includes all accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-electronic spirometer", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "A9285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Inversion/eversion correction device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inversion eversion cor devic", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9286", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hygienic item or device, disposable or non-disposable, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Any hygienic item, device", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9291", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Prescription digital cognitive and/or behavioral therapy, fda cleared, per course of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Pres dig cog behav thera fda", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9292", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Prescription digital visual therapy, software-only, fda cleared, per course of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Pres dig visual therapy fda", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Fertility cycle (contraception & conception) tracking software application, fda cleared, per month, includes accessories (e.g., thermometer)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fertility cycl tracking soft", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9294", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Prescription digital cognitive and/or behavioral therapy, biofeedback, fda cleared, per course of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Biofeed dig cog behav tx fda", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Exercise equipment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Exercise equipment", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m sestamibi, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m sestamibi", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m teboroxime, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Technetium tc-99m teboroxime", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m tetrofosmin, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m tetrofosmin", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m medronate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m apcitide", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Thallium tl-201 thallous chloride, diagnostic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tl201 thallium", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Graphite crucible for preparation of technetium tc 99m-labeled carbon aerosol, one crucible", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Tc-99m graphite crucible", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9507", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "In111 capromab", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9508", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "I131 iodobenguate, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-123 sodium iodide, diagnostic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Iodine i-123 sod iodide mil", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tc99m disofenin", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m pertechnetate, diagnostic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m pertechnetate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lutetium lu 177, dotatate, therapeutic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Lutetium lu 177 dotatat ther", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Choline c-11, diagnostic, per study dose up to 20 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Choline c-11", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Iodine i-123 sod iodide mic", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I131 iodide cap, rx", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99 tilmanocept diag 0.5mci", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m exametazime", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I131 serum albumin, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Nitrogen n-13 ammonia", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9527", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-125, sodium iodide solution, therapeutic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Iodine i-125 sodium iodide", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9528", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Iodine i-131 iodide cap, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9529", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 sodium iodide solution, diagnostic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I131 iodide sol, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 sodium iodide solution, therapeutic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I131 iodide sol, rx", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I131 max 100uci", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9532", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-125 serum albumin, diagnostic, per 5 microcuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I125 serum albumin, dx", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9536", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m depreotide", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9537", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m mebrofenin", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9538", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m pyrophosphate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9539", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m pentetate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m maa", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m sulfur colloid", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "In111 ibritumomab, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Y90 ibritumomab, rx", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9544", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 tositumomab, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I131 tositumomab, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131 tositumomab, therapeutic, per treatment dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "I131 tositumomab, rx", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9546", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Co57/58", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9547", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "In111 oxyquinoline", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9548", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 pentetate, diagnostic, per 0.5 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "In111 pentetate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tc99m gluceptate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9551", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tc99m succimer", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "F18 fdg", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9553", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cr51 chromate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9554", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "I125 iothalamate, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Rb82 rubidium", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9556", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Gallium ga-67 citrate, diagnostic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Ga67 gallium", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9557", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m bicisate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Xenon xe-133 gas, diagnostic, per 10 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Xe133 xenon 10mci", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9559", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Co57 cyano", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m labeled rbc", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m oxidronate", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m mertiatide", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Sodium phosphate p-32, therapeutic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "P32 na phosphate", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9564", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Chromic phosphate p-32 suspension, therapeutic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "P32 chromic phosphate", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9566", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Tc99m fanolesomab", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9567", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Technetium tc-99m aerosol", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9568", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Technetium tc99m arcitumomab", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9569", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Technetium tc-99m auto wbc", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 labeled autologous white blood cells, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Indium in-111 auto wbc", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9571", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 labeled autologous platelets, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Indium in-111 auto platelet", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9572", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Indium in-111 pentetreotide", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9573", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadopiclenol, 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, gadopiclenol, 1 ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadoterate meglumine, 0.1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj gadoterate meglumi 0.1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9576", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadoteridol, (prohance multipack), per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj prohance multipack", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9577", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadobenate dimeglumine (multihance), per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj multihance", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9578", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadobenate dimeglumine (multihance multipack), per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj multihance multipack", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9579", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gad-base mr contrast nos,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Sodium fluoride f-18", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9581", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadoxetate disodium, 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gadoxetate disodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "A9582", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Iodine i-123 iobenguane", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9583", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadofosveset trisodium, 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gadofosveset trisodium inj", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9584", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Iodine i-123 ioflupane", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9585", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gadobutrol, 0.1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Gadobutrol injection", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9586", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Florbetapir f18, diagnostic, per study dose, up to 10 millicuries", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Florbetapir f18", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9587", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Gallium ga-68, dotatate, diagnostic, 0.1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Gallium ga-68", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9588", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Fluciclovine f-18, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Fluciclovine f-18", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9589", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Instillation, hexaminolevulinate hydrochloride, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Insti hexaminolevulinate hcl", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Iodine i-131, iobenguane, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Iodine i-131 iobenguane 1mci", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9591", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Fluoroestradiol f 18, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Fluoroestradiol f 18", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9592", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Copper cu-64, dotatate, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Copper cu 64 dotatate diag", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9593", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Gallium ga-68 psma-11 ucsf", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9594", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Gallium ga-68 psma-11, ucla", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Piflufolastat f-18, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Piflu f-18, dia 1 millicurie", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Gallium illuccix 1 millicure", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Pet, dx, for tumor id, noc", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9598", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Pet dx for non-tumor id, noc", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Radioph dx b amyloid pet nos", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Strontium sr-89 chloride, therapeutic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Sr89 strontium", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Flortaucipir f 18 injection, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Flortaucipir inj 1 millicuri", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Fluorodopa f-18, diagnostic, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Fluorodopa f-18 diag per mci", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pafolacianine, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pafolacianine, 0.1 mg", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Sm 153 lexidronam", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radium ra-223 dichloride, therapeutic, per microcurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Radium ra223 dichloride ther", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Lutetium lu 177 vipivotide", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Flotufolastat f 18, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Flotufolastat f18 diag 1 mci", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Fludeoxyglucose f18 up to 15 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "F18 fdg, 15 millicuries", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Xenon xe-129 hyperpolarized gas, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Xe129 xenon, diagnostic", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Flurpiridaz f 18, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Flurpiridaz f18, diag, 1 mci", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9612", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fluorescein, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj, fluorescein, 1 mg", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegulicianine, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pegulicianine, 1 mg", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9616", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gallium ga-68 gozetotide (gozellix), diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Gallium gozellix 1 millicuri", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9697", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, carboxydextran-coated superparamagnetic iron oxide, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, magtrace per study dose", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9698", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-radioactive contrast imaging material, not otherwise classified, per study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Non-rad contrast materialnoc", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Radiopharmaceutical, therapeutic, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Radiopharm rx agent noc", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "A9700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Supply of injectable contrast material for use in echocardiography, per study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Echocardiography contrast", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Gallium locametz 1 millicuri", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "A9900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Miscellaneous dme supply, accessory, and/or service component of another hcpcs code", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply/accessory/service", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Dme delivery, set up, and/or dispensing service component of another hcpcs code", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Delivery/set up/dispensing", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "A9999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Miscellaneous dme supply or accessory, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Dme supply or accessory, nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "B4034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enter feed supkit syr by day", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enteral feed supp pump per d", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enteral feed sup kit grav by", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nasogastric tubing with stylet", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enteral ng tubing w/ stylet", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4082", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nasogastric tubing without stylet", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enteral ng tubing w/o stylet", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stomach tube - levine type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enteral stomach tube levine", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4087", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Gastrostomy/jejunostomy tube, standard, any material, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Gastro/jejuno tube, std", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4088", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Gastrostomy/jejunostomy tube, low-profile, any material, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Gastro/jejuno tube, low-pro", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Food thickener, administered orally, per ounce", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Food thickener oral", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef adult fluids and electro", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ef ped fluid and electrolyte", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Additive for enteral formula (e.g., fiber)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Additive for enteral formula", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "Q9994", "longDescription": "In-line cartridge containing digestive enzyme(s) for enteral feeding, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enzyme cartridge enteral nut", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enteral feed elastomer daily", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4149", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef blenderized foods", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef complet w/intact nutrient", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef calorie dense>/=1.5kcal", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef hydrolyzed/amino acids", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef spec metabolic noninherit", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef incomplete/modular", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Ef special metabolic inherit", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4158", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ef ped complete intact nut", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4159", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ef ped complete soy based", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ef ped caloric dense>/=0.7kc", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ef ped hydrolyzed/amino acid", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ef ped specmetabolic inherit", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral 50% dextrose solu", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol amino acid 3.", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - home mix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol amino acid 5.", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4176", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol amino acid 7-", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4178", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol amino acid >", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol carb > 50%", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution, not otherwise specified, 10 grams lipids", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Pn soln nos 10 grams lipids", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4187", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Omegaven, 10 grams lipids", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Omegaven, 10 grams lipids", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4189", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol amino acid &", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4193", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol 52-73 gm prot", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol 74-100 gm pro", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol > 100gm prote", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral nutrition additiv", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition supply kit; premix, per day", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral supply kit premix", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition supply kit; home mix, per day", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral supply kit homemi", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B4224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition administration kit, per day", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral administration ki", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B5000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal-aminosyn-rf, nephramine, renamine-premix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol renal-amirosy", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B5100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic, hepatamine-premix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral solution hepatic", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B5200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress-branch chain amino acids-freamine-hbc-premix", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral sol hepatic fream", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B9000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral nutrition infusion pump - without alarm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enter infusion pump w/o alrm", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "B9002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Enteral nutrition infusion pump, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enter nutr inf pump any type", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "B9004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition infusion pump, portable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral infus pump portab", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "B9006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral nutrition infusion pump, stationary", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Parenteral infus pump statio", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "B9998", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Noc for enteral supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Enteral supp not otherwise c", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "B9999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Noc for parenteral supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Parenteral supp not othrws c", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "C1052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hemostatic agent, gastrointestinal, topical", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Hemostatic agent, gi, topic", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intravertebral body fracture augmentation with implant (e.g., metal, polymer)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intravertebral fx aug impl", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "August 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Hyperbaric oxygen", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C1600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal intravascular lesion preparation device, bladed, sheathed (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, bladed, vasc prep", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95) F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endo, single, pulmonary", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95) F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic/device/drug matrix/absorbable bone void filler, antimicrobial-eluting (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Orth/matrx/bn fill drug-elut", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95) F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Retrieval device, insertable, laser (used to retrieve intravascular inferior vena cava filter)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ret dev, laser, ivc filter", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95) F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Graft, transmural transvenous arterial bypass (implantable), with all delivery system components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Grft, trnsmurl/trnsvens byps", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95) F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pmkr, dual, leadless", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adapter, single-use (i.e. disposable), for attaching ultrasound system to upper gastrointestinal endoscope", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Adapter, us to endoscope", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1607", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Neurostimulator, integrated (implantable), rechargeable with all implantable and external components including charging system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Neurostim integ rechg", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1608", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthesis, total, dual mobility, first carpometacarpal joint (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Prosthesis, dual mob cmc1", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1713", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Anchor/screw bn/bn,tis/bn", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1714", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal atherectomy, directional", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, trans atherectomy, dir", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1715", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy needle", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytherapy needle", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1716", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, gold-198, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-str, gold-198", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C1717", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, high dose rate iridium-192, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-str,hdr ir-192", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C1719", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, ns, non-hdrir-192", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C1721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cardioverter-defibrillator, dual chamber (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Aicd, dual chamber", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1722", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cardioverter-defibrillator, single chamber (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Aicd, single chamber", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1724", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal atherectomy, rotational", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, trans atherec,rotation", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, translumin non-laser", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1726", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, balloon dilatation, non-vascular", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, bal dil, non-vascular", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1727", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, balloon tissue dissector, non-vascular (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, bal tis dis, non-vas", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1728", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, brachytherapy seed administration", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, brachytx seed adm", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1729", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, drainage", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, drainage", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, ep, 19 or few elect", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1731", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, ep, 20 or more elec", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1732", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, ep, diag/abl, 3d/vect", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1733", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, ep, othr than cool-tip", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1734", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Orth/devic/drug bn/bn,tis/bn", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1735", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath renal denerv radiofreq", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1736", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter(s), intravascular for renal denervation, ultrasound, including all single use system components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath renal denerv ultrasnd", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1737", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Joint fusion and fixation device(s), sacroiliac and pelvis, including all system components (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Si&pelvis fusn&fixn dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1738", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Powered, single-use (i.e. disposable) endoscopic ultrasound-guided biopsy device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Power endo us-guid bx dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1739", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tissue marker, uniquely detectable and identifiable with probe/sensor, any method (implantable), with delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Marker uniq detect w/prbe", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C1740", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Leadless electrode, transmitter, battery (all implantable), for sequential left ventricular pacing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lt vent pacing syst, sequen", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1741", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Anchor/screw for bone fixation, absorbable, metallic (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Anchor/screw bone absorb", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1742", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pressure monitoring system, compartmental intramuscular (implantable), continuous, including all components (e.g., introducer, sensor), excludes mobile (wireless) software application", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pressure sens syst, cont im", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1743", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Scaffold, endovascular non-coronary, resorbable drug eluting, with delivery system (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Scafld endovas resrb drg elu", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C1747", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endo, single, urinary tract", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1748", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscope, single-use (i.e. disposable), upper gi, imaging/illumination device (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endoscope, single, ugi", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1749", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscope, retrograde imaging/illumination colonoscope device (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endo, colon, retro imaging", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, hemodialysis/peritoneal, long-term", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, hemodialysis,long-term", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1751", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, inf, per/cent/midline", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1752", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, hemodialysis/peritoneal, short-term", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath,hemodialysis,short-term", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1753", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, intravascular ultrasound", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, intravas ultrasound", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1754", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, intradiscal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Catheter, intradiscal", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, intraspinal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Catheter, intraspinal", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1756", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, pacing, transesophageal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, pacing, transesoph", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1757", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, thrombectomy/embolectomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, thrombectomy/embolect", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1758", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, ureteral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Catheter, ureteral", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1759", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, intracardiac echocardiography", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, intra echocardiography", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Closure device, vascular (implantable/insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Closure dev, vasc", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1761", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal intravascular lithotripsy, coronary", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, trans intra litho/coro", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C1762", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Connective tissue, human (includes fascia lata)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Conn tiss, human(inc fascia)", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1763", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Connective tissue, non-human (includes synthetic)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Conn tiss, non-human", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1764", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Event recorder, cardiac (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Event recorder, cardiac", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1765", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adhesion barrier", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Adhesion barrier", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1766", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intro/sheath,strble,non-peel", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1767", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, neurostimulator (implantable), non-rechargeable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Generator, neuro non-recharg", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1768", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Graft, vascular", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Graft, vascular", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1769", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Guide wire", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Guide wire", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Imaging coil, magnetic resonance (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Imaging coil, mr, insertable", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1771", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Repair device, urinary, incontinence, with sling graft", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Rep dev, urinary, w/sling", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1772", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion pump, programmable (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Infusion pump, programmable", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1773", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Retrieval device, insertable (used to retrieve fractured medical devices)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ret dev, insertable", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1776", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Joint device (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Joint device (implantable)", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1777", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, cardioverter-defibrillator, endocardial single coil (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, aicd, endo single coil", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1778", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, neurostimulator (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, neurostimulator", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1779", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, pacemaker, transvenous vdd single pass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, pmkr, transvenous vdd", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lens, intraocular (new technology)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lens, intraocular (new tech)", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mesh (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mesh (implantable)", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1782", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Morcellator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Morcellator", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1783", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ocular implant, aqueous drainage assist device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ocular imp, aqueous drain de", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1784", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ocular device, intraoperative, detached retina", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ocular dev, intraop, det ret", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pacemaker, dual chamber, rate-responsive (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pmkr, dual, rate-resp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1786", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pacemaker, single chamber, rate-responsive (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pmkr, single, rate-resp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1787", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Patient programmer, neurostimulator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Patient progr, neurostim", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1788", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Port, indwelling (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Port, indwelling, imp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1789", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthesis, breast (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Prosthesis, breast, imp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1813", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthesis, penile, inflatable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Prosthesis, penile, inflatab", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1814", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Retinal tamponade device, silicone oil", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Retinal tamp, silicone oil", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1815", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthesis, urinary sphincter (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pros, urinary sph, imp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1816", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Receiver and/or transmitter, neurostimulator (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Receiver/transmitter, neuro", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1817", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Septal defect implant system, intracardiac", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Septal defect imp sys", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1818", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Integrated keratoprosthesis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Integrated keratoprosthesis", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1819", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Surgical tissue localization and excision device (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tissue localization-excision", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1820", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, neurostimulator (implantable), with rechargeable battery and charging system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Generator neuro rechg bat sy", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1821", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Interspinous process distraction device (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Interspinous implant", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C1822", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Gen, neuro, hf, rechg bat", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1823", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Gen, neuro, trans sen/stim", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1824", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, cardiac contractility modulation (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Generator, ccm, implant", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1825", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Gen, neuro, carot sinus baro", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1826", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Gen, neuro, clo loop, rechg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C1827", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Gen, neuro, imp led, ex cntr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C1830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Powered bone marrow biopsy needle", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Power bone marrow bx needle", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1831", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Interbody cage, anterior, lateral or posterior, personalized (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Personalized interbody cage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C1832", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Autograft suspension, including cell processing and application, and all system components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Auto cell process sys", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1833", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Monitor, cardiac, including intracardiac lead and all system components (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cardiac monitor sys", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1834", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pressure sensor system, im", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1839", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Iris prosthesis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Iris prosthesis", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services) S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lens, intraocular (telescopic)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Telescopic intraocular lens", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Retinal prosthesis, includes all internal and external components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Retinal prosth int/ext comp", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1842", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Retinal prosthesis, includes all internal and external components; add-on to c1841", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Retinal prosth, add-on", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1849", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Skin substitute, synthetic, resorbable, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Skin substitute, synthetic", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1874", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stent, coated/covered, with delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Stent, coated/cov w/del sys", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1875", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stent, coated/covered, without delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Stent, coated/cov w/o del sy", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1876", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stent, non-coated/non-covered, with delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Stent, non-coa/non-cov w/del", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1877", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stent, non-coated/non-covered, without delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Stent, non-coat/cov w/o del", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1878", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Material for vocal cord medialization, synthetic (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Matrl for vocal cord", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1880", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Vena cava filter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Vena cava filter", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1881", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysis access system (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Dialysis access system", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1882", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cardioverter-defibrillator, other than single or dual chamber (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Aicd, other than sing/dual", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1883", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adapter/extension, pacing lead or neurostimulator lead (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Adapt/ext, pacing/neuro lead", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1884", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Embolization protective system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Embolization protect syst", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1885", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal angioplasty, laser", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, translumin angio laser", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1886", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, extravascular tissue ablation, any modality (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Catheter, ablation", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1887", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, guiding (may include infusion/perfusion capability)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Catheter, guiding", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1888", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, ablation, non-cardiac, endovascular (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endovas non-cardiac abl cath", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1889", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable/insertable device, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Implant/insert device, noc", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "No implantable/insertable device used with device-intensive procedures", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "No device w/dev-intensive px", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C1891", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion pump, non-programmable, permanent (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Infusion pump,non-prog, perm", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1892", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intro/sheath,fixed,peel-away", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1893", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intro/sheath, fixed,non-peel", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1894", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intro/sheath, non-laser", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1895", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, cardioverter-defibrillator, endocardial dual coil (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, aicd, endo dual coil", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1896", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, aicd, non sing/dual", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1897", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, neurostimulator test kit (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, neurostim test kit", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1898", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, pacemaker, other than transvenous vdd single pass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, pmkr, other than trans", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1899", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, pacemaker/cardioverter-defibrillator combination (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, pmkr/aicd combination", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lead, left ventricular coronary venous system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lead, coronary venous", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C1982", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, pressure-generating, (e.g., one-way valve, intermittently occlusive)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, pressure,valve-occlu", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C2596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Probe, image-guided, robotic, waterjet ablation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Probe, robotic, water-jet", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C2613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lung biopsy plug with delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lung bx plug w/del sys", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C2614", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Probe, percutaneous lumbar discectomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Probe, perc lumb disc", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sealant, pulmonary, liquid", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Sealant, pulmonary, liquid", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, yttrium-90, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-str,yttrium-90", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C2617", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stent, non-coronary, temporary, without delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Stent, non-cor, tem w/o del", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2618", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Probe/needle, cryoablation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Probe/needle, cryo", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2619", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pacemaker, dual chamber, non rate-responsive (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pmkr, dual, non rate-resp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pacemaker, single chamber, non rate-responsive (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pmkr, single, non rate-resp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pacemaker, other than single or dual chamber (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pmkr, other than sing/dual", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthesis, penile, non-inflatable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Prosthesis, penile, non-inf", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2623", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal angioplasty, drug-coated, non-laser", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, translumin, drug-coat", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C2624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Wireless pressure sensor", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C2625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stent, non-coronary, temporary, with delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Stent, non-cor, tem w/del sy", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion pump, non-programmable, temporary (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Infusion pump, non-prog,temp", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, suprapubic/cystoscopic", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, suprapubic/cystoscopic", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, occlusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Catheter, occlusion", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Introducer/sheath, other than guiding, other than intracardiac electrophysiological, laser", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intro/sheath, laser", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, cool-tip", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath, ep, cool-tip", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Repair device, urinary, incontinence, without sling graft", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Rep dev, urinary, w/o sling", "typeOfServiceCode": "9 = Other medical items or services\n\nS = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "C2634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-str, ha, i-125", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C2635", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-str, ha, p-103", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C2636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy linear source, non-stranded, palladium-103, per 1 mm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachy linear, non-str,p-103", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C2637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, ytterbium-169, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachy,non-str,ytterbium-169", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C2638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, stranded, iodine-125, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, stranded, i-125", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C2639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, iodine-125, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-stranded,i-125", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C2640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, stranded, palladium-103, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, stranded, p-103", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C2641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, palladium-103, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-stranded,p-103", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C2642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, stranded, cesium-131, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, stranded, c-131", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C2643", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, cesium-131, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-stranded,c-131", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C2644", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, cesium-131 chloride solution, per millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx cesium-131 chloride", "typeOfServiceCode": "6 = Therapeutic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C2645", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy planar source, palladium-103, per square millimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx planar, p-103", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C2698", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, stranded, not otherwise specified, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, stranded, nos", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C2699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brachytherapy source, non-stranded, not otherwise specified, per source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brachytx, non-stranded, nos", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C5271", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C5272", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C5273", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C5274", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C5275", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C5276", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C5277", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C5278", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Low cost skin substitute app", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C7500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Debridement, bone including epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, first 20 sq cm or less with manual preparation and insertion of deep (e.g., subfacial) drug-delivery device(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Deb bone 20 cm2 w/drug dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous breast biopsies using stereotactic guidance, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral and bilateral (for single lesion biopsy, use appropriate code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Perc bx breast lesions stero", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous breast biopsies using magnetic resonance guidance, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, all lesions unilateral or bilateral (for single lesion biopsy, use appropriate code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Perc bx breast lesions mr", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Open biopsy or excision of deep cervical node(s) with intraoperative identification (e.g., mapping) of sentinel lymph node(s) including injection of non-radioactive dye when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Open exc cerv node(s) w/ id", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous vertebroplasties (bone biopsies included when performed), first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Perq cvt&ls inj vert bodies", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous vertebroplasties (bone biopsies included when performed), first lumbosacral and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Perq ls&cvt inj vert bodies", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Arthrodesis, interphalangeal joints, with or without internal fixation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Fusion of finger joints", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous vertebral augmentations, first thoracic and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Perq thor&lumb vert aug", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous vertebral augmentations, first lumbar and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Perq lumb&thor vert aug", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dx bronch w/ navigation", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Bronch/lavag w/ navigation", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Bronch/bpsy(s) w/ navigation", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Bronchoscopy, rigid or flexible, with single or multiple bronchial or endobronchial biopsy(ies), single or multiple sites, with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s), including fluoroscopic guidance when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Bronch/bpsy(s) w/ ebus", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty of central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cath/angio dialcir w/aplasty", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with all angioplasty in the central dialysis segment, and transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all required imaging, radiological supervision and interpretation, image documentation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cath/angio dial cir w/stents", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with dialysis circuit permanent endovascular embolization or occlusion of main circuit or any accessory veins, including all required imaging, radiological supervision and interpretation, image documentation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cath/angio dial cir w/embol", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cor angio w/ ivus or oct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cor angio w/ilic/fem angio", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging, supervision, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cor/gft angio w/ ivus or oct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7519", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cor/gft angio w/ flow resrv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) includes intraprocedural injection(s) for bypass graft angiography with iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cor/gft angio w/ilic/fem ang", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography with right heart catheterization with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "R hrt angio w/ ivus or oct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right heart catheterization, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "R hrt angio w/flow resrv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "L hrt angio w/ ivus or oct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "L hrt angio w/flow resrv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "L hrt gft ang w/ ivus or oct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "L hrt gft ang w/flow resrv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7527", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "R&l hrt angio w/ ivus or oct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7528", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "R&l hrt angio w/flow resrv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7529", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "R&l hrt gft ang w/flow resrv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty and all angioplasty in the central dialysis segment, with transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging, radiological supervision and interpretation, documentation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cath/aplasty dial cir w/stnt", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal angioplasty with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Angio fem/pop w/ us", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7532", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), initial artery, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Angio w/ us non-coronary", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7533", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ptca w/ plcmt brachytx dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7534", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with atherectomy, includes angioplasty within the same vessel, when performed with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Fem/pop revasc w/arthr & us", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal stent placement(s), includes angioplasty within the same vessel, when performed, with intravascular ultrasound (initial noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Fem/pop revasc w/stent & us", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7537", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion of new or replacement of permanent pacemaker with atrial transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Insrt atril pm w/l vent lead", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7538", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Insrt vent pm w/l vent lead", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7539", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Insrt a & v pm w/l vent lead", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rmv&rplc pm dul w/l vnt lead", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ercp w/ pancreatoscopy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ercp w/bx & pancreatoscopy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ercp w/otomy, pancreatoscopy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7544", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic retrograde cholangiopancreatography (ercp) with removal of calculi/debris from biliary/pancreatic duct(s), with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ercp rmv calc pancreatoscopy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), with removal of calculi/debris from biliary duct(s) and/or gallbladder, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, including diagnostic cholangiography(ies) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Exch bil cath w/ rmv calculi", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7546", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, with ureteral stricture balloon dilation, including imaging guidance and all associated radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rep nph/urt cath w/dil stric", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7547", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Convert nephrostomy catheter to nephroureteral catheter, percutaneous via pre-existing nephrostomy tract, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cnvrt neph cath w/ dil stric", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7548", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Exchange nephrostomy catheter, percutaneous, with ureteral stricture balloon dilation, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Exch neph cath w/ dil stric", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7549", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit with ureteral stricture balloon dilation, including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Chge urtr stent w/ dil stric", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Cystourethroscopy, with biopsy(ies) with adjunctive blue light cystoscopy with fluorescent imaging agent", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cysto w/ bx(s) w/ blue light", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7551", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Excision of major peripheral nerve neuroma, except sciatic, with implantation of nerve end into bone or muscle", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Exc neuroma w/ implnt nv end", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, initial vessel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "R hrt art/grft ang hrt flow", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7553", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "R&i hrt art/vent ang drg ad", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7554", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Cystourethroscopy with adjunctive blue light cystoscopy with fluorescent imaging agent", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cystureth blu li cyst fl img", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Thyroidectomy, total or complete with parathyroid autotransplantation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rmvl thyrd w/autotran parath", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7556", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bronchoscopy, rigid or flexible, with bronchial alveolar lavage and transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s), including fluoroscopic guidance, when performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Bronch lavage w/ebus", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7557", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed and intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Cor angio/vent w/ffr", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Cor angio/vent w/drug admin", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic retrograde cholangiopancreatography (ercp) with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) and endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Ercp remove forgn body&endo", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed with intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "R&l hrt angio w/ffr & 3d map", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, initial artery and all additional arteries", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Trluml ballo angiop all art", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7564", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance with intravascular ultrasound (noncoronary vessel(s)) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Vein mech throm w/intrvas us", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s) less than 3 cm, reducible with removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Rpr aa hrn < 3 rdc w/ rmvl", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7566", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Arthrodesis, interphalangeal joints, with or without internal fixation, with autografts (includes obtaining grafts)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Fuse finger joints w/grafts", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7567", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed, with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i), with computer-assisted image-guided naviagation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Bronch/needle bx(s) w/ nav", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7568", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Cor angio w/flow resrv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7569", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Ptca w/ ivus or oct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7570", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with intraprocedural coronary fractional flow reserve (ffr) with 3d functional mapping of color-coded ffr values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Cor angio w/ffr & 3d map", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7571", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with percutaneous transluminal coronary lithotripsy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Pcta w/ cor lithotrip", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C7900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, 15-29 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hopd mntl hlt, 15-29 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C7901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, 30-60 minutes, provided remotely by hospital staff who are licensed to provided mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hopd mntl hlt, 30-60 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C7902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Service for diagnosis, evaluation, or treatment of a mental health or substance use disorder, each additional 15 minutes, provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service (list separately in addition to code for primary service)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hopd mntl hlt, ea addl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C7903", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Group psychotherapy service for diagnosis, evaluation, or treatment of a mental health or substance use disorder provided remotely by hospital staff who are licensed to provide mental health services under applicable state law(s), when the patient is in their home, and there is no associated professional service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Hopd mntl hlt, grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C8000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Support device, extravascular, for arteriovenous fistula (implantable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Suprt dev, a-v fistula, imp", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "3d anat seg imaging preop", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Preparation of skin cell suspension autograft, automated, including all enzymatic processing and device components (do not report with manual suspension preparation)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Prep skin cell susp, automtd", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Imp extar knee shck absrb", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Simulation angiogram with use of a pressure-generating catheter (e.g., one-way valve, intermittently occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the angiogram, for subsequent therapeutic radioembolization of tumors", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Sim ang w/prs cath rad emb", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8005", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bronchoscopy, rigid or flexible, non-thermal transbronchial ablation of lesion(s) by pulsed electric field (pef) energy, including fluoroscopic and/or ultrasound guidance, when performed, with computed tomography acquisition(s) and 3d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]) of lung(s) and all mediastinal and/or hilar lymph node stations or structures, and therapeutic intervention(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pef bronch ablt 3d nav ebus", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8006", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion of pleural-peritoneal shunt with intercostal pump chamber, including imaging, injection(s) of contrast with radiological supervision and interpretation, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inst pleu-perit shnt w pump", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8007", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Open implantation of hypoglossal nerve neurostimulator array and pulse generator, not requiring insertion of a separate distal respiratory sensor electrode or electrode array", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Opn mplnt hpgls ns ary ps gn", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8008", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Revision or replacement of hypoglossal nerve neurostimulator array including connection to existing pulse generator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rv/rpl hpgls ns inc cnt pg", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8009", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Removal of hypoglossal nerve neurostimulator array and pulse generator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rmv hpgls ns ary and pg", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8010", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous placement of permanent common carotid embolic protection device, including all system components and imaging guidance; bilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pc plm pm c ctd emb prtc", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8011", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Open implantation of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver, including external power source and all system components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Opn mplnt hpgls ns ary rec", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8012", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Revision or replacement of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rv/rpl hpgls ns ary rec", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8013", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Removal of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rmv hpls ns ary rec", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C8900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography with contrast, abdomen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/cont, abd", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast, abdomen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o cont, abd", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast followed by with contrast, abdomen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o fol w/cont, abd", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8903", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance imaging with contrast, breast; unilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mri w/cont, breast, uni", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8904", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "77046", "longDescription": "Magnetic resonance imaging without contrast, breast; unilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mri w/o cont, breast, uni", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8905", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mri w/o fol w/cont, brst, un", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8906", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance imaging with contrast, breast; bilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mri w/cont, breast, bi", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8907", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "77047", "longDescription": "Magnetic resonance imaging without contrast, breast; bilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mri w/o cont, breast, bi", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8908", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mri w/o fol w/cont, breast,", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8909", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography with contrast, chest (excluding myocardium)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/cont, chest", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8910", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast, chest (excluding myocardium)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o cont, chest", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8911", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o fol w/cont, chest", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8912", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography with contrast, lower extremity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/cont, lwr ext", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8913", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast, lower extremity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o cont, lwr ext", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8914", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast followed by with contrast, lower extremity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o fol w/cont, lwr ext", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8918", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography with contrast, pelvis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/cont, pelvis", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8919", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast, pelvis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o cont, pelvis", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast followed by with contrast, pelvis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra w/o fol w/cont, pelvis", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8921", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tte w or w/o fol w/cont, com", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8922", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tte w or w/o fol w/cont, f/u", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8923", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, without spectral or color doppler echocardiography", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "2d tte w or w/o fol w/con,co", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8924", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "2d tte w or w/o fol w/con,fu", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8925", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, real time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "2d tee w or w/o fol w/con,in", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8926", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tee w or w/o fol w/cont,cong", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8927", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tee w or w/o fol w/cont, mon", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8928", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tte w or w/o fol w/con,stres", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8929", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tte w or wo fol wcon,doppler", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tte w or w/o contr, cont ecg", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8931", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography with contrast, spinal canal and contents", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra, w/dye, spinal canal", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8932", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast, spinal canal and contents", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra, w/o dye, spinal canal", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8933", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra, w/o&w/dye, spinal canal", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8934", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography with contrast, upper extremity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra, w/dye, upper extremity", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8935", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast, upper extremity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra, w/o dye, upper extr", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8936", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance angiography without contrast followed by with contrast, upper extremity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mra, w/o&w/dye, upper extr", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8937", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0159T", "longDescription": "Computer-aided detection, including computer algorithm analysis of breast mri image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cad breast mri", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C8957", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than 8 hours), requiring use of portable or implantable pump", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Prolonged iv inf, req pump", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0567", "longDescription": "Injection, cerliponase alfa, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, cerliponase alfa", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0599", "longDescription": "Injection, c-1 esterase inhibitor (human), haegarda, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "C-1 esterase, haegarda", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3316", "longDescription": "Injection, triptorelin extended release, 3.75 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, triptorelin ext rel", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, obinutuzumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, obinutuzumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1322", "longDescription": "Injection, elosulfase alfa, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, elosulfase alfa", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3145", "longDescription": "Injection, testosterone undecanoate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj testosterone undecanoate", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9153", "longDescription": "Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, daunorubicin-cytarabine", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9308", "longDescription": "Injection, ramucirumab, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, ramucirumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3380", "longDescription": "Injection, vedolizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, vedolizumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9271", "longDescription": "Injection, pembrolizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, pembrolizumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9229", "longDescription": "Injection, inotuzumab ozogamicin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj. inotuzumab ozogamicin", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1628", "longDescription": "Injection, guselkumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, guselkumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9057", "longDescription": "Injection, copanlisib, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj copanlisib", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "A9513", "longDescription": "Lutetium lu 177, dotatate, therapeutic, 1 mci", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lutetium lu 177 dotatate, tx", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3398", "longDescription": "Injection, voretigene neparvovec-rzyl, 1 billion 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services)", "year": "2026" }, { "code": "C9034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1095", "longDescription": "Injection, dexamethasone 9%, intraocular, 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, dexamethasone 9%", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aripiprazole lauroxil (aristada initio), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, aristada initio", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, patisiran, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, patisiran", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, risperidone (perseris), 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, risperidone", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mogamulizumab-kpkc, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj mogamulizumab-kpkc", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, plazomicin, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, plazomicin", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3031", "longDescription": "Injection, fremanezumab-vfrm, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, fremanezumab-vfrm", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7169", "longDescription": "Injection, coagulation factor xa (recombinant), inactivated (andexxa), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, coagulation factor xa", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bendamustine hcl (belrapzo), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj., belrapzo 1 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0642", "longDescription": "Injection, levoleucovorin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, levoleucovorin", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9119", "longDescription": "Injection, cemiplimab-rwlc, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, cemiplimab-rwlc", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9313", "longDescription": "Injection, moxetumomab pasudotox-tdfk, 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Moxetumomab pasudotox-tdfk", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cocaine hydrochloride nasal solution (goprelto), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cocaine hcl nasal (goprelto)", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, caplacizumab-yhdp, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, caplacizumab-yhdp", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1096", "longDescription": "Dexamethasone, lacrimal ophthalmic insert, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Dexamethasone ophth insert", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9269", "longDescription": "Injection, tagraxofusp-erzs, 10 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, tagraxofusp-erzs", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9210", "longDescription": "Injection, emapalumab-lzsg, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, emapalumab-lzsg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0121", "longDescription": "Injection, omadacycline, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, omadacycline", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1303", "longDescription": "Injection, ravulizumab-cwvz, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, ravulizumab-cwv", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0791", "longDescription": "Injection, crizanlizumab-tmca, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, crizanlizumab-tmca", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0691", "longDescription": "Injection, lefamulin (xenleta), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, lefamulin", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1632", "longDescription": "Injection, brexanolone, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, brexanolone", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0223", "longDescription": "Injection, givosiran, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, givosiran", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1201", "longDescription": "Injection, cetirizine hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj cetirizine hydrochloride", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 15, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q5120", "longDescription": "Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo) 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection,pegfilgrastim-bmez", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9059", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1738", "longDescription": "Injection, meloxicam, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, meloxicam", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "A9591", "longDescription": "Fluoroestradiol f18, diagnostic, 1 mci", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Fluoroestradiol f18", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3241", "longDescription": "Injection, teprotumumab-trbw, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, teprotumumab-trbw", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9144", "longDescription": "Injection, daratumumab 10 mg and hyaluronidase-fihj", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Daratumumab hyaluronidase", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9063", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3032", "longDescription": "Injection, eptinezumab-jjmr, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, eptinezumab-jjmr", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9064", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9281", "longDescription": "Mitomycin pyelocalyceal instillation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mitomycin pyelocalyceal inst", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, romidepsin, non-lyophilized (e.g. liquid), 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Romidepsin non-lyophilized", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9066", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9317", "longDescription": "Injection, sacituzumab govitecan-hziy, 2.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Sacituzumab govitecan-hziy", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9067", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gallium ga-68, dotatoc, diagnostic, 0.01 mci", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Gallium ga-68 dotatoc", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9068", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "A9592", "longDescription": "Copper cu-64, dotatate, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Copper cu-64, dotatate, dx", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9069", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9037", "longDescription": "Injection, belantamab mafodontin-blmf, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Belantamab mafodontin-blmf", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9349", "longDescription": "Injection, tafasitamab-cxix, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, tafasitamab-cxix", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1427", "longDescription": "Injection, viltolarsen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, viltolarsen", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9072", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1554", "longDescription": "Injection, immune globulin (asceniv), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, imm glob asceniv", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q2053", "longDescription": "Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Brexucabtagene autoleucel ca", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9074", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lumasiran, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, lumasiran", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9075", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, casimersen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, casimersen, 10 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9076", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lisocabtagene car pos t", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9077", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cabotegravir and rilpivirine, 2mg/3mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj cabotegravir/rilpivirine", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9078", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, trilaciclib, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, trilaciclib, 1 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9079", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, evinacumab-dgnb, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, evinacumab-dgnb, 5 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, melphalan flufenamide hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, melphalan flufen, 1 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q2055", "longDescription": "Idecabtagene vicleucel, up to 460 million autologous anti-bcma car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Idecabtagene car pos t", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9082", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9272", "longDescription": "Injection, dostarlimab-gxly, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj dostarlimab-gxly, 100 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9061", "longDescription": "Injection, amivantamab-vmjw, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, amivantamab-vmjw, 10 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9084", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, loncastuximab tesirine-lpyl, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Loncastuximab-lpyl, 0.1 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9085", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, avalglucosidase alfa-ngpt, 4 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj avalglucosid alfa-ngpt", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9086", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, anifrolumab-fnia, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, anifrolumab-fnia", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9087", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cyclophosphamide, (auromedics), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj cyclophosphamd auromedic", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9088", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Instill, bupivac and meloxic", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9089", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bupivacaine, collagen-matrix implant, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Bupivacaine implant, 1 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, plasminogen, human-tvmh, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Plasminogen, human-tvmh 1 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9091", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sirolimus protein-bound particles, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Sirolimus, protein-bound,1mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9092", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triamcinolone acetonide, suprachoroidal (xipere), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj., xipere, 1 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9093", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ranibizumab, via sustained release intravitreal implant (susvimo), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj., susvimo, 0.1 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9094", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Inj, sutimlimab-jome, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, sutimlimab-jome, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9095", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Inj, tebentafusp-tebn, 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, tebentafusp-tebn, 1 mcg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9096", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, releuko, 1 mcg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9097", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Inj, faricimab-svoa, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, faricimab-svoa, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9098", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Ciltacabtagene autoleucel, up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ciltacabtagene car pos t", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, oliceridine, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, oliceridine 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pantoprazole sodium, per vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj pantoprazole sodium, via", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0883", "longDescription": "Injection, argatroban, per 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, argatroban", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "C9122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7402", "longDescription": "Mometasone furoate sinus implant, 10 micrograms (sinuva)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mometasone furoate (sinuva)", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Kcentra, per i.u.", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9133", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7200", "longDescription": "Factor ix (antihemophilic factor, recombinant), rixubis, per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Factor ix recombinant", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9134", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7181", "longDescription": "Factor xiii (antihemophilic factor, recombinant), tretten, per 10 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Factor xiii a-subunit recomb", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7201", "longDescription": "Factor ix (antihemophilic factor, recombinant), alprolix, per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Factor ix (alprolix)", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q9975", "longDescription": "Injection, factor viii, fc fusion protein, (recombinant), per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Factor viii (eloctate)", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7207", "longDescription": "Injection, factor viii (antihemophilic factor, recombinant) pegylated, 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Adynovate factor viii recom", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7209", "longDescription": "Injection, factor viii (antihemophilic factor, recombinant) (nuwiq), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Nuwiq factor viii recomb", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7202", "longDescription": "Injection, factor ix, albumin fusion protein (recombinant), idelvion, 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Idelvion, 1 i.u.", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7210", "longDescription": "Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Afstyla factor viii recomb", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl (jivi), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Factor viii pegylated-aucl", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9142", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, alymsys, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9143", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cocaine hydrochloride nasal solution (numbrino), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cocaine hcl nasal (numbrino)", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9144", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bupivacaine (posimir), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bupivacaine (posimir)", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9145", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aprepitant, (aponvie), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, aponvie, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9146", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mirvetuximab soravtansine-gynx, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, elahere, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9147", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tremelimumab-actl, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, tremelimumab-actl, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, teclistamab-cqyv, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, teclistamab-cqyv, 0.5mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9149", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, teplizumab-mzwv, 5 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, teplizumab-mzwv, 5 mcg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "A9610", "longDescription": "Xenon xe-129 hyperpolarized gas, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Xe129 xenon, diagnostic", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2781", "longDescription": "Injection, pegcetacoplan, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, pegcetacoplan 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aripiprazole, (abilify asimtufii), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, abilify asimtufii, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amisulpride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, amisulpride, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, buprenorphine extended-release (brixadi), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj buprenorph (brixadi) 1mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epcoritamab-bysp, 0.16 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj epcoritamab-bysp,0.16 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Flotufolastat f 18, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Flotufolastat f18, dia 1 mci", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tofersen, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, tofersen, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9158", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, risperidone, (uzedy), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, uzedy, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9159", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, prothrombin complex concentrate (human), balfaxar, per i.u. of factor ix activity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, balfaxar, per i.u", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, daxibotulinumtoxina-lanm, 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj daxibotulinumtoxina-lanm", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aflibercept hd, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, aflibercept hd, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, avacincaptad pegol, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, avacincaptad peg 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9163", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, talquetamab-tgvs, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj talquetamab-tgvs 0.25 mg", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cantharidin top, applicator", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, elranatamab-bcmm, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, elranatamab-bcmm, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9166", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3247", "longDescription": "Injection, secukinumab, intravenous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, secukinumab", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9167", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7171", "longDescription": "Injection, adamts13, recombinant-krhn, 10 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, adzynma, 10 iu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mirikizumab-mrkz, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, mirikizumab-mrkz", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9169", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, nogapendekin pmln 1 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tarlatamab-dlle, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, tarlatamab-dlle, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pegulicianine, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, pegulicianine, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, beqvez, per tx dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9173", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q5148", "longDescription": "Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, nypozi, 1 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9174", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, datopotamab deruxtecan-dlnk, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Datopotamab deruxtecan, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9175", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, treosulfan, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, treosulfan, 50 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9176", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tc-99m from domestically produced non-heu mo-99, [minimum 50 percent], full cost recovery add-on, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Dom nonheu tc99m add-on/dose", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9248", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, clevidipine butyrate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute\n\n11 = Price established using national RVU's", "shortDescription": "Inj, clevidipine butyrate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Artiss fibrin sealant", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9254", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lacosamide, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, lacosamide", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bevacizumab, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Bevacizumab injection", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "A9589", "longDescription": "Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Hexaminolevulinate hcl", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lidocaine 70 mg/tetracaine 70 mg, per patch", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Patch, lidocaine/tetracaine", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bupivacaine liposome, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, bupivacaine liposome", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, glucarpidase, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, glucarpidase", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9300", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9220", "longDescription": "Injection, indigotindisulfonate sodium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Indigotindisulfonate, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9301", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q2058", "longDescription": "Obecabtagene autoleucel, up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Obecabtagene car pos t", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9302", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9276", "longDescription": "Injection, zanidatamab-hrii, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj zanidatamab, 2 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9303", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1326", "longDescription": "Injection, zolbetuximab-clzb, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj zolbetuximab, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9304", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7172", "longDescription": "Injection, marstacimab-hncq, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj marstacimab, 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9305", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nipocalimab-aahu, 3 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, nipocalimab-aahu, 3 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9306", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, telisotuzumab vedotin-tllv, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Telisotuzumab vedotin-tllv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9307", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, linvoseltamab-gcpt, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj linvoseltamab-gcpt 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9308", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, carboplatin (avyxa), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, carboplatin (avyxa)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9309", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, onasemnogene abeparvovec-brve, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj onase abepar-brve treat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9349", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q4172", "longDescription": "Puraply, and puraply antimicrobial, any type, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Puraply, puraply antimic", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9352", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Microporous collagen implantable tube (neuragen nerve guide), per centimeter length", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Neuragen nerve guide, per cm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Microporous collagen implantable slit tube (neurawrap nerve protector), per centimeter length", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Neurawrap nerve protector,cm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Acellular pericardial tissue matrix of non-human origin (veritas), per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Veritas collagen matrix, cm2", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen nerve cuff (neuromatrix), per 0.5 centimeter length", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Neuromatrix nerve cuff, cm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9356", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix (tenoglide tendon protector sheet), per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Tenoglide tendon prot, cm2", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Surgimend, fetal", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9359", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Porous purified collagen matrix bone void filler (integra mozaik osteoconductive scaffold putty, integra os osteoconductive scaffold putty), per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Implnt,bon void filler-putty", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dermal substitute, native, non-denatured collagen, neonatal bovine origin (surgimend collagen matrix), per 0.5 square centimeters", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Surgimend, neonatal", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen matrix nerve wrap (neuromend collagen nerve wrap), per 0.5 centimeter length", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Neuromend nerve wrap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9362", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Porous purified collagen matrix bone void filler (integra mozaik osteoconductive scaffold strip), per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Implnt,bon void filler-strip", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9363", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Skin substitute, integra meshed bilayer wound matrix, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Integra meshed bil wound mat", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Porcine implant, permacol, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Porcine implant, permacol", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Unclassified drugs or biologicals", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Unclassified drugs or biolog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9407", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Iodine i-131 iobenguane, diagnostic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Iodine i-131 iobenguane, dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9408", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "A9590", "longDescription": "Iodine i-131 iobenguane, therapeutic, 1 millicurie", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Iodine i-131 iobenguane, tx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9441", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ferric carboxymaltose, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, ferric carboxymaltose", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9032", "longDescription": "Injection, belinostat, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, belinostat", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9443", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0875", "longDescription": "Injection, dalbavancin, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, dalbavancin", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9444", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2407", "longDescription": "Injection, oritavancin, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, oritavancin", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9445", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0596", "longDescription": "Injection, c-1 esterase inhibitor (recombinant), ruconest, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "C-1 esterase, ruconest", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9446", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3090", "longDescription": "Injection, tedizolid phosphate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, tedizolid phosphate", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9447", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, phenylephrine and ketorolac, 4 ml vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, phenylephrine ketorolac", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9448", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2015", "coverageCode": "D = 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"coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2547", "longDescription": "Injection, peramivir, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, peramivir", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0695", "longDescription": "Injection, ceftolozane 50 mg and tazobactam 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, ceftolozane/tazobactam", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9453", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9299", "longDescription": "Injection, nivolumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, nivolumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9454", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2015", "coverageCode": "D = 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Special coverage instructions apply", "crossReferenceCode": "Q9950", "longDescription": "Injection, sulfur hexafluoride lipid microsphere, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lumason contrast agent", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9458", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q9983", "longDescription": "Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Florbetaben f18", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9459", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q9982", "longDescription": "Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Flutemetamol f18", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cangrelor, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, cangrelor", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9461", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "A9515", "longDescription": "Choline c 11, diagnostic, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Choline c 11, diagnostic", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory 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"code": "C9465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7318", "longDescription": "Hyaluronan or derivative, durolane, for intra-articular injection, per dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, durolane", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9466", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0517", "longDescription": "Injection, 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"crossReferenceCode": "Q9993", "longDescription": "Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj triamcinolone acetonide", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1942", "longDescription": "Injection, aripiprazole lauroxil, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Aripiprazole lauroxil im", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9471", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7322", "longDescription": "Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Hymovis, 1 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9325", "longDescription": "Injection, talimogene laherparepvec, 1 million plaque forming units (pfu)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj talimogene laherparepvec", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9473", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2182", "longDescription": "Injection, mepolizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = 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"anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9295", "longDescription": "Injection, necitumumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, necitumumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9476", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9145", "longDescription": "Injection, daratumumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, daratumumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9477", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9176", "longDescription": "Injection, elotuzumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, elotuzumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9478", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2840", "longDescription": "Injection, sebelipase alfa, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, sebelipase alfa", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9479", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7342", "longDescription": "Instillation, ciprofloxacin otic suspension, 6 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Instill, ciprofloxacin otic", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9352", "longDescription": "Injection, trabectedin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, trabectedin", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9481", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2786", "longDescription": "Injection, reslizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, reslizumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sotalol hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Sotalol hydrochloride iv", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9483", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9022", "longDescription": "Injection, atezolizumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, atezolizumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9484", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1428", "longDescription": "Injection, eteplirsen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, eteplirsen", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9285", "longDescription": "Injection, olaratumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, olaratumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9486", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1627", "longDescription": "Injection, granisetron extended release, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inj, granisetron ext", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9487", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q9989", "longDescription": "Ustekinumab, for intravenous injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ustekinumab iv inj, 1 mg", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9488", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, conivaptan hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Conivaptan hcl", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9489", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2326", "longDescription": "Injection, nusinersen, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, nusinersen", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0565", "longDescription": "Injection, bezlotoxumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, bezlotoxumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9491", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9023", "longDescription": "Injection, avelumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, avelumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9492", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J9173", "longDescription": "Injection, durvalumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, durvalumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9493", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J1301", "longDescription": "Injection, edaravone, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, edaravone", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9494", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2350", "longDescription": "Injection, ocrelizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, ocrelizumab", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9497", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2062", "longDescription": "Loxapine, inhalation powder, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Loxapine, inhalation powder", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 28, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 28, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Plasma, high titer covid-19 convalescent, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Covid-19 convalescent plasma", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9600", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc drug-el cor stent sing", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc drug-el cor stent bran", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9602", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc d-e cor stent ather s", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc d-e cor stent ather br", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9604", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc d-e cor revasc t cabg s", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc d-e cor revasc t cabg b", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc d-e cor revasc w ami s", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9607", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc d-e cor revasc chro sin", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc d-e cor revasc chro add", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheter, transluminal drug delivery with or without angioplasty, coronary, non-laser (insertable)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cath coronary drug-delivery", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9724", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "43210", "longDescription": "Endoscopic full-thickness plication of the stomach using endoscopic plication system (eps); includes endoscopy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Eps stomach plic", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Placement of endorectal intracavitary applicator for high intensity brachytherapy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Place endorectal app", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C9726", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Placement and removal (if performed) of applicator into breast for intraoperative radiation therapy, add-on to primary breast procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Rxt breast appl place/remov", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C9727", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion of implants into the soft palate; minimum of three implants", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Insert palate implants", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9728", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Placement of interstitial device(s) for radiation therapy/surgery guidance (e.g., fiducial markers, dosimeter), for other than the following sites (any approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or multiple", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Place device/marker, non pro", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9733", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-ophthalmic fluorescent vascular angiography", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Non-ophthalmic fva", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9734", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "U/s trtmt, not leiomyomata", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9735", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2013", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0377T", "longDescription": "Anoscopy; with directed submucosal injection(s), any substance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Anoscopy, submucosal inj", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9737", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0392T", "longDescription": "Laparoscopy, surgical, esophageal sphincter augmentation with device (e.g., magnetic band)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Lap esoph augmentation", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9738", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Blue light cysto imag agent", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9739", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cystoscopy prostatic imp 1-3", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cysto impl 4 or more", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9741", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "33289", "longDescription": "Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Impl pressure sensor w/angio", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9742", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "31573\n\n,31574", "longDescription": "Laryngoscopy, flexible fiberoptic, with injection into vocal cord(s), therapeutic, including diagnostic laryngoscopy, if performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Laryngoscopy with injection", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9743", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0438T", "longDescription": "Injection/implantation of bulking or spacer material (any type) with or without image guidance (not to be used if a more specific code applies)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Bulking/spacer material impl", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9744", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "76978\n\n,76979", "longDescription": "Ultrasound, abdominal, with contrast", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Abd us w/contrast", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9745", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "69705\n\n,69706", "longDescription": "Nasal endoscopy, surgical; balloon dilation of eustachian tube", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Nasal endo eustachian tube", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9746", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transperineal implantation of permanent adjustable balloon continence device, with cystourethroscopy, when performed and/or fluoroscopy, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Trans imp balloon cont", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9747", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "55880", "longDescription": "Ablation of prostate, transrectal, high intensity focused ultrasound (hifu), including imaging guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ablation, hifu, prostate", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9748", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "53854", "longDescription": "Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Prostatic rf water vapor tx", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9749", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "30468", "longDescription": "Repair of nasal vestibular lateral wall stenosis with implant(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Repair nasal stenosis w/imp", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0525T", "longDescription": "Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation and peri-operative interrogation and programming; complete system (includes device and electrode)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Ins/rem-replace compl iims", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9751", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3-d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]) and all mediastinal and/or hilar lymph node stations or structures and therapeutic intervention(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Microwave bronch, 3d, ebus", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9752", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "64628", "longDescription": "Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intraosseous des lumb/sacrum", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9753", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "64629", "longDescription": "Destruction of intraosseous basivertebral nerve, each additional vertebral body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Intraosseous destruct add'l", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9754", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Creation of arteriovenous fistula, percutaneous; direct, any site, including all imaging and radiologic supervision and interpretation, when performed and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization, when performed)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Perc av fistula, direct", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Rf magnetic-guide av fistula", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9756", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intraoperative near-infrared fluorescence lymphatic mapping of lymph node(s) (sentinel or tumor draining) with administration of indocyanine green (icg) (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Fluorescence lymph map w/icg", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9757", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Spine device implant surgery", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9758", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blinded procedure for nyha class iii/iv heart failure; transcatheter implantation of interatrial shunt or placebo control, including right heart catheterization, trans-esophageal echocardiography (tee)/intracardiac echocardiography (ice), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (ide) study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Blind interatrial shunt ide", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9759", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transcatheter intraoperative blood vessel microinfusion(s) (e.g., intraluminal, vascular wall and/or perivascular) therapy, any vessel, including radiological supervision and interpretation, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Transcath intraop microinf", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9760", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-randomized, non-blinded procedure for nyha class ii, iii, iv heart failure; transcatheter implantation of interatrial shunt, including right and left heart catheterization, transeptal puncture, trans-esophageal echocardiography (tee)/intracardiac echocardiography (ice), and all imaging with or without guidance (e.g., ultrasound, fluoroscopy), performed in an approved investigational device exemption (ide) study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Non-blind interatrial shunt", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9761", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cysto, litho, vacuum kidney", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9762", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with strain imaging", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cardiac mri seg dys strain", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9763", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imaging", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cardiac mri seg dys stress", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9764", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc intravasc lithotripsy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9765", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc intra lithotrip-stent", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9766", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel(s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc intra lithotrip-ather", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9767", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel(s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc lithotrip-stent-ather", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9768", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic ultrasound-guided direct measurement of hepatic portosystemic pressure gradient by any method (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endo us-guide hep porto grad", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9769", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "53865", "longDescription": "Cystourethroscopy, with insertion of temporary prostatic implant/stent with fixation/anchor and incisional struts", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cysto w/temp pros implant", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Vitrec/mech pars, subret inj", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9771", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Nsl/sins cryo post nasal tis", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9772", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with intravascular lithotripsy, includes angioplasty within the same vessel (s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc lithotrip tibi/perone", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9773", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy, and transluminal stent placement(s), includes angioplasty within the same vessel(s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc lithotr-stent tib/per", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9774", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel (s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc lithotr-ather tib/per", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9775", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and transluminal stent placement(s), and atherectomy, includes angioplasty within the same vessel (s), when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Revasc lith-sten-ath tib/per", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9776", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Intraoperative near-infrared fluorescence imaging of major extra-hepatic bile duct(s) (e.g., cystic duct, common bile duct and common hepatic duct) with intravenous administration of indocyanine green (icg) (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Fluo bile duct imaging w/icg", "typeOfServiceCode": "4 = Diagnostic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9777", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Esophageal mucosal integrity testing by electrical impedance, transoral, includes esophagoscopy or esophagogastroduodenoscopy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Esophag muc integ w/eso egd", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9778", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colpopexy, vaginal; minimally invasive extra-peritoneal approach (sacrospinous)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Colpopexy, min/inv, ex-perit", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9779", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Esd endoscopy or colonoscopy", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9780", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insertion of central venous catheter through central venous occlusion via inferior and superior approaches (e.g., inside-out technique), including imaging guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Insert cv cath inf & sup app", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Arthro/shoul surg; w/spacer", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9782", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blinded procedure for new york heart association (nyha) class ii or iii heart failure, or canadian cardiovascular society (ccs) class iii or iv chronic refractory angina; transcatheter intramyocardial transplantation of autologous bone marrow cells (e.g., mononuclear) or placebo control, autologous bone marrow harvesting and preparation for transplantation, left heart catheterization including ventriculography, all laboratory services, and all imaging with or without guidance (e.g., transthoracic echocardiography, ultrasound, fluoroscopy), performed in an approved investigational device exemption (ide) study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Blind myocar trpl bon marrow", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9783", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blinded procedure for transcatheter implantation of coronary sinus reduction device or placebo control, including vascular access and closure, right heart catheterization, venous and coronary sinus angiography, imaging guidance and supervision and interpretation when performed in an approved investigational device exemption (ide) study", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Blind cor sinus reducer impl", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9784", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gastric restrictive procedure, endoscopic sleeve gastroplasty, with esophagogastroduodenoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endo sleeve gastro w/tube", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9785", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endo outlet restrict w/tube", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9786", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0932T", "longDescription": "Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Echo cad for hf preserved ef", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9787", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0868T", "longDescription": "Gastric electrophysiology mapping with simultaneous patient symptom profiling", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Gastric ep mapg simult pt sx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9788", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0857T", "longDescription": "Opto-acoustic imaging, breast (including axilla when performed), unilateral, with image documentation, analysis and report, obtained with ultrasound examination", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Uni breas optoacoustic imag", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9789", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Instillation of anti-neoplastic pharmacologic/biologic agent into renal pelvis, any method, including all imaging guidance, including volumetric measurement if performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Instill pharm renal pelvis", "typeOfServiceCode": "2 = Surgery\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9790", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "0888T", "longDescription": "Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including image guidance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Kidney histotripsy w/image", "typeOfServiceCode": "6 = Therapeutic radiology\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "C9791", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Magnetic resonance imaging with inhaled hyperpolarized xenon-129 contrast agent, chest, including preparation and administration of agent", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Mri hyperpolarized xenon129", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9792", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blinded or nonblinded procedure for symptomatic new york heart association (nyha) class ii, iii, iva heart failure; transcatheter implantation of left atrial to coronary sinus shunt using jugular vein access, including all imaging necessary to intra procedurally map the coronary sinus for optimal shunt placement (e.g., tee or ice ultrasound, fluoroscopy), performed under general anesthesia in an approved investigational device exemption (ide) study)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Blind/nonblind trans atrial", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9793", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "3d predictive model generation for pre-planning of a cardiac procedure, using data from cardiac computed tomographic angiography and/or magnetic resonance imaging with report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pre 3d mdl w/ccta and/or mri", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "C9795", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "G0563", "longDescription": "Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Sbrt w/positron emission del", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "C9796", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis])", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Rpr intst excl anrect fist", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9797", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Vascular embolization or occlusion procedure with use of a pressure-generating catheter (e.g., one-way valve, intermittently occluding), inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Vasc emb/occ w/prs cath", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2010", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "G0429", "longDescription": "Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and provision of radiesse or sculptra dermal filler, including all items and supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Dermal filler inj px/suppl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9803", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Hopd covid-19 spec collect", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9804", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Elastomeric infusion pump (e.g., on-q* pump with bolus), including catheter and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pump elastomc non-opioid dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Rotary peristaltic infusion pump (e.g., ambit pump), including catheter and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pump perist non-opioid dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9807", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nerve stimulator, percutaneous, peripheral (e.g., sprint peripheral nerve stimulation system), including electrode and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Nerve stim non-opioid dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9808", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nerve cryoablation probe (e.g., cryoice, cryosphere, cryosphere max, cryoice cryosphere, cryoice cryo2), including probe and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cryo probe non-opioid dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9809", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cryoablation needle (e.g., iovera system), including needle/tip and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cryo needle non-opioid dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9810", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Water circulating motorized cold therapy device (e.g., iceman) including all system components (e.g. pads, console, disposable parts), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Cold therapy non-opioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9811", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Electronic ambulatory infusion pump (e.g. sapphire pump), including all pump components, including disposable components , non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Elec amb pmp nonopioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9812", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Echogenic nerve block needles (e.g. sonoplex, sonoblock, sonotap), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Echgnc nv ndls nonopioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9813", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Perforated continuous infusion catheter set (e.g. infiltralong), including all components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Prf infs cth nonopioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9814", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "February 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Continuous anesthesia echogenic conduction catheter set (e.g. sonolong, e-cath), including all components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Echognc cathr nonopioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9815", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Linear peristaltic pain management infusion pump (e.g. cadd-solis ambulatory infusion pump), and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Peristlc pmp nonopioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9816", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Rotary peristaltic infusion pump (e.g., reusable ambit pump) including all disposable system components, reusable non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Pmp prs reusbl nonopioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9817", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Electronic cryo-pneumatic compression, pain management system (e.g. game ready grpro 2.1 system), including control unit, anatomically correct wrap(s), and other system component(s), non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Crypnm cmprs nonopioid dev", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "C9818", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 23, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 23, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Suzetrigine, oral, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Suzetrigine, orl, 1mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "C9898", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Radiolabeled product provided during a hospital inpatient stay", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inpnt stay radiolabeled item", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9899", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Inpt implant pros dev,no cov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "C9901", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Endo defect closure gi tract", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "E0100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cane, includes canes of all materials, adjustable or fixed, with tip", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Cane adjust/fixed with tip", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Cane adjust/fixed quad/3 pro", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch forearm pair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch forearm each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch underarm pair wood", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch underarm each wood", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch underarm pair no wood", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0116", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch underarm each no wood", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Crutch, underarm, articulating, spring assisted, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Underarm springassist crutch", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0118", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Crutch substitute, lower leg platform, with or without wheels, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch substitute", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Walker, rigid (pickup), adjustable or fixed height", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker rigid adjust/fixed ht", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Walker, folding (pickup), adjustable or fixed height", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker folding adjust/fixed", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Walker, with trunk support, adjustable or fixed height, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Walker w trunk support", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Walker, rigid, wheeled, adjustable or fixed height", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Rigid wheeled walker adj/fix", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0143", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Walker, folding, wheeled, adjustable or fixed height", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker folding wheeled w/o s", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Enclosed walker w rear seat", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0147", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Walker, heavy duty, multiple braking system, variable wheel resistance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker variable wheel resist", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Walker, heavy duty, without wheels, rigid or folding, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Heavyduty walker no wheels", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0149", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Walker, heavy duty, wheeled, rigid or folding, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Heavy duty wheeled walker", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0150", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Combination wheeled walker with seat and transport chair, folding, adjustable or fixed height", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Combo walker-transport chair", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "I = Not payable by Medicare", "longDescription": "Walker, battery powered, wheeled, folding, adjustable or fixed height", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Walker, battery power wheels", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Platform attachment, forearm crutch, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Forearm crutch platform atta", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Platform attachment, walker, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker platform attachment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Wheel attachment, rigid pick-up walker, per pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker wheel attachment,pair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Seat attachment, walker", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker seat attachment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Crutch attachment, walker, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker crutch attachment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0158", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Leg extensions for walker, per set of four (4)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Walker leg extenders set of4", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0159", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Brake attachment for wheeled walker, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Brake for wheeled walker", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sitz type bath or equipment, portable, used with or without commode", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sitz type bath or equipment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sitz bath/equipment w/faucet", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sitz bath chair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sitz bath chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0163", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Commode chair, mobile or stationary, with fixed arms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Commode chair with fixed arm", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Commode chair, mobile or stationary, with detachable arms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Commode chair with detacharm", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0167", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pail or pan for use with commode chair, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Commode chair pail or pan", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Heavyduty/wide commode chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Commode chair with integrated seat lift mechanism, electric, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Commode chair electric", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Commode chair with integrated seat lift mechanism, non-electric, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Commode chair non-electric", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Seat lift mechanism placed over or on top of toilet, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Seat lift mechanism toilet", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Foot rest, for use with commode chair, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Commode chair foot rest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Press pad alternating w/ pum", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pump for alternating pressure pad, for replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Replace pump, alt press pad", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0183", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Powered pressure reducing underlay/pad, alternating, with pump, includes heavy duty", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Press underlay alter w/pump", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0184", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dry pressure mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Dry pressure mattress", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gel or gel-like pressure pad for mattress, standard mattress length and width", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gel pressure mattress pad", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Air pressure mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Air pressure mattress", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0187", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Water pressure mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Water pressure mattress", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0188", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Synthetic sheepskin pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Synthetic sheepskin pad", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0189", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lambswool sheepskin pad, any size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Lambswool sheepskin pad", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Positioning cushion", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0191", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Heel or elbow protector, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Protector heel or elbow", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0193", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "C = Carrier judgment", "longDescription": "Powered air flotation bed (low air loss therapy)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Powered air flotation bed", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0194", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Air fluidized bed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Air fluidized bed", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0196", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gel pressure mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Gel pressure mattress", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Air pressure pad for mattress, standard mattress length and width", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Air pressure pad for mattres", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0198", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Water pressure pad for mattress, standard mattress length and width", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Water pressure pad for mattr", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dry pressure pad for mattress, standard mattress length and width", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Dry pressure pad for mattres", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heat lamp, without stand (table model), includes bulb, or infrared element", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Heat lamp without stand", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Penile contracture device, manual, greater than 3 lbs traction force", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Penile contractur devic manu", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Phototherapy (bilirubin) light with photometer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Phototherapy light w/ photom", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Therapeutic lightbox, minimum 10,000 lux, table top model", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Therapeutic lightbox tabletp", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heat lamp, with stand, includes bulb, or infrared element", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Heat lamp with stand", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Electric heat pad, standard", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Electric heat pad standard", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95) P = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Electric heat pad, moist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Electric heat pad moist", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Water circulating heat pad with pump", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Water circ heat pad w pump", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fluid circulating cold pad with pump, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Fluid circ cold pad w pump", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Infrared heating pad system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Infrared heating pad system", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocollator unit, includes pads", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Hydrocollator unit", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wound warming device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0232", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Warming card for use with the non contact wound warming device and non contact wound warming wound cover", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Warming card for nwt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Paraffin bath unit, portable (see medical supply code a4265 for paraffin)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Paraffin bath unit portable", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0236", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pump for water circulating pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pump for water circulating p", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydrocollator unit, portable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Hydrocollator unit portable", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Bath/shower chair, with or without wheels, any size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bath/shower chair", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0241", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Bath tub wall rail, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bath tub wall rail", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0242", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Bath tub rail, floor base", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bath tub rail floor", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Toilet rail, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Toilet rail", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Raised toilet seat", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Toilet seat raised", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Tub stool or bench", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tub stool or bench", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Transfer tub rail attachment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transfer tub rail attachment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer bench for tub or toilet with or without commode opening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trans bench w/wo comm open", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer bench, heavy duty, for tub or toilet with or without commode opening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hdtrans bench w/wo comm open", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pad for water circulating heat unit, for replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pad water circulating heat u", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, fixed height, with any type side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed fixed ht w/ mattres", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, fixed height, with any type side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed fixd ht w/o mattres", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, variable height, hi-lo, with any type side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hospital bed var ht w/ mattr", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0256", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, variable height, hi-lo, with any type side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hospital bed var ht w/o matt", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed semi-electr w/ matt", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed semi-electr w/o mat", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed total electr w/ mat", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed total elec w/o matt", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospital bed institutional t", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mattress, innerspring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Mattress innerspring", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mattress, foam rubber", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Mattress foam rubber", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0273", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Bed board", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bed board", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Over-bed table", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Over-bed table", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bed pan, standard, metal or plastic", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Bed pan standard", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0276", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bed pan, fracture, metal or plastic", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Bed pan fracture", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0277", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Powered pressure-reducing air mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Powered pres-redu air mattrs", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Bed cradle, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Bed cradle", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, fixed height, without side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed fx ht w/o rails w/m", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0291", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, fixed height, without side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed fx ht w/o rail w/o", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0292", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, variable height, hi-lo, without side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed var ht no sr w/matt", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, variable height, hi-lo, without side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed var ht no sr no mat", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0294", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed semi-elect w/ mattr", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed semi-elect w/o matt", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0296", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1992", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed total elect w/ matt", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0297", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed total elect w/o mat", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Pediatric crib, hospital grade, fully enclosed, with or without top enclosure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Enclosed ped crib hosp grade", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hd hosp bed, 350-600 lbs", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ex hd hosp bed > 600 lbs", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed hvy dty xtra wide", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hosp bed xtra hvy dty x wide", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bed side rails, half length", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rails bed side half length", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bed side rails, full length", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Rails bed side full length", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Bed accessory: board, table, or support device, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bed accessory brd/tbl/supprt", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Safety enclosure frame/canopy for use with hospital bed, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Bed safety enclosure", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Urinal; male, jug-type, any material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Urinal male jug-type", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Urinal; female, jug-type, any material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Urinal female jug-type", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ped hospital bed, manual", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ped hospital bed semi/elect", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "C = Carrier judgment", "longDescription": "Control unit for electronic bowel irrigation/evacuation system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Control unit bowel system", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0352", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "C = Carrier judgment", "longDescription": "Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Disposable pack w/bowel syst", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Air pressure elevator for heel", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Air elevator for heel", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0371", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Nonpower mattress overlay", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Powered air overlay for mattress, standard mattress length and width", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Powered air mattress overlay", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0373", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Nonpowered advanced pressure reducing mattress", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Nonpowered pressure mattress", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Stationary compressed gas 02", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gas system stationary compre", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxygen system gas portable", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0431", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Portable gaseous 02", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0433", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Portable liquid oxygen sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0434", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Portable liquid 02", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxygen system liquid portabl", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0439", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Stationary liquid 02", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0440", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxygen system liquid station", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0441", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stationary oxygen contents, gaseous, 1 month's supply = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Stationary o2 contents, gas", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stationary oxygen contents, liquid, 1 month's supply = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Stationary o2 contents, liq", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0443", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable oxygen contents, gaseous, 1 month's supply = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Portable 02 contents, gas", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0444", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable oxygen contents, liquid, 1 month's supply = 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Portable 02 contents, liquid", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0445", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Oximeter device for measuring blood oxygen levels non-invasively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oximeter non-invasive", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0446", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Topical ox deliver sys, nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0447", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Port o2 cont, liq over 4 lpm", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Vol control vent invasiv int", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oxygen tent, excluding croup or pediatric tents", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Oxygen tent excl croup/ped t", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0457", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "I = Not payable by Medicare", "longDescription": "Chest shell (cuirass)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chest shell", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0459", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "I = Not payable by Medicare", "longDescription": "Chest wrap", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chest wrap", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Negative pressure ventilator; portable or stationary", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Neg press vent portabl/statn", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0461", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Vol control vent noninv int", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0462", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "C = Carrier judgment", "longDescription": "Rocking bed with or without side rails", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rocking bed w/ or w/o side r", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0463", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Press supp vent invasive int", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0464", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Press supp vent noninv int", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Home vent invasive interface", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0466", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Home vent non-invasive inter", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0467", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Home vent multi-function", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0468", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Home vent dual fnct incl all", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0469", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Lung expansion airway clearance, continuous high frequency oscillation, and nebulization device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Lung expans high oscil neb", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rad w/o backup non-inv intfc", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0471", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rad w/backup non inv intrfc", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rad w backup invasive intrfc", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percussor, electric or pneumatic, home model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Percussor elect/pneum home m", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0481", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Intrapulmonary percussive ventilation system and related accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intrpulmnry percuss vent sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Cough stimulating device, alternating positive and negative airway pressure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Cough stimulating device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0483", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hi freq chest wall oscil sys", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0484", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Oscillatory positive expiratory pressure device, non-electric, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Non-elec oscillatory pep dvc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Oral device/appliance prefab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0486", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Oral device/appliance cusfab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0487", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Spirometer, electronic, includes all accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Electronic spirometer", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by hardware remote", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Control unit nm hw remote", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0491", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hardware remote, 90-day supply", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Oral dv nm mouthpc hw remote", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0492", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Control unit nm stim w phone", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0493", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oral dv/app neuromus mouthpi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0500", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Ippb all types", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Electronic posa treatment", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Humidif extens supple w ippb", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Humidifier for use w/ regula", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E0560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Humidifier supplemental w/ i", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Humidifier, non-heated, used with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Humidifier nonheated w pap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Humidifier, heated, used with positive airway pressure device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Humidifier heated used w pap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0565", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Compressor, air power source for equipment which is not self-contained or cylinder driven", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Compressor air power source", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nebulizer, with compressor", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer with compression", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0572", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Aerosol compressor, adjustable pressure, light duty for intermittent use", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Aerosol compressor adjust pr", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0574", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Ultrasonic/electronic aerosol generator with small volume nebulizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ultrasonic generator w svneb", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nebulizer, ultrasonic, large volume", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer ultrasonic", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer for use w/ regulat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E0585", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nebulizer, with compressor and heater", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Nebulizer w/ compressor & he", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Respiratory suction pump, home model, portable or stationary, electric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Suction pump portab hom modl", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Continuous positive airway pressure (cpap) device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Cont airway pressure device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Breast pump, manual, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Manual breast pump", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Breast pump, electric (ac and/or dc), any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Electric breast pump", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Breast pump, hospital grade, electric (ac and / or dc), any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp grade elec breast pump", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Vaporizer, room type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Vaporizer room type", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Postural drainage board", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Drainage board postural", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Home blood glucose monitor", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Blood glucose monitor home", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pacemaker monitr audible/vis", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Implantable cardiac event recorder with memory, activator and programmer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cardiac event recorder", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0617", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "External defibrillator with integrated electrocardiogram analysis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Automatic ext defibrillator", "typeOfServiceCode": "9 = Other medical items or services\n\nR = Rental of DME", "year": "2026" }, { "code": "E0618", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Apnea monitor, without recording feature", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Apnea monitor", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0619", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Apnea monitor, with recording feature", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Apnea monitor w recorder", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Skin piercing device for collection of capillary blood, laser, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Cap bld skin piercing laser", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sling or seat, patient lift, canvas or nylon", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Patient lift sling or seat", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Patient lift, bathroom or toilet, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Patient lift bathroom or toi", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Seat lift mechanism, electric, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seat lift mech, electric any", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Separate seat lift mechanism for use with patient owned furniture-electric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seat lift for pt furn-electr", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Seat lift mechanism, non-electric, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seat lift mech, non-electric", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Patient lift hydraulic", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0635", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Patient lift, electric with seat or sling", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Patient lift electric", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Multipositional patient support system, with integrated lift, patient accessible controls", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pt support & positioning sys", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Combination sit to stand sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Standing frame sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Moveable patient lift system", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Patient lift, fixed system, includes all components/accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fixed patient lift system", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Multi-position stnd fram sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Standing frame/table system, mobile (dynamic stander), any size including pediatric", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dynamic standing frame", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pneumatic compressor, non-segmental home model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneuma compresor non-segment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0651", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pneumatic compressor, segmental home model without calibrated gradient pressure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneum compressor segmental", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pneumatic compressor, segmental home model with calibrated gradient pressure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneum compres w/cal pressure", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0655", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-segmental pneumatic appliance for use with pneumatic compressor, half arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic appliance half arm", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0656", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, trunk", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Segmental pneumatic trunk", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0657", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, chest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Segmental pneumatic chest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0658", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Seg pneum comp 2 arm chest", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0659", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, integrated, head, neck and chest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Seg pneum comp head neck che", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-segmental pneumatic appliance for use with pneumatic compressor, full leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic appliance full leg", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0665", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-segmental pneumatic appliance for use with pneumatic compressor, full arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic appliance full arm", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0666", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-segmental pneumatic appliance for use with pneumatic compressor, half leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic appliance half leg", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0667", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, full leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seg pneumatic appl full leg", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0668", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, full arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seg pneumatic appl full arm", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0669", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, half leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seg pneumatic appli half leg", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seg pneum int legs/trunk", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0671", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental gradient pressure pneumatic appliance, full leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pressure pneum appl full leg", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0672", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental gradient pressure pneumatic appliance, full arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pressure pneum appl full arm", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0673", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Segmental gradient pressure pneumatic appliance, half leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pressure pneum appl half leg", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0675", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic compression device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0676", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Intermittent limb compression device (includes all accessories), not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inter limb compress dev nos", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0677", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic sequential compression garment, trunk", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum seq comp trunk", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0678", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic sequential compression garment, full leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum seq comp full leg", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0679", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic sequential compression garment, half leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum seq comp half leg", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic compression controller with sequential calibrated gradient pressure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum comp control cal", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0681", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic compression controller without calibrated gradient pressure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneu comp control w/o ca", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0682", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic sequential compression garment, full arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum compress full arm", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0683", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic, non-sequential, peristaltic wave compression pump", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneu peristalic comp pmp", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0691", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Uvl pnl 2 sq ft or less", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0692", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Uvl sys panel 4 ft", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0693", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Uvl sys panel 6 ft", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0694", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Uvl md cabinet sys 6 ft", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Safety equipment, device or accessory, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Safety equipment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0705", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer device, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Transfer device", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Restraints, any type (body, chest, wrist or ankle)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Restraints any type", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0711", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ue enclosure restr rom", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0715", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Intravaginal device intended to strengthen pelvic floor muscles during kegel exercises", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intravag pelvic floor kegel", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0716", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Supplies and accessories for intravaginal device intended to strengthen pelvic floor muscles during kegel exercises", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supp and acces intravag pelv", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tens two lead", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Transcutaneous electrical nerve stimulator for nerves in the auricular region", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Trans elec stim auricular", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tens four lead", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0731", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Conductive garment for tens/", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0732", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Cranial electrotherapy stimulation (ces) system, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ces system", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0733", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Trans elec nerv for trigemin", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0734", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "External upper limb tremor stimulator of the peripheral nerves of the wrist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ext up limb tremor stim wris", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0735", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Non-invasive vagus nerve stimulator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non-invasive vagus nerv stim", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0736", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Transcutaneous tibial nerve stimulator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Transcut tibial nerv stimula", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0737", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Transcutaneous tibial nerve stimulator, controlled by phone application", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transcut tibial stim by app", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0738", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity rehabilitation system providing active assistance to facilitate muscle re-education, include microprocessor, all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Upper extremity rehab", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0739", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rehab sys active assist rt", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-implanted pelvic floor electrical stimulator, complete system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non-implant pelv flr e-stim", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0743", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "External lower extremity nerve stimulator for restless legs syndrome, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ext low ext nerve stimu rls", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0744", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Neuromuscular stimulator for scoliosis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Neuromuscular stim for scoli", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0745", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Neuromuscular stimulator, electronic shock unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Neuromuscular stim for shock", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0746", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Electromyography (emg), biofeedback device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Electromyograph biofeedback", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0747", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Osteogenesis stimulator, electrical, non-invasive, other than spinal applications", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Elec osteogen stim not spine", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0748", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Osteogenesis stimulator, electrical, non-invasive, spinal applications", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Elec osteogen stim spinal", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0749", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Osteogenesis stimulator, electrical, surgically implanted", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Elec osteogen stim implanted", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic salivary reflex stimulator (intra-oral/non-invasive)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Electronic salivary reflex s", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Osteogenesis stimulator, low intensity ultrasound, non-invasive", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Osteogen ultrasound stimltor", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0761", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nontherm electromgntc device", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0762", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Transcutaneous electrical joint stimulation device system, includes all accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Trans elec jt stim dev sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0764", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Functional neuromuscularstim", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0765", "actionCode": "B = Change in both administrative data field and long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Fda approved nerve stimulator, for treatment of nausea and vomiting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nerve stimulator for tx n&v", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0766", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Electrical stimulation device used for cancer treatment, includes all accessories, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Elec stim cancer treatment", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0767", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Intrabuccal, systemic delivery of amplitude-modulated, radiofrequency electromagnetic field device, for cancer treatment, includes all accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Intrabuc am rf emf cancer tx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0769", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Electrical stimulation or electromagnetic wound treatment device, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Electric wound treatment dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Functional electric stim nos", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0776", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Iv pole", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Iv pole", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nE = Enteral/parenteral nutrients/supplies (eff 04/95) P = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0779", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Amb infusion pump mechanical", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Mech amb infusion pump <8hrs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "External ambulatory infus pu", "typeOfServiceCode": "9 = Other medical items or services\n\nR = Rental of DME", "year": "2026" }, { "code": "E0782", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Non-programble infusion pump", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0783", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Programmable infusion pump", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0784", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "External ambulatory infusion pump, insulin", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ext amb infusn pump insulin", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replacement impl pump cathet", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0786", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Implantable pump replacement", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0787", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "September 15, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "I = Not payable by Medicare", "longDescription": "External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cgs dose adj insulin inf pmp", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E0791", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Parenteral infusion pump, stationary, single or multi-channel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Parenteral infusion pump sta", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ambulatory traction device, all types, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ambulatory traction device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E0840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Traction frame, attached to headboard, cervical traction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tract frame attach headboard", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0849", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Cervical pneum trac equip", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Traction stand, free standing, cervical traction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Traction stand free standing", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0855", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical traction equipment not requiring additional stand or frame", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Cervical traction equipment", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0856", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical traction device, with inflatable air bladder(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Cervic collar w air bladders", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0860", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Traction equipment, overdoor, cervical", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tract equip cervical tract", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0870", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Traction frame, attached to footboard, extremity traction, (e.g., buck's)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tract frame attach footboard", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0880", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Traction stand, free standing, extremity traction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Trac stand free stand extrem", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Traction frame, attached to footboard, pelvic traction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Traction frame attach pelvic", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Traction stand, free standing, pelvic traction, (e.g., buck's)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Trac stand free stand pelvic", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0910", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1984", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Trapeze bars, a/k/a patient helper, attached to bed, with grab bar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Trapeze bar attached to bed", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0911", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hd trapeze bar attach to bed", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0912", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hd trapeze bar free standing", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fracture frame, attached to bed, includes weights", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Fracture frame attached to b", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fracture frame, free standing, includes weights", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Fracture frame free standing", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0935", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Continuous passive motion exercise device for use on knee only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Cont pas motion exercise dev", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0936", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Continuous passive motion exercise device for use other than knee", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cpm device, other than knee", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0940", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Trapeze bar, free standing, complete with grab bar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Trapeze bar free standing", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0941", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gravity assisted traction device, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Gravity assisted traction de", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0942", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1986", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical head harness/halter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Cervical head harness/halter", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0944", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Pelvic belt/harness/boot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pelvic belt/harness/boot", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0945", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Extremity belt/harness", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Belt/harness extremity", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0946", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Fracture frame dual w cross", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0947", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fracture frame, attachments for complex pelvic traction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Fracture frame attachmnts pe", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0948", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fracture frame, attachments for complex cervical traction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Fracture frame attachmnts ce", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair accessory, tray, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tray", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0951", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Heel loop/holder, any type, with or without ankle strap, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Loop heel", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0952", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Toe loop/holder, any type, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Toe loop/holder, each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0953", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c lateral thigh/knee sup", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0954", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foot box, any type each foot", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0955", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Cushioned headrest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0956", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c lateral trunk/hip suppor", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0957", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c medial thigh support", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0958", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Manual wheelchair accessory, one-arm drive attachment, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Whlchr att- conv 1 arm drive", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0959", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, adapter for amputee, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Amputee adapter", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c shoulder harness/straps", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0961", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, wheel lock brake extension (handle), each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair brake extension", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0966", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, headrest extension, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair head rest extensi", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0967", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Manual wheelchair accessory, hand rim with projections, any type, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Man wc rim/projection rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0968", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Commode seat, wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair commode seat", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0969", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Narrowing device, wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair narrowing device", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0037\n\n,K0042", "longDescription": "No. 2 footplates, except for elevating leg rest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair no. 2 footplates", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0971", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "K0021", "longDescription": "Manual wheelchair accessory, anti-tipping device, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair anti-tipping devi", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0973", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "W/ch access det adj armrest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0974", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Manual wheelchair accessory, anti-rollback device, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "W/ch access anti-rollback", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0978", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, positioning belt/safety belt/pelvic strap, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c acc,saf belt pelv strap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Safety vest, wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair safety vest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, seat upholstery, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seat upholstery, replacement", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, back upholstery, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Back upholstery, replacement", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0983", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Add pwr joystick", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0984", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Add pwr tiller", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0985", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, seat lift mechanism", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "W/c seat lift mechanism", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0986", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, power assist system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Man w/c powr assist syst", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0988", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, lever-activated, wheel drive, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Lever-activated wheel drive", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E0990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, elevating leg rest, complete assembly, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair elevating leg res", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0992", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, solid seat insert", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair solid seat insert", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0994", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Arm rest, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair arm rest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E0995", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, calf rest/pad, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wc calf rest, pad replacemnt", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seating system, tilt only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat tilt", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seating system, recline only, without shear reduction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat recline", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seating system, recline only, with mechanical shear reduction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat recline mech", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seating system, recline only, with power shear reduction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat recline pwr", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat combo w/o shear", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat combo w/shear", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat combo pwr shear", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Add mech leg elevation", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Add pwr leg elevation", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Ped wc modify width adjustm", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ctr mount pwr elev leg rest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Reclining back, addition to pediatric size wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Reclining back add ped w/c", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Shock absorber for manual wheelchair, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Shock absorber for man w/c", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Shock absorber for power wheelchair, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Shock absorber for power w/c", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Hd shck absrbr for hd man wc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Hd shck absrber for hd powwc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Residual limb support system for wheelchair, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Residual limb support system", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Wheelchair transportation securement system, any type includes all components and accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchr transport secur", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E1023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Wheelchair transit securement system, includes all components and accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchr transit securement", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E1028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "W/c manual swingaway", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, ventilator tray, fixed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "W/c vent tray fixed", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, ventilator tray, gimbaled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "W/c vent tray gimbaled", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Rollabout chair, any and all types with casters 5\" or greater", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rollabout chair with casters", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair joystick drive", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair hardware headrest", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair trunk hip support", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Patient transfer system <300", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Patient transfer system >300", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transport chair, pediatric size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Transport chair, ped size", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transport chair, adult size, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Transport chair pt wt<=300lb", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Transport chair pt wt >300lb", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1984", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Whelchr fxd full length arms", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair detachable arms", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair detachable foot r", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hemi-wheelchair fixed arms", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1084", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hemi-wheelchair detachable a", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1085", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0002", "longDescription": "Hemi-wheelchair, fixed full length arms, swing away detachable foot rests", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hemi-wheelchair fixed arms", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1086", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0002", "longDescription": "Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hemi-wheelchair detachable a", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1087", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair lightwt fixed arm", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1088", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair lightweight det a", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1089", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0004", "longDescription": "High strength lightweight wheelchair, fixed length arms, swing away detachable footrest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair lightwt fixed arm", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0004", "longDescription": "High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair lightweight det a", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1092", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair wide w/ leg rests", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1093", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair wide w/ foot rest", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1988", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Whchr s-recl fxd arm leg res", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair semi-recl detach", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0001", "longDescription": "Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Whlchr stand fxd arm ft rest", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0001", "longDescription": "Wheelchair, detachable arms, desk or full length, swing away detachable footrests", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair standard detach a", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair standard w/ leg r", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, fixed full length arms, swing away detachable elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair fixed arms", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Manual adult size wheelchair, includes tilt in space", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Manual adult wc w tiltinspac", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Whlchr ampu fxd arm leg rest", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Amputee wheelchair, fixed full length arms, without footrests or legrest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair amputee w/o leg r", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair amputee detach ar", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair amputee w/ foot r", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair amputee w/ leg re", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1195", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair amputee heavy dut", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Amputee wheelchair, fixed full length arms, swing away detachable footrest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair amputee fixed arm", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "45 = Customized DME items", "shortDescription": "Whlchr special size/constrc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E1221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair with fixed arm, footrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair spec size w foot", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair with fixed arm, elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair spec size w/ leg", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair with detachable arms, footrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair spec size w foot", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair with detachable arms, elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair spec size w/ leg", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Manual semi-reclining back", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1226", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Manual fully reclining back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1227", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Special height arms for wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair spec sz spec ht a", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1228", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Special back height for wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair spec sz spec ht b", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1229", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair, pediatric size, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pediatric wheelchair nos", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power operated vehicle (three or four wheel nonhighway) specify brand name and model number", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Power operated vehicle", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Rigid ped w/c tilt-in-space", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1232", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Folding ped wc tilt-in-space", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1233", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rig ped wc tltnspc w/o seat", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1234", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Fld ped wc tltnspc w/o seat", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, rigid, adjustable, with seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rigid ped wc adjustable", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1236", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, folding, adjustable, with seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Folding ped wc adjustable", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1237", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, rigid, adjustable, without seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rgd ped wc adjstabl w/o seat", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1238", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wheelchair, pediatric size, folding, adjustable, without seating system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Fld ped wc adjstabl w/o seat", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, pediatric size, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ped power wheelchair nos", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Whchr litwt det arm leg rest", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0003", "longDescription": "Lightweight wheelchair, fixed full length arms, swing away detachable footrest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair lightwt fixed arm", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0003", "longDescription": "Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair lightwt foot rest", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair lightweight leg r", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Whchr h-duty det arm leg res", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0006", "longDescription": "Heavy duty wheelchair, fixed full length arms, swing away detachable footrest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair heavy duty fixed", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "K0006", "longDescription": "Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheelchair hvy duty detach a", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heavy duty wheelchair, fixed full length arms, elevating legrest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair heavy duty fixed", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1296", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Special wheelchair seat height from floor", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair special seat heig", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1297", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Special wheelchair seat depth, by upholstery", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair special seat dept", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1298", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Special wheelchair seat depth and/or width, by construction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair spec seat depth/w", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Whirlpool, portable (overtub type)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Whirlpool portable", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Whirlpool tub, walk-in, portable", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Whirlpool tub walkin portabl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E1310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Whirlpool, non-portable (built-in type)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Whirlpool non-portable", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1352", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Oxygen accessory, flow regulator capable of positive inspiratory pressure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O2 flow reg pos inspir press", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E1353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Regulator", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxygen supplies regulator", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wheeled cart, port cyl/conc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Stand/rack", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxygen supplies stand/rack", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1356", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Batt pack/cart, port conc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Battery charger, port conc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc power adapter, port conc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Immersion external heater for nebulizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Oxy suppl heater for nebuliz", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Oxygen concentrator", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1391", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Oxygen concentrator, dual", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Portable oxygen concentrator, rental", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Portable oxygen concentrator", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Durable medical equipment, miscellaneous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Durable medical equipment mi", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oxygen and water vapor enriching system with heated delivery", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "O2/water vapor enrich w/heat", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1406", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oxygen and water vapor enriching system without heated delivery", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "O2/water vapor enrich w/o he", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Centrifuge, for dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Centrifuge", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, i.v. poles, pressure gauge, concentrate container", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Kidney dialysate delivry sys", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heparin infusion pump for hemodialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Heparin infusion pump", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Air bubble detector for hemodialysis, each, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replacement air bubble detec", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pressure alarm for hemodialysis, each, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replacement pressure alarm", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bath conductivity meter for hemodialysis, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bath conductivity meter", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood leak detector for hemodialysis, each, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replace blood leak detector", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Adjustable chair, for esrd patients", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adjustable chair for esrd pt", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transducer protectors/fluid barriers, for hemodialysis, any size, per 10", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transducer protect/fld bar", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Unipuncture control system for hemodialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unipuncture control system", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hemodialysis machine", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hemodialysis machine", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1592", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Automatic intermittent peritoneal dialysis system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Auto interm peritoneal dialy", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1594", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cycler dialysis machine for peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cycler dialysis machine", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Delivery and/or installation charges for hemodialysis equipment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Deli/install chrg hemo equip", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Reverse osmosis water purification system, for hemodialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reverse osmosis h2o puri sys", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Deionizer water purification system, for hemodialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Deionizer h2o puri system", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood pump for hemodialysis, replacement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Replacement blood pump", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Water softening system, for hemodialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Water softening system", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Tablo hemodialysis system for the billable dialysis service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tablo for dialysis service", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Reciprocating peritoneal dialysis system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reciprocating peritoneal dia", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Wearable artificial kidney, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wearable artificial kidney", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Peritoneal dialysis clamps, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Peritoneal dialysis clamp", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1635", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compact (portable) travel hemodialyzer system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Compact travel hemodialyzer", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sorbent cartridges, for hemodialysis, per 10", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sorbent cartridges per 10", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hemostats, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hemostats for dialysis, each", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Scale, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scale, each", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dialysis equipment, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dialysis equipment noc", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "E1700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Jaw motion rehabilitation system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Jaw motion rehab system", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1701", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement cushions for jaw motion rehabilitation system, pkg. of 6", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Repl cushions for jaw motion", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E1702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Repl measr scales jaw motion", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E1800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable elbow extension and flexion device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust elbow ext & flex dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1801", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sps/pass elbow device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1802", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable forearm pronation/supination device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjst forearm pro/sup device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1803", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable elbow extension only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust elbow extension dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1804", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable elbow flexion only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust elbow flexion dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1805", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable wrist extension and flexion device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust wrist ext & flex dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sps wrist device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1807", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable wrist extension only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust wrist extension dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1808", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable wrist flexion only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust wrist flexion device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable knee extension and flexion device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust knee ext & flex dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1811", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sps/pass knee device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1812", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic knee, extension/flexion device with active resistance control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Knee ext/flex w act res ctrl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1813", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable knee extension only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust knee extension device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1814", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable knee flexion only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust knee flexion device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1815", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable ankle extension and flexion device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust ankle ext & flex dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1816", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sps/pass ankle device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1818", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sps/pass forearm device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1820", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement soft interface material, dynamic adjustable extension/flexion device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Soft interface material", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1821", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement soft interface material/cuffs for bi-directional static progressive stretch device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replacement interface spsd", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1822", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable ankle extension only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust ankle extension dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1823", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable ankle flexion only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust ankle flexion device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1825", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable finger extension and flexion device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust finger ext & flex dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1826", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable finger extension only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust finger extension dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1827", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable finger flexion only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust finger flexion device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1828", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable toe extension only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust toe extension device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1829", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable toe flexion only device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust toe flexion device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable toe extension and flexion device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adjust toe ext & flex device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1831", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Static str toe dev ext/flex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1832", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sps finger device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Adj shoulder ext/flex device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "E1841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sps/pass shoulder device", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E1902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Communication board, non-electronic augmentative or alternative communication device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aac non-electronic board", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E1905", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Vr cbt therapy", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E2000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Gastric suction pump, home model, portable or stationary, electric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Gastric suction pump hme mdl", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E2001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Suct pum ext mgmt sys", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E2100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood glucose monitor with integrated voice synthesizer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Bld glucose monitor w voice", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood glucose monitor with integrated lancing/blood sample", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Bld glucose monitor w lance", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Adjunctive, non-implanted continuous glucose monitor or receiver", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Adju cgm receiver/monitor", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Non-adjunctive, non-implanted continuous glucose monitor or receiver", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Non-adju cgm receiver/mon", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Glucose monitor w cartridge", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Pulse generator system for tympanic treatment of inner ear endolymphatic fluid", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pulse gen sys tx endolymp fl", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E2201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Man w/ch acc seat w>=20\"<24\"", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seat width 24-27 in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Frame depth less than 22 in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Frame depth 22 to 25 in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Manual wc accessory, handrim", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Man wc whl lock comp repl ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, crutch and cane holder, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Crutch and cane holder", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, cylinder tank carrier, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Cylinder tank carrier", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Accessory, arm trough, with or without hand support, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Arm trough each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, bearings, any type, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wheelchair bearings", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, pneumatic propulsion tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic propulsion tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic prop tire tube", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic prop tire insert", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, pneumatic caster tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic caster tire each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, tube for pneumatic caster tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic caster tire tube", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, foam filled propulsion tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam filled propulsion tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, foam filled caster tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam filled caster tire each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, foam propulsion tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam propulsion tire each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, foam caster tire, any size, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam caster tire any size ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Solid propuls tire, repl, ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Solid caster tire repl, each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Solid caster integ whl, repl", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Propulsion whl excl tire rep", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Caster wheel excludes tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2226", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, caster fork, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Caster fork replacement only", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2227", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, gear reduction drive wheel, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Gear reduction drive wheel", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2228", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, wheel braking system and lock, complete, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Mwc acc, wheelchair brake", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, manual standing system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Manual standing system", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Solid seat support base", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2291", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Back, planar, for pediatric size wheelchair including fixed attaching hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Planar back for ped size wc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2292", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Seat, planar, for pediatric size wheelchair including fixed attaching hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Planar seat for ped size wc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Back, contoured, for pediatric size wheelchair including fixed attaching hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Contour back for ped size wc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2294", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Seat, contoured, for pediatric size wheelchair including fixed attaching hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Contour seat for ped size wc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Ped dynamic seating frame", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2298", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Complex rehabilitative power wheelchair accessory, power seat elevation system, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat elev sys for crt", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power seat elevation system, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pwr seat elevation sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, power standing system, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pwr standing", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Electro connect btw control", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2311", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Electro connect btw 2 sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Mini-prop remote joystick", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc harness, expand control", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hand interface joystick", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2322", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Mult mech switches", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Special joystick handle", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2324", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, chin cup for chin control interface", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Chin cup interface", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Sip and puff interface", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, breath tube kit for sip and puff interface", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Breath tube kit", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Head control interface mech", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Head/extremity control inter", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Head control nonproportional", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Head control proximity switc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2331", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Attendant control", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, nonstandard seat frame width, 20-23 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c wdth 20-23 in seat frame", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, nonstandard seat frame width, 24-27 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c wdth 24-27 in seat frame", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c dpth 20-21 in seat frame", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2343", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "W/c dpth 22-25 in seat frame", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Electronic sgd interface", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, group 34 non-sealed lead acid battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gr 34 nonsealed leadacid", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2359", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gr34 sealed leadacid battery", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, 22nf non-sealed lead acid battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "22nf nonsealed leadacid", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "22nf sealed leadacid battery", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2362", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, group 24 non-sealed lead acid battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gr24 nonsealed leadacid", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2363", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gr24 sealed leadacid battery", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, u-1 non-sealed lead acid battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "U1nonsealed leadacid battery", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2365", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "U1 sealed leadacid battery", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2366", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Battery charger, single mode", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2367", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Battery charger, dual mode", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2368", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair component, drive wheel motor, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr wc drivewheel motor repl", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2369", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair component, drive wheel gear box, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr wc drivewheel gear repl", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwr wc dr wh motor/gear comb", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2371", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gr27 sealed leadacid battery", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, group 27 non-sealed lead acid battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gr27 non-sealed leadacid", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2373", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hand/chin ctrl spec joystick", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2374", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Hand/chin ctrl std joystick", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2375", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non-expandable controller", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2376", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Expandable controller, repl", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2377", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Expandable controller, initl", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2378", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair component, actuator, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pw actuator replacement", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2381", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneum drive wheel tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2382", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tube, pneum wheel drive tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2383", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Insert, pneum wheel drive", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2384", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pneumatic caster tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2385", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Tube, pneumatic caster tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2386", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam filled drive wheel tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2387", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, foam filled caster tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam filled caster tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2388", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam drive wheel tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2389", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, foam caster tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Foam caster tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Solid drive wheel tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2391", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Solid caster tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Solid caster tire, integrate", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Drive wheel excludes tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2395", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Caster wheel excludes tire", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power wheelchair accessory, caster fork, any size, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Caster fork", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, lithium-based battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pwc acc, lith-based battery", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "E2398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, dynamic positioning hardware for back", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wc dynamic pos back hardware", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Negative pressure wound therapy electrical pump, stationary or portable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Neg press wound therapy pump", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E2500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd digitized pre-rec <=8min", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd prerec msg >8min <=20min", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd prerec msg>20min <=40min", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd prerec msg > 40 min", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd spelling phys contact", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd w multi methods msg/accs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Speech generating software program, for personal computer or personal digital assistant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd sftwre prgrm for pc/pda", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Accessory for speech generating device, mounting system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd accessory, mounting sys", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Accessory for speech generating device, electromyographic sensor", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Sgd accessory, emg sensor", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Accessory for speech generating device, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Sgd accessory noc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "General use wheelchair seat cushion, width less than 22 inches, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gen w/c cushion wdth < 22 in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "General use wheelchair seat cushion, width 22 inches or greater, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gen w/c cushion wdth >=22 in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection wheelchair seat cushion, width less than 22 inches, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Skin protect wc cus wd <22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection wheelchair seat cushion, width 22 inches or greater, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Skin protect wc cus wd>=22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair seat cushion, width less than 22 inches, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Position wc cush wdth <22 in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair seat cushion, width 22 inches or greater, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Position wc cush wdth>=22 in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Skin pro/pos wc cus wd <22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Skin pro/pos wc cus wd>=22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Custom fabricated wheelchair seat cushion, any size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Custom fabricate w/c cushion", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair seat cushion, powered", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Powered w/c cushion", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gen use back cush wdth <22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Gen use back cush wdth>=22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Position back cush wd <22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2614", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Position back cush wd>=22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pos back post/lat wdth <22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pos back post/lat wdth>=22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2617", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Custom fabricated wheelchair back cushion, any size, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Custom fab w/c back cushion", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2619", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement cover for wheelchair seat cushion or back cushion, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Replace cover w/c seat cush", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wc planar back cush wd <22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Wc planar back cush wd>=22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Adj skin pro w/c cus wd<22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2623", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Adj skin pro wc cus wd>=22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Adj skin pro/pos cus<22in", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Adj skin pro/pos wc cus>=22", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seo mobile arm sup att to wc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Arm supp att to wc rancho ty", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Mobile arm supports reclinin", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Friction dampening arm supp", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Monosuspension arm/hand supp", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, addition to mobile arm support, elevating proximal arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Elevat proximal arm support", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Offset/lat rocker arm w/ela", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E2633", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, addition to mobile arm support, supinator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Mobile arm support supinator", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "E3000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Speech volume modulation system, any type, including all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Speech volume modulation sys", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E3200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Gait modulation system, rhythmic auditory stimulation, including restricted therapy software, all components and accessories, prescription only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Gait mod systm rhym auditory", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "E8000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gait trainer, pediatric size, posterior support, includes all accessories and components", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Posterior gait trainer", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E8001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gait trainer, pediatric size, upright support, includes all accessories and components", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Upright gait trainer", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "E8002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gait trainer, pediatric size, anterior support, includes all accessories and components", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anterior gait trainer", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Administration of influenza virus vaccine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Admin influenza virus vac", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "G0009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Administration of pneumococcal vaccine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Admin pneumococcal vaccine", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "G0010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Administration of hepatitis b vaccine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Admin hepatitis b vaccine", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "G0011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 02, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Individual counseling for pre-exposure prophylaxis (prep) by physician or qualified health care professional (qhp) to prevent human immunodeficiency virus (hiv), includes hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence, 15-30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hiv prep counsel, md 15-30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 02, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Injection of hiv prep drug", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 02, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Individual counseling for pre-exposure prophylaxis (prep) by clinical staff to prevent human immunodeficiency virus (hiv), includes: hiv risk assessment (initial or continued assessment of risk), hiv risk reduction and medication adherence", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hiv prep counsel, clin staff", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Crisis psychotherapy 60m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Crisis psychotherapy add 30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit. ++ conducting a person-centered assessment to understand patient's life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal-setting and establishing an action plan. ++ providing tailored support to the patient as needed to accomplish the practitioner's treatment plan. practitioner, home-, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; and from home- and community-based service providers, social service providers, and caregiver (if applicable). ++ communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) to address the sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, and preferences, in the context of the sdoh need(s), and educating the patient on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the sdoh need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Comm hlth intg svs sdoh 60mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Comm hlth intg svs add 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month, in the following activities: person-centered assessment, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered assessment to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors and including unmet sdoh needs (that are not separately billed). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care coordination. ++ coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers; and caregiver (if applicable). ++ communication with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ coordination of care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education- helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. health care access / health system navigation. ++ helping the patient access healthcare, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them. ++ providing the patient with information/resources to consider participation in clinical trials or clinical research as applicable. facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Pin service 60m per month", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Pin srv add 30 min pr m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "C = Carrier judgment", "longDescription": "Semen analysis; presence and/or motility of sperm excluding huhner", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Semen analysis", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no scr tob", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No tob scr/cess int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scr tob & cess int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Palliative care services given to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2+ antipsy schiz", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2+ benzo seiz", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients receiving palliative care during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has any emergency department encounter during the performance period with place of service indicator 23", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ed pos 23", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient or care partner decline assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt/ptn decln assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not able to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician determines patient does not require referral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Clin pt no ref", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not referred, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no ref, rn spec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient already receiving physical/occupational/speech/recreational therapy during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt phys/occ therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient and/or care partner decline referral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt/ptn decln referral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Referral to physical, occupational, speech, or recreational therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ref to therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with mechanical prosthetic heart valve", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt mech pros ht valv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with moderate or severe mitral stenosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt mitral stenosis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mrs 90 days post stk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No mrs 90 days post stk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped blunt hd traum", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who receive palliative care services any time during the intake period through the end of the measurement year", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "With maintenance hemodialysis (in-center and home hd) for the complete reporting month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Main hemo in-cntr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a catheter that have limited life expectancy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ lmted life expec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients under hospice care in the current reporting month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hospice mnth", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients on peritoneal dialysis for any portion of the reporting month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt peri dialysis dur mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Advancing rheumatology patient care mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adv rheum pt care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Strk cr prev pos outcme mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Advancing care for heart disease mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adv care heart dx mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Optimizing chronic disease management mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Opt chronic dx mang mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Best pct pt safety em mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Improving care for lower extremity joint repair mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Imprv care le jnt repr mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0059", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient safety and support of positive experiences with anesthesia mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt sfty pos exp w aneth mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Allergy/immunology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Allergy/immunology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Anesthesiology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anesthesiology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Audiology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Audiology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0063", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Cardiology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cardiology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0064", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Certified nurse midwife mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cert nurse midwife ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Chiropractic medicine mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chiropractic ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0066", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical social work mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Clinical social work ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0067", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Dentistry mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dentistry ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0068", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Adm iv infusion drug in home", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0069", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Adm sq infusion drug in home", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Adm of chemo drug in home", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0071", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Comm svcs by rhc/fqhc 5 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0076", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manag h vst new pt 20 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0077", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manag h vst new pt 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0078", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manag h vst new pt 45 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0079", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manag h vst new pt 60 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manag h vst new pt 75 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care man h v ext pt 20 mi", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0082", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care man h v ext pt 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care man h v ext pt 45 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0084", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care man h v ext pt 60 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0085", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care man h v ext pt 75 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0086", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care man home care plan 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0087", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care man home care plan 60 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0088", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Adm iv drug 1st home visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0089", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Adm subq drug 1st home visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Adm iv chemo 1st home visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cervical or vaginal cancer screening; pelvic and clinical breast examination", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ca screen;pelvic/breast exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prostate cancer screening; digital rectal examination", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Prostate ca screening; dre", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prostate cancer screening; prostate specific antigen test (psa)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Psa screening", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colorectal cancer screening; flexible sigmoidoscopy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ca screen;flexi sigmoidscope", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colorectal cancer screening; colonoscopy on individual at high risk", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Colorectal scrn; hi risk ind", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Colon ca screen;barium enema", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Diabetes outpatient self-management training services, individual, per 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Diab manage trn per indiv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0109", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Diab manage trn ind/group", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Glaucoma scrn hgh risk direc", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "G0118", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Glaucoma scrn hgh risk direc", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "G0120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Colon ca scrn; barium enema", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Colon ca scrn not hi rsk ind", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Colorectal cancer screening; barium enema", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Colon ca scrn; barium enema", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0123", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Screen cerv/vag thin layer", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0124", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician", "multiplePricingIndicatorCode": "C = Physician interpretation of clinical lab service is priced under physician fee schedule using RVU's, while pricing of lab service is paid under clinical lab fee schedule", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Screen c/v thin layer by md", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0127", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Trimming of dystrophic nails, any number", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Trim nail(s)", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Corf skilled nursing service", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Php/iop ot service", "typeOfServiceCode": "U = Occupational therapy", "year": "2026" }, { "code": "G0130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Single energy x-ray study", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0136", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Adm of pa/n assess 5-15 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Inten outpt svs,min 9 pr 7 d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Iv cipaglucosidase alfa-atga", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner's treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Nav srv peer sup 60 min pr m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Scr c/v cyto,autosys and md", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0143", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Scr c/v cyto,thinlayer,rescr", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Scr c/v cyto,thinlayer,rescr", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Scr c/v cyto,thinlayer,rescr", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0146", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Nav srv peer sup add 30 pr m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0147", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Scr c/v cyto, automated sys", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Scr c/v cyto, autosys, rescr", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhcp-serv of pt,ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhcp-serv of ot,ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhcp-svs of s/l path,ea 15mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhcp-svs of rn,ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Services of clinical social worker in home health or hospice settings, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhcp-svs of csw,ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Services of home health/hospice aide in home health or hospice settings, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhcp-svs of aide,ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc pt assistant ea 15", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0158", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc ot assistant ea 15", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0159", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc pt maint ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc occup therapy ea 15", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc slp ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc rn e&m plan svs, 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0163", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled services of a licensed nurse (lpn or rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc lpn/rn obs/asses ea 15", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled services of a licensed nurse (lpn or rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhc lis nurse train ea 15", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0166", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "External counterpulsation, per treatment session", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Extrnl counterpulse, per tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Wound closure utilizing tissue adhesive(s) only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wound closure by adhesive", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0173", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "August 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Linear acc stereo radsur com", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Opps service,sched team conf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0176", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Opps/php/iop; activity thrpy", "typeOfServiceCode": "U = Occupational therapy", "year": "2026" }, { "code": "G0177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Opps/php/iop; train & educ", "typeOfServiceCode": "U = Occupational therapy", "year": "2026" }, { "code": "G0179", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Md recertification hha pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Md certification hha patient", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision of care plans", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Home health care supervision", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Hospice care supervision", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0183", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from ct scan(s) data of the chest/heart (with or without contrast)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Software meas of cardiac vol", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dstry eye lesn,fdr vssl tech", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "77067", "longDescription": "Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Scr mammo bi incl cad", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "77066", "longDescription": "Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Dx mammo incl cad bi", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2001", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "77065", "longDescription": "Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Dx mammo incl cad uni", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Pet imaging whole body; melanoma for non-covered indications", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pet img wholbod melano nonco", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Pet imaging, any site, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pet not otherwise specified", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0237", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Therapeutic procd strg endur", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0238", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Oth resp proc, indiv", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Oth resp proc, group", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Initial foot exam pt lops", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Followup eval of foot pt lop", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Routine footcare pt w lops", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 19, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Demonstrate use home inr mon", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 19, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Provide inr test mater/equip", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 19, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Md inr test revie inter mgmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Linear acc based stero radio", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pet imaging initial dx", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Current percep threshold tst", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unsched dialysis esrd pt hos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection procedure for sacroiliac joint; arthrography", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inject for sacroiliac joint", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj for sacroiliac jt anesth", "typeOfServiceCode": "F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "G0268", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Removal of impacted wax md", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0269", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Occlusive device in vein art", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Mnt subs tx for change dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Group mnt 2 or more 30 mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0276", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Pild/placebo control clin tr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0277", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hbot, full body chamber, 30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0278", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Iliac art angio,cardiac cath", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0279", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Tomosynthesis, mammo", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Elec stim unattend for press", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0282", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Elect stim wound care not pd", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0283", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Elec stim other than wound", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0288", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Recon, cta for surg plan", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0289", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Arthro, loose body + chondro", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-cov surg proc,clin trial", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0294", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-cov proc, clinical trial", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Electromagnetic therapy onc", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0296", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "February 05, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 05, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Visit to determ ldct elig", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0297", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 05, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Low dose ct scan (ldct) for lung cancer screening", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ldct for lung ca screen", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "November 02, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 02, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhs/hospice of rn ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "November 02, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 02, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hhs/hospice of lpn ea 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-op service lvrs complete", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-op service lvrs 10-15dos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-op service lvrs 1-9 dos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Post op service lvrs min 6", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Cbc/diffwbc w/o platelet", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0307", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Cbc without platelet", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0308", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "180 d implant glucose sensor", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0309", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Rem/inser glu sensor dif sit", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 11, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 11, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Immunize counsel 5-15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0311", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 11, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 11, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time (this code is used for medicaid billing purposes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Immunize counsel 16-30 mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 11, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 11, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Immunize couns < 21yr 5-15 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 11, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 11, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time (this code is used for medicaid billing purposes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Immunize couns < 21yr 6-30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0314", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 11, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 11, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 16-30 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Counsel immune <21 16-30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 11, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 11, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Immunization counseling by a physician or other qualified health care professional for covid-19, ages under 21, 5-15 mins time (this code is used for the medicaid early and periodic screening, diagnostic, and treatment benefit (epsdt)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Counsel immune <21 5-15 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Prolong inpt eval add15 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0317", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services). (do not report g0317 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418). (do not report g0317 for any time unit less than 15 minutes)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Prolong nursin fac eval 15m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0318", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Prolong home eval add 15m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Two-way audio and video hhs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Audio-only hhs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0322", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Home h physio data collec tr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist, clinical social worker, mental health counselor, or marriage and family therapist time, per calendar month. (these services include the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, coordination with and/or referral to physicians and practitioners who are authorized by medicare to prescribe medications and furnish e/m services, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manage beh svs 20mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colorectal cancer screening; blood-based biomarker", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Colon ca scrn;bld-bsd biomrk", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Fecal blood scrn immunoassay", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Electromagntic tx for ulcers", "typeOfServiceCode": "1 = Medical care\n\nU = Occupational therapy W = Physical therapy", "year": "2026" }, { "code": "G0330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Facility svs dental rehab", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0333", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Dispense fee initial 30 day", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0337", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice evaluation and counseling services, pre-election", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Hospice evaluation preelecti", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0339", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Robot lin-radsurg com, first", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Robt lin-radsurg fractx 2-5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Percutaneous islet cell transplant, includes portal vein catheterization and infusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Percutaneous islet celltrans", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Laparoscopy islet cell trans", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0343", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Laparotomy for islet cell transplant, includes portal vein catheterization and infusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Laparotomy islet cell transp", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Bone marrow aspirate &biopsy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0365", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Vessel mapping hemo access", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 25, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 25, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Physician service required to establish and document the need for a power mobility device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Md service required for pmd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0378", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospital observation service, per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospital observation per hr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0379", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Direct admission of patient for hospital observation care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Direct refer hospital observ", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lev 1 hosp type b ed visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0381", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lev 2 hosp type b ed visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0382", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lev 3 hosp type b ed visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0383", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lev 4 hosp type b ed visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0384", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lev 5 hosp type b ed visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0389", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ultrasound exam aaa screen", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Trauma response team associated with hospital critical care service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trauma respons w/hosp criti", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alcohol/subs interv 15-30mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alcohol/subs interv >30 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 13, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 13, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Home sleep test/type 2 porta", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 13, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 13, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Home sleep test/type 3 porta", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 13, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 13, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Home sleep test/type 4 porta", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Initial preventive exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0403", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ekg for initial prevent exam", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ekg tracing for initial prev", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ekg interpret & report preve", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0406", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Inpt/tele follow up 15", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "G0407", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Inpt/tele follow up 25", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "G0408", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Inpt/tele follow up 35", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "G0409", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Corf related serv 15 mins ea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Grp psych php/iop 45-50", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Interactive grp psyc php/iop", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0412", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Open tx iliac spine uni/bil", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0413", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Pelvic ring fracture uni/bil", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0414", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Pelvic ring fx treat int fix", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0415", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Open tx post pelvic fxcture", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0416", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Prostate biopsy, any mthd", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0417", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Sat biopsy prostate 21-40", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0418", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Sat biopsy prostate 41-60", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0419", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Sat biopsy prostate: >60", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ed svc ckd ind per session", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0421", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ed svc ckd grp per session", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0422", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Intens cardiac rehab w/exerc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0423", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Intens cardiac rehab no exer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Pulmonary rehab w exer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Inpt/ed teleconsult30", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "G0426", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Inpt/ed teleconsult50", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "G0427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Inpt/ed teleconsult70", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "G0428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 25, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 25, 2010", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Collagen meniscus implant", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0429", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 23, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Dermal filler injection(s)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0431", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Drug screen multiple class", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0432", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 08, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Eia hiv-1/hiv-2 screen", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0433", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 08, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Elisa hiv-1/hiv-2 screen", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0434", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug screen multi drug class", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 08, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Oral hiv-1/hiv-2 screen", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0436", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "99406\n\n,99407", "longDescription": "Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Tobacco-use counsel 3-10 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0437", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "99406\n\n,99407", "longDescription": "Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Tobacco-use counsel>10min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0438", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ppps, initial visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0439", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ppps, subseq visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 14, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Annual alcohol misuse screening, 5 to 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Annual alcohol screen 15 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0443", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 14, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 14, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Brief alcohol misuse counsel", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0444", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 14, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Annual depression screening, 5 to 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Depression screen annual", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0445", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "November 08, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 08, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "High inten beh couns std 30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0446", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "November 08, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 08, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Intens behave ther cardio dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0447", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "November 29, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 29, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Face-to-face behavioral counseling for obesity, 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Behavior counsel obesity 15m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0448", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Place perm pacing cardiovert", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0451", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Development testing, with interpretation and report, per standardized instrument form", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Devlopment test interpt&rep", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Molecular pathology procedure; physician interpretation and report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Molecular pathology interpr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0453", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cont intraop neuro monitor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0454", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Md document visit by npp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fecal microbiota prep instil", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0456", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Neg pre wound <=50 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0457", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Neg pres wound >50 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0458", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Low dose rate (ldr) prostate brachytherapy services, composite rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldr prostate brachy comp rat", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G0459", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "August 02, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "August 02, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Telehealth inpt pharm mgmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "August 02, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Autolog prp not diab ulcer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0461", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Immunohisto/cyto chem 1st st", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0462", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Immunohisto/cyto chem add", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0463", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hospital outpatient clinic visit for assessment and management of a patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospital outpt clinic visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0464", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 09, 2014", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "81528", "longDescription": "Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Colorec ca scr, sto bas dna", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 13, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Autolog prp diab wound ulcer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0466", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fqhc visit new patient", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0467", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fqhc visit, estab pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0468", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fqhc visit, ippe or awv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0469", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fqhc visit, mh new pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fqhc visit, mh estab pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0471", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Ven blood coll snf/hha", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "June 02, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hepatitis c antibody screening, for individual at high risk and other covered indication(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hep c screen high risk/other", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0473", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Group behave couns 2-10", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0475", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 13, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 13, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Hiv antigen/antibody, combination assay, screening", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hiv combination assay", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0476", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 09, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 09, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hpv combo assay ca screen", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0477", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "80305", "longDescription": "Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test presump optical", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0478", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "80306", "longDescription": "Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test presump opt inst", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0479", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "80307", "longDescription": "Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes sample validation when performed, per date of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test presump not opt", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test def 1-7 classes", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0481", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test def 8-14 classes", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test def 15-21 classes", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0483", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test def 22+ classes", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Face-to-face home health nursing visit by a rural health clinic (rhc) or federally qualified health center (fqhc) in an area with a shortage of home health agencies; (services limited to rn or lpn only)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Home visit rn, lpn by rhc/fq", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0491", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Dialysis acu kidney no esrd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0492", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Md/oth eval acut kid no esrd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0493", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled services of a registered nurse (rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rn care ea 15 min hh/hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0494", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lpn care ea 15min hh/hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0495", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rn care train/edu in hh", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0496", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lpn care train/edu in hh", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0498", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Chemo extend iv infus w/pump", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "September 28, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hepb screen high risk indiv", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Mod sedat endo service >5yrs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Resource-intensive services for patients for whom the use of specialized mobility-assistive technology (such as adjustable height chairs or tables, patient lift, and adjustable padded leg supports) is medically necessary and used during the provision of an office/outpatient, evaluation and management visit (list separately in addition to primary service)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Resource-inten svc during ov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "99492", "longDescription": "Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Init psych care manag, 70min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "99493", "longDescription": "Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Subseq psych care man,60mi", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "99494", "longDescription": "Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separately in addition to code for primary procedure); (use g0504 in conjunction with g0502, g0503)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Init/sub psych care add 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "99483", "longDescription": "Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cog/func assessment outpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Comp asses care plan ccm svc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "99484", "longDescription": "Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manage serv minimum 20", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Crit care telehea consult 60", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Crit care telehea consult 50", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0511", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ccm/bhi by rhc/fqhc 20min mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0512", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cocm by rhc/fqhc 60 min mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Prolong prev svcs, first 30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Prolong prev svcs, addl 30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cognitive skills development", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Insert drug del implant, >=4", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remove drug implant", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remove w insert drug implant", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0519", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "New pt-cg dyad dem low cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "New pt-cg dyad dem mod cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "New pt-cg dyad dem hig cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of a new patient with dementia, low complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Mgt nw pt dementia low cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of a new patient with dementia, moderate to high complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Mgt nw pt dem mod-high cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Est pt-cg dyad dem low cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Est pt-cg dyad dem mod cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Est pt-cg dyad dem hig cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0527", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of established patient with dementia, low complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Mgt est pt dmentia low cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0528", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Management of established patient with dementia, moderate to high complexity, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Mgt est pt dem mod-hi cmplx", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0529", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "In-home respite care, 4-hour unit, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "In home respite care, 4 hr u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Adult day center, 8-hour unit, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Adult daycare center, 8 hr u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Facility-based respite, 24-hour unit, for use in cmmi model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fclty-based respite, 24 hr u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0532", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Take home supp nasal spray", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0533", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Buprenorphone inj weekly", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0534", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Coordinated care/or referral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Pt navigat svs direct/ref", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0536", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Peer recover support svs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0537", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Risk ascvd tst once pr 12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0538", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ascvd rsk mng clin stf pr mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0539", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Initial care training 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; each additional 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Train for caregiver add 15", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; initial 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "No pt prsnt train initial 30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (use g0542 in conjunction with g0541)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "No pt prsnt train add 15", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Group caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face with multiple sets of caregivers", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Group train w/o patient", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0544", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post d/c phone follow up", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Inherent visit to inpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0546", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 5-10 minutes of medical consultative discussion and review", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Phone/internet ehr assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0547", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 11-20 minutes of medical consultative discussion and review", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Phone/internet svs 11-20 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0548", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 21-30 minutes of medical consultative discussion and review", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Phone/inter svs 21-30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0549", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a verbal and written report to the patient's treating/requesting practitioner; 31 or more minutes of medical consultative discussion and review", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Phone/inter for treat>31m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Interprofessional telephone/internet/electronic health record assessment and management service provided by a practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, including a written report to the patient's treating/requesting practitioner, 5 minutes or more of medical consultative time", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Phone/inter for dx/treat >5m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0551", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting practitioner in a specialty whose covered services are limited by statute to services for the diagnosis and treatment of mental illness, 30 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Phn/intr svs fr dx treat 30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Supply of digital device", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0553", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "First 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing information related to the use of the dmht device, including patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Monthly tx for dmht 20mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0554", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing data generated from the dmht device from patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Add 20 m of monthly tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Replacment pt electronic sys", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G0556", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Advanced primary care management services for a patient with one chronic condition [expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline], or fewer, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan with typical care plan elements when clinically relevant; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Adv prim care mgmt lvl 1", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0557", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Adv prim care mgmt lvl 2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Advanced primary care management services for a patient that is a qualified medicare beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the following elements, as appropriate: consent; ++ inform the patient of the availability of the service; that only one practitioner can furnish and be paid for the service during a calendar month; of the right to stop the services at any time (effective at the end of the calendar month); and that cost sharing may apply. ++ document in patient's medical record that consent was obtained. initiation during a qualifying visit for new patients or patients not seen within 3 years; provide 24/7 access for urgent needs to care team/practitioner, including providing patients/caregivers with a way to contact health care professionals in the practice to discuss urgent needs regardless of the time of day or day of week; continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; deliver care in alternative ways to traditional office visits to best meet the patient's needs, such as home visits and/or expanded hours; overall comprehensive care management; ++ systematic needs assessment (medical and psychosocial). ++ system-based approaches to ensure receipt of preventive services. ++ medication reconciliation, management and oversight of self-management. development, implementation, revision, and maintenance of an electronic patient-centered comprehensive care plan; ++ care plan is available timely within and outside the billing practice as appropriate to individuals involved in the beneficiary's care, can be routinely accessed and updated by care team/practitioner, and copy of care plan to patient/caregiver; coordination of care transitions between and among health care providers and settings, including referrals to other clinicians and follow-up after an emergency department visit and discharges from hospitals, skilled nursing facilities or other health care facilities as applicable; ++ ensure timely exchange of electronic health information with other practitioners and providers to support continuity of care. ++ ensure timely follow-up communication (direct contact, telephone, electronic) with the patient and/or caregiver after an emergency department visit and discharges from hospitals, skilled nursing facilities, or other health care facilities, within 7 calendar days of discharge, as clinically indicated. ongoing communication and coordinating receipt of needed services from practitioners, home- and community-based service providers, community-based social service providers, hospitals, and skilled nursing facilities (or other health care facilities), and document communication regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors, in the patient's medical record; enhanced opportunities for the beneficiary and any caregiver to communicate with the care team/practitioner regarding the beneficiary's care through the use of asynchronous non-face-to-face consultation methods other than telephone, such as secure messaging, email, internet, or patient portal, and other communication-technology based services, including remote evaluation of pre-recorded patient information and interprofessional telephone/internet/ehr referral service(s), to maintain ongoing communication with patients, as appropriate; ++ ensure access to patient-initiated digital communications that require a clinical decision, such as virtual check-ins and digital online assessment and management and e/m visits (or e-visits). analyze patient population data to identify gaps in care and offer additional interventions, as appropriate; risk stratify the practice population based on defined diagnoses, claims, or other electronic data to identify and target services to patients; be assessed through performance measurement of primary care quality, total cost of care, and meaningful use of certified ehr technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Adv prim care mgmt lvl 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0559", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care and requires the following required elements, when possible and applicable: reading available surgical note to understand the relative success of the procedure, the anatomy that was affected, and potential complications that could have arisen due to the unique circumstances of the patient's operation. research the procedure to determine expected post-operative course and potential complications (in the case of doing a post-op for a procedure outside the specialty). evaluate and physically examine the patient to determine whether the post-operative course is progressing appropriately. communicate with the practitioner who performed the procedure if any questions or concerns arise. (list separately in addition to office/outpatient evaluation and management visit, new or established)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Unrelat prac follow up visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safe", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Safety plan interven", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Tympanostomy with local or topical anesthesia and insertion of a ventilating tube when performed with tympanostomy tube delivery device, unilateral (list separately in addition to 69433) (do not use in conjunction with 0583t)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Temp tube delivery, unil", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Therapeutic radiology simulation-aided field setting; complex, including acquisition of pet and ct imaging data required for radiopharmaceutical-directed radiation therapy treatment planning (i.e., modeling)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Complex simulation w/pet-ct", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G0563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Sbrt w/positron emission del", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G0564", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Creation of subcutaneous pocket with insertion of 365 day implantable interstitial glucose sensor, including system activation and patient training", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "365 d implant glucose sensor", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 365 day implantable sensor, including system activation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Rem/ins glu snsr 365 dif sit", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0566", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "3d radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "3d bn img algor drvd fr mri", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "G0567", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "June 27, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "June 27, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious agent detection by nucleic acid (dna or rna); hepatitis c, screening, amplified probe technique", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Screening hep c detect", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0568", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Initial psychiatric collaborative care management, in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional, initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan, review by the psychiatric consultant with modifications of the plan if recommended, entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant, and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies (list separately in addition to the advanced primary care management code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Int psych care mng, 1 cal mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0569", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Subsequent psychiatric collaborative care management, in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation, participation in weekly caseload consultation with the psychiatric consultant, ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers, additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant, provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies, monitoring of patient outcomes using validated rating scales, and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment (list separately in addition to advanced primary care management code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Subs psych care mng, subs mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0570", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Care management services for behavioral health conditions, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales, behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes, facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and continuity of care with a designated member of the care team (list separately in addition to advanced primary care management code)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Care manage serv, pr cal mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0571", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Intraoperative nerve(s) cryoablation for post-surgical pain relief (list separately in addition to code for primary service)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Intraop nerve cryoablation", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0659", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug test def simple all cl", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G0660", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m new pt 10mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m new pt 10 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0661", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m new pt 20mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m new pt 20 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0662", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m new pt 30 mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m new pt 30 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0663", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m new pt 45mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m new pt 45 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0664", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m new pt 60mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m new pt 60 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0665", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m est. pt 10mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m est pt 10 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0666", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m est. pt 15mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m est pt 15 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0667", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m est. pt 25mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m est pt 25 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0668", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Team remote e/m est. pt 40mins", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team remote e/m est pt 40 mn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0680", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Detection and quantification of coronary artery calcium and/or aortic valve calcification from algorithmic analysis of computed tomography of the chest with report", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cr art clc art vlv clc w rpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0681", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; first 25 sq cm or less of wound surface area", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "App of non-sheet skin sub", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0682", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "App non-sheet skin sub add", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0683", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "App of non-sheet skin sub g", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0684", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "App non-sheet skin sb g addl", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G0908", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent hemoglobin (hgb) level > 12.0 g/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hgb > 12 g/dl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0909", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Hemoglobin level measurement not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hbg not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0910", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent hemoglobin level <= 12.0 g/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hgb <= 12 g/dl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0913", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Improvement in visual function achieved within 90 days following cataract surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Improve visual funct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0914", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient care survey was not completed by patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Survey not complete", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0915", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Improvement in visual function not achieved within 90 days following cataract surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No improve visual funct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0916", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Satisfaction with care achieved within 90 days following cataract surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Satisfy with care", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0917", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient care survey was not completed by patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Care survey not complete", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0918", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Satisfaction with care not achieved within 90 days following cataract surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No satisfy with care", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0919", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flu immunize not avail", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Type, anatomic location, and activity all documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Type loc act doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0921", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt reas no assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G0922", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of disease type, anatomic location, and activity, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Type loc act not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm applied pathways", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm evicore", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm medcurrent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm medicalis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm ndsc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm nia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm test approp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm aim", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm cranberry pk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm sage health", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm stanson", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm qualified nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm agilemd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm evidencecare", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm inveniqa", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm reliant", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm speed of care", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm healthhelp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm infinx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm logicnets", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm curbside", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm ehealthline", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm intermountain", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm persivia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cdsm radrite", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt mnth 1 mcp prov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hemo > 3mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hemo < 3mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G1028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Take home supply 8mg per 0.1", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "August 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "August 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Blinded administration of convulsive therapy procedure, either electroconvulsive therapy (ect, current covered gold standard) or magnetic seizure therapy (mst, non-covered experimental therapy), performed in an approved ide-based clinical trial, per treatment session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Blinded conv. tx mdd clin tr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Brief (20 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post d/c h vst new pt 20 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Limited (30 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst new pt 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Moderate (45 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst new pt 45 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst new pt 60 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Extensive (75 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst new pt 75 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Brief (20 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst ext pt 20 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Limited (30 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst ext pt 30 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Moderate (45 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst ext pt 45 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst ext pt 60 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remot image submit by pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Alcohol/sub misuse assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "98016", "longDescription": "Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Brief check in by md/qhp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Extensive (75 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c h vst ext pt 75 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Limited (30 minutes) care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c care plan overs 30m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive (60 mins) home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Post-d/c care plan overs 60m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hi inten serv for sip model", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Health care practitioners rendering treatment in place (tip)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hea care pract tx in place", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G2022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Benef refuses service, mod", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G2023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 12, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Specimen collect covid-19", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G2024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 12, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Spec coll snf/lab covid-19", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G2025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 27, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 27, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Dis site tele svcs rhc/fqhc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month). (use g2058 in conjunction with 99490). (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491)).", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ccm add 20min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "98970", "longDescription": "Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Qual nonmd est pt 5-10m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "98971", "longDescription": "Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Qual nonmd est pt 11-20m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2063", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "98972", "longDescription": "Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Qual nonmd est pt 21>min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2064", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Md mang high risk dx 30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Clin mang h risk dx 30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2066", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Inter devc remote 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2067", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med assist tx meth wk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2068", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med assist tx bupre oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2069", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med assist tx inject", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med assist tx implant", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med tx remove implant", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2072", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med tx insert/remove imp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med tx naltrexone", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2074", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med assist tx no drug", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2075", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Med tx meds nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2076", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based assessment, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, physical activity and/or nutrition needs and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Intake act w/med exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2077", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical, nutrition and psychiatric treatment needs and goals; may be informed by administration of a standardized, evidence-based assessment, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Periodic assessment", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2078", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Take-home meth", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2079", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Take-hom buprenorphine", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Add 30 mins counsel", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2082", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Visit esketamine 56m or less", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Visit esketamine, > 56m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2086", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Off base opioid tx 70min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2087", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Off base opioid tx, 60 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2088", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Off base opioid tx, add30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2089", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0%", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "A1c level 7 to 9%", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2091", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2092", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ace arb arni", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2093", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med doc rsn no ace arn arni", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2094", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rsn no ace arn arni", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2095", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sys rsn no ace arn arni", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2096", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rsn ace arb arni", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2097", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dx uri 3d after other dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2098", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2099", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dil retinal eye exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "7 stereo photos interpret", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eye img valid w/7 stereo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2107", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2109", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pred<=5 mg ra glu <6m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pred>5 mg >6m, no chg da", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2116", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2118", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 81+ frailty", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2119", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc vitd opt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No calc vitd opt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Depression, anxiety, apathy, and psychosis assessed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psy dep anx ap and icd asse", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Depression, anxiety, apathy, and psychosis not assessed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psy/dep/anx/apandicd noasse", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2123", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2124", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2125", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 81+ frailty", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2127", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g. history of gastrointestinal bleed, intra-cranial bleed, blood disorders, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No aspirin med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Procedure-related bp's not taken during an outpatient visit. examples include same day surgery, ambulatory service center, g.i. lab, dialysis, infusion center, chemotherapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No bp outpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ lt inst > 90", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 81 years and older with a diagnosis of frailty", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 81+ frailty", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2133", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66-80 frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2134", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bk pain vas 6-20wk <= 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bk pain vas 6-20wk > 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bk pain vas 9-15mo <= 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bk pain vas 9-15mo > 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Leg pain vas 6-20wk <= 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated improvement of less than 5.0 points", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Leg pain vas 6-20wk > 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2142", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs odi 9-15mo postop<= 22", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2143", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs odi 9-15mo > 22", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6-20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6-20 weeks) postoperatively demonstrated an improvement of 30 points or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs odi 6-20wk postop <= 22", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fsodi 6-20wk >22 or chg 30pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2146", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain as measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Leg pain vas 9-15mo <= 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2147", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) or numeric pain scale within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated improvement of less than 5.0 points", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Leg pain vas 9-15mo > 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Multimodal pain management was used", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mpm used", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2149", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not using multimodal pain management (e.g., allergy to multiple classes of analgesics, intubated patient, hepatic failure, patient reports no pain during pacu stay, other medical reason(s))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No mpm med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Multimodal pain management was not used", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No mpm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Res change sc >=0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "In hospice or using hospice services during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp dur meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Td 9 yrs start end meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hist contraindications", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period; or have history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No prior td or hx contra", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patients received both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pneum vacc 12 mo 60+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2158", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pneum vacc adv rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2159", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during measurement period; or have prior pneumococcal vaccine adverse reaction any time during or before the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pneum vacc 12 mo 60+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Herpzos 50+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adv rx zos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period; or have prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No herpzos 50+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2163", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Infl vacc 07/01 to 06/30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adv rx infl vacc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period; or did not have a prior influenza virus vaccine adverse reaction any time before or during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No infl vacc 07/01 to 06/30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2166", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate at admission and/or discharge; patient unable to complete the neck fs prom at admission or discharge due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, and a suitable proxy/recorder is not available; patient self-discharged early; medical reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pt adm dx no neck fs prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2167", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the neck impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Res change sc < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Svs by pt in home health", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2169", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Svs by ot in home health", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "36836", "longDescription": "Percutaneous arteriovenous fistula creation (avf), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Avf by tissue w thermal e", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G2171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "36837", "longDescription": "Percutaneous arteriovenous fistula creation (avf), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, wen performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Avf use magnetic/art/ven", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G2172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tx for opioid use demo proj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2173", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Uri w comorb 12m oth dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2174", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Uri new rx antibiotic 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt comorb dx 12m of epi", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2176", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Outpatient, ed, or observation visits that result in an inpatient admission", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Outpt ed obs w inpt admit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bronch w rx antibx 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2178", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer's, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not elig low neuro ex", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2179", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient had medical reason for not performing lower extremity neurological exam", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med doc rsn no low ex", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inelig footwr eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi not documented due to medical reason or patient refusal of height or weight measurement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmi not doc medrsn ptref", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving first-time biologic and/or immune response modifier therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 1st biolog antirheum", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2183", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation patient unable to communicate and informant not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt unable comm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2184", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient does not have a caregiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No caregiver", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation caregiver is trained and certified in dementia care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Caregiver dem trained", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ref app rsrcs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2187", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: head trauma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Clin ind img hd trauma", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2188", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 50 yrs w/clin ind hd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2189", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: abnormal neurologic exam", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Img hd abnml neuro exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: headache radiating to the neck", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ind img hd rad neck", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2191", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: positional headaches", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ind img hd pos hd ache", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2192", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": ">55 yrs temp hd ache", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2193", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "<6yr new onset hd ache", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2194", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "New hdache ped pt dis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2195", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head: occipital headache in children", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Occip hdache child", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2196", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Screen unhlthy etoh use", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Screen hlthy etoh use", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2198", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no unhlthy etoh", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not screened for unhealthy alcohol use using a systematic screening method", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not scrn etoh no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient identified as an unhealthy alcohol user received brief counseling", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unhlthy etoh rcvd couns", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no brief couns", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive brief counseling if identified as an unhealthy alcohol user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rsn no brief couns", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no etoh couns", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 45-85 w/ scope", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with pregnancy during adjuvant treatment course", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Preg drng adjv trtmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adjv trtmt chemo her2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rsn no trtmt chem her2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No trtmt chemo and her2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No neck fs prom no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2211", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to home or residence or office/outpatient evaluation and management service, new or established)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Complex e/m visit add on", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Prolong outpt/office vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Initiat med assist tx in er", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Init/sub psych care m 1st 30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Home supply nasal naloxone", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Home supply inject naloxon", "typeOfServiceCode": "1 = Medical care\n\n9 = Other medical items or services", "year": "2026" }, { "code": "G2250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remot img sub by pt, non e/m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Brief chkin, 5-10, non-e/m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G2252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Brief chkin by md/qhp, 11-20", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G3001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Administration and supply of tositumomab, 450 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Admin + supply, tositumomab", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G3002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Chronic pain mgmt 30 mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G3003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (list separately in addition to code for g3002. when using g3003, 15 minutes must be met or exceeded.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Chronic pain mgmt addl 15m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Dermatology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dermatology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Diagnostic radiology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diagnostic rad ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Electrophysiology cardiac specialist mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ep cardio ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Emergency medicine mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Emergency med ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Endocrinology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Endocrinology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Family medicine mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Family medicine ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Gastro-enterology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gastroenterology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "General surgery mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "General surgery ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Geriatrics mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Geriatrics ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Hospitalists mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospitalists ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious disease mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Infectious disease ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Internal medicine mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Internal medicine ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Interventional radiology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interventional rad ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Mental/behavioral and psychiatry mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mntal/behav/psych hlth ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Nephrology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nephrology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Neurology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neurology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Neurosurgical mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neurosurgical ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Nutrition/dietician mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nutrition/dietician ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Obstetrics/gynecology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ob/gyn ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology/hematology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oncology/hema ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Ophthalmology/optometry mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ophthalmology/optometry ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Orthopedic surgery mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orthopedic surgery ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Otolaryngology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Otolaryngology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pathology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Pediatrics mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pediatrics ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Physical medicine mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Physical medicine ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Physical therapy/occupational therapy mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Phys/occ therapy ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Plastic surgery mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Plastic surgery ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Podiatry mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Podiatry ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Preventive medicine mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Preventive medicine ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Pulmonology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pulmonology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation oncology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Radiation oncology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Rheumatology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rheumatology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Skilled nursing facility mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Skilled nursing facility ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Speech language pathology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Speech language path ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Thoracic surgery mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Thoracic surgery ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Urgent care mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Urgent care ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Urology mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Urology ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G4038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Vascular surgery mips specialty set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vascular surgery ss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G6001", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ultrasonic guidance for placement of radiation therapy fields", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Echo guidance radiotherapy", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6002", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Stereoscopic x-ray guidance", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6003", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6004", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6005", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6006", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6007", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6008", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6009", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6010", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6011", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6012", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6013", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6014", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation treatment delivery", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6015", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Radiation tx delivery imrt", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6016", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Delivery comp imrt", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6017", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface tracking), each fraction of treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Intrafraction track motion", "typeOfServiceCode": "6 = Therapeutic radiology", "year": "2026" }, { "code": "G6018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ileoscopy w/stent", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Colonoscopy lesion removal", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Colonoscopy w/stent", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Unlisted procedure, intestine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Unlisted px small intestine", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Sigmoidoscopy w/ablate tumr", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Sigmoidoscopy w/stent", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Lesion removal colonoscopy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Colonoscopy w/stent", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Anoscopy hra w/spec collect", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Anoscopy hra w/biopsy", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "G6030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Amitriptyline", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of amitriptyline", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Benzodiazepines", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of benzodiazepines", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Desipramine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of desipramine", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Doxepin", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of doxepin", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Gold", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of gold", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Assay of imipramine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of imipramine", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Nortriptyline", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of nortiptyline", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Salicylate", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of salicylate", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Acetaminophen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of acetaminophen", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Alcohol (ethanol); any specimen except breath", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of ethanol", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Alkaloids, urine, quantitative", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of urine alkaloids", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Amphetamine or methamphetamine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of amphetamines", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Barbiturates, not elsewhere specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of barbiturates", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Cocaine or metabolite", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of cocaine", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Dihydrocodeinone", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of dihydrocodeinone", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Dihydromorphinone", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of dihydromorphinone", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Dihydrotestosterone", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of dihydrotestosterone", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Dimethadione", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of dimethadione", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Epiandrosterone", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Asssay of epiandrosterone", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Ethchlorvynol", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of ethchlorvynol", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Flurazepam", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of flurazepam", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Meprobamate", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of meprobamate", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Methadone", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of methadone", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Methsuximide", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of methsuximide", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Nicotine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of nicotine", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Opiate(s), drug and metabolites, each procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of opiates", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Phenothiazine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Assay of phenothiazine", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G6058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Drug confirmation, each procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Drug confirmation", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "G8126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt treat w/antidepress12wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8127", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not treat w/antidepres12w", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig for antidepres med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8395", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef>=40% doc normal or mild", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Left ventricular ejection fraction (lvef) not performed or documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef not performed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dil macula/fundus exam/w doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Dilated macular or fundus exam not performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dil macular/fundus not perfo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/dxa results document", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/dxa no results doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig osteo screen measu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Lower extremity neurological exam performed and documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Low extemity neur exam docum", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Lower extremity neurological exam not performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Low extemity neur not perfor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8406", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig lower extrem neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Footwear evaluation performed and documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eval on foot documented", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8415", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Footwear evaluation was not performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eval on foot not performed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8416", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for footwear evaluation measure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig footwear evaluatio", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8417", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented above normal parameters and a follow-up plan is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi abv up param f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8418", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented below normal parameters and a follow-up plan is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi blw low param f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8419", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi documented outside normal parameters, no follow-up plan documented, no reason given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi out nrm param nof/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented within normal parameters and no follow-up plan is required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi norm parameters", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8421", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi not documented and no reason is given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmi not calculated", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8422", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi not documented, documentation the patient is not eligible for bmi calculation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig bmi calculation", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docrev cur meds by elig clin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cur meds not document", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8430", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an acute health crisis where time is of the essence and delay of treatment would jeopardize the patient's health status)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no medrec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8431", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Screening for depression is documented as being positive and a follow-up plan is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pos clin depres scrn f/u doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8432", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Depression screening not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dep scr not doc, rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8433", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Screening for depression not completed, documented patient or medical reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scr for dep not cpt doc rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pain as nt perf, not elg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Beta-blocker therapy prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Beta-bloc rx pt w/abn lvef", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8451", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Beta-blocker therapy for lvef <=40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/abn lvef inelig b-bloc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Beta-blocker therapy not prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/abn lvef b-bloc no rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8458", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient is not an eligible candidate for genotype testing; patient not receiving antiviral treatment for hepatitis c during the measurement period (e.g. genotype test done prior to the reporting period, patient declines, patient not a candidate for antiviral treatment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig geno no antvir tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig rna no antvir tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8461", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving antiviral treatment for hepatitis c during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rec antivir treat hep c", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8464", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig; lo to no dter rsk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "High or very high risk of recurrence of prostate cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "High risk recurrence pro ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8473", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ace/arb thxpy rx'd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8474", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ace/arb not rx'd; doc reas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8475", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ace/arb thxpy not rx'd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8476", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp sys <140 and dias <90", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8477", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp sys>=140 and/or dias >=90", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8478", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Blood pressure measurement not performed or documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp not performed/doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Influenza immunization administered or previously received", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flu immunize order/admin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8483", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flu imm no admin doc rea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8484", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Influenza immunization was not administered, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flu immunize no admin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the diabetes mellitus (dm) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Report, diabetes measures", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8486", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the preventive care measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Report, prev care measures", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8487", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the chronic kidney disease (ckd) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Report ckd measures", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8489", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the coronary artery disease (cad) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cad measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the rheumatoid arthritis (ra) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ra measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8491", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the hiv/aids measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hiv/aids measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8492", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the perioperative care measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Periop care measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8493", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the back pain measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Back pain measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8494", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dm meas qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8495", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ckd meas qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8496", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the preventive care measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prev care mg qual act perfrm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8497", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cabg meas qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8498", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cad meas qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ra meas qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hiv meas qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Perio meas qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the back pain measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Back pain mg qual act perfrm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rec ace/arb", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pos pain assess no f/u doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Screening for depression is documented as negative, a follow-up plan is not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scr dep neg, no plan reqd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Screening for depression documented as positive, follow-up plan not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scr dep pos, no plan doc rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Autogenous av fistula received", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Auto av fistula recd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for autogenous av fistula", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig; auto av fistula", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8532", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient received vascular access other than autogenous av fistula, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No auto av fistula; no reas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eld maltreatment not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8536", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of an elder maltreatment screen, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc elder mal scrn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8539", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc funct and care plan", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foa not doc as being perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Functional outcome assessment using a standardized tool not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc cur funct assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc funct no deficiencies", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cur funct asses; no care pln", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8544", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the coronary artery bypass graft (cabg) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cabg measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the hepatitis c measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hepc measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8547", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the ischemic vascular disease (ivd) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ivd measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8548", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the heart failure (hf) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hf measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8549", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hepc mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8551", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hf mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ivd mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8559", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ref doc oto eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has a history of active drainage from the ear within the previous 90 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hx act drain prev 90 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig for ref oto eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient does not have a history of active drainage from the ear within the previous 90 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no hx act drain 90 d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no ref oto reas no spec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8564", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ref oto eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Verification and documentation of sudden or rapidly progressive hearing loss", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ver doc hear loss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8566", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is not eligible for the \"referral for otologic evaluation for sudden or rapidly progressive hearing loss\" measure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt inelig ref oto eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8567", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient does not have verification and documentation of sudden or rapidly progressive hearing loss", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no doc hear loss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8568", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no ref otolo no spec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8569", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged postoperative intubation (> 24 hrs) required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prol intubation req", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Prolonged postoperative intubation (> 24 hrs) not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No prol intub req", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8571", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Development of deep sternal wound infection/mediastinitis within 30 days postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ster wd ifx 30 d postop", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8572", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "No deep sternal wound infection/mediastinitis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No ster wd ifx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8573", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Stroke following isolated cabg surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stk cabg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8574", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "No stroke following isolated cabg surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No strk cabg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Developed postoperative renal failure or required dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Postop ren fail", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8576", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "No postoperative renal failure/dialysis not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No postop ren fail", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8577", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Re-exploration required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reop req bld grft oth", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8578", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Re-exploration not required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No reop req bld grft oth", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8579", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Antiplatelet medication at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antplt med disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Antiplatelet medication contraindicated", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antplt med contraind", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8581", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "No antiplatelet medication at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No antplt med disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8582", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Beta-blocker at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bblock disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8583", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Beta-blocker contraindicated", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bblock contraind", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8584", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "No beta-blocker at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No bblock disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8585", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Anti-lipid treatment at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antilipid treat disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8586", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Anti-lipid treatment contraindicated", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antlip disch contra", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8587", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "No anti-lipid treatment at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No antlipid treat disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8593", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lipid pn results", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8594", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Lipid profile not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No lipid prof perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent ldl-c < 100 mg/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl < 100", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent ldl-c >= 100 mg/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl >= 100", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8598", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Aspirin or another antiplatelet therapy used", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asa/antiplat ther used", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Aspirin or another antiplatelet therapy not used, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No asa/antiplat ther use rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tpa initi w/in 4.5 hr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No elig tpa init w/in 4.5 hr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No tpa init w/in 4.5 hr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surg proc w/in 30 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No surg proc w/in 30 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc antibio order b/4 surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that administration of prophylactic parenteral antibiotics was initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required), as ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc antibio given b/4 surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no elg 4 order antbi give", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Prophylactic parenteral antibiotics were not ordered to be given or given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required), reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc no antibi order b/4 surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8633", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pharm ther osteo rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no elg phar ther osteo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8635", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Pharmacologic therapy for osteoporosis was not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pharm ther osteo rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8645", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the asthma measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asthma measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8646", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the asthma measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asthma mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8647", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs ki scor >= 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8648", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the knee impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs ki scor < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8649", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs ki no scor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafs crs ki no scor no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8651", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs hi scor >=0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the hip impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs hi scor < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8653", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual scores for the hip impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs hi no scor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8654", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafs crs hi no scor no surv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8655", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs llfai scor >= 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8656", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs llfai scor < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8657", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs llfai no scor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8658", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs llfai no scor + surv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8659", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs lbi scor >= 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the low back impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs lbi scor < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8661", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs lbi no scor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8662", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafs crs lbi no scor no surv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8663", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs si scor >= 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8664", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs si scor < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8665", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs si no scor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8666", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafs crs si no scor no surv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8667", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs ewh scor >= 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8668", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs ewh scor < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8669", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafs crs ewh no scor no surv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8671", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs goi scor >= 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8672", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was less than zero (< 0)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs goi scor < 0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8673", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs goi no scor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8674", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation and/or near discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rafscrs neck, no msr/no foto", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8682", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Lvf testing documented as being performed prior to discharge or in the previous 12 months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvg test perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8683", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not elig for lvf test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8685", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvf test not perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8694", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Current or prior left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef <=40%", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8696", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Antithrombotic therapy prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antithromb thx presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8697", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antithromb no presc doc reas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8698", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Antithrombotic therapy was not prescribed at discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antithromb no presc no reas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rehab ordered disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rehab not indicated disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8701", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Rehabilitation services were not ordered, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rehab not ordered", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antiobiotics 4 hr prior surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8703", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antibiotics not prior surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8704", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "12-lead electrocardiogram (ecg) performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ecg performed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8705", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med reas no ecg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8706", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt reas no ecg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8707", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "12-lead electrocardiogram (ecg) not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ecg not performed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8708", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not prescribed antibiotic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antibiotic not pres", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8709", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Uri ep compete diag", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient prescribed antibiotic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt pres antibiotic", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8711", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Prescribed antibiotic on or within 3 days after the episode date", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pres antibx on/within 3 day", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8712", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Antibiotic not prescribed or dispensed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not pres antibiotic", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8713", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v])", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spkt/v great 1.2 kt/v", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8714", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Hemodialysis treatment performed exactly three times per week for > 90 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hemodialysis 3 times week", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8717", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Less 1.2 kt/v", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8718", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v])", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Great 1.7 kt/v per week", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v])", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Less 1.7 kt/v per week", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt, pn, hist grade doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8722", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med reas pt, pn, not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8723", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site is other than anatomic location of primary tumor", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spec sit not prim tumor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8724", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Pt category, pn category and histologic grade were not documented in the pathology report, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt, pn, hist grade not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lipid profile perf doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8726", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no lipid profile", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8728", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Fasting lipid profile not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lipid profile not perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Pain assessment documented as positive using a standardized tool and a follow-up plan is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pain doc pos and plan", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8731", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Pain assessment using a standardized tool is documented as negative, no follow-up plan required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pain neg no plan", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8732", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of pain assessment, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc of pain", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8733", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Elder maltreatment screen documented as positive and a follow-up plan is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pos elder mal scrn plan", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8734", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Elder maltreatment screen documented as negative, follow-up is not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc neg eld req", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8735", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eld mal scrn pos no plan", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8736", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most current ldl-c <100mg/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl-c <100mg/dl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8737", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most current ldl-c >=100mg/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl-c >=100mg/dl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8738", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef < 40%", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8739", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef >= 40%", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Left ventricular ejection fraction (lvef) not performed or assessed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef not perfrmd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8749", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No signs melanoma", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8751", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Smoking status and exposure to second hand smoke in the home not assessed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Smkg status not assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8752", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent systolic blood pressure < 140 mmhg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sys bp less 140", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8753", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent systolic blood pressure >= 140 mmhg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sys bp > or = 140", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8754", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent diastolic blood pressure < 90 mmhg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dias bp less 90", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent diastolic blood pressure >= 90 mmhg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dias bp > or = 90", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8756", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of blood pressure measurement, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No bp measure doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8757", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Copd mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8758", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ibd mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8759", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Osa mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8761", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the dementia measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dementia mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8762", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the parkinson's disease measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pd mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8763", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hyperten mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8764", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Car prev mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8765", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the cataract measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cataract mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8767", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lipid panel res doc rev", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8768", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing lipid profile (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no lipid profle", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8769", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Lipid profile not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lipid profile not perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Urine protein test result documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Urine protein test doc rev", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8771", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of diagnosis of chronic kidney disease", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc dx ckd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8772", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing urine protein test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not cllinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no urine protn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8773", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Urine protein test was not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No urine protein test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8774", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Serum creatinine test result documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Serum creatinine doc rev", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8775", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no serum crtn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8776", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Serum creatinine test not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No serum creatinine test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8777", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Diabetes screening test performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diabetes screen", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8778", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with a diagnosis of diabetes, or with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no diabete scrn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8779", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Diabetes screening test not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No diabetes screen", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Counseling for diet and physical activity performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Counsel diet phys activity", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for patient not receiving counseling for diet and physical activity (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no counsel diet", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8782", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Counseling for diet and physical activity not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No counsel diet phys act", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8783", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Normal blood pressure reading documented, follow-up not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp scrn perf rec interval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8784", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no elig for bp assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Blood pressure reading not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp scrn no perf at interval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8797", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic location of esophagus", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Specimen site not esophagus", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8798", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic location of prostate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Specimen site not prostate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Perf ultrsnd to lct preg doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8807", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No ta tv ultrasnd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8808", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Trans-abdominal or trans-vaginal ultrasound not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ultrasound not perf, rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8809", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Rh-immunoglobulin (rhogam) ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rh-immunoglobulin order", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no rh-immuno", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8811", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rh-immunoglobulin order", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8815", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no statin therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8816", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Statin medication prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Statin med pres at disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8817", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Statin therapy not prescribed at discharge, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no statin med disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8818", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient discharge to home no later than post-operative day #7", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt disch to home by day#7", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8825", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not discharged to home by post-operative day #7", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not disch to home day#7", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8826", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient discharged to home no later than post-operative day #2 following evar", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt disch home day #2 evar", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8833", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not discharged to home by post-operative day #2 following evar", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not disch home day#2 evar", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8834", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient discharged to home no later than post-operative day #2 following cea", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt disch home day #2 cea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8838", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not discharged to home by post-operative day #2 following cea", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not disch home by day #2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8839", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sleep apnea assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no sleep apnea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Sleep apnea symptoms not assessed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No sleep apnea assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8842", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ahi rdi rei doc win 2mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8843", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months after initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients previously diagnosed with osa and severity assessed by another provider, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no ahi rdi rei", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8844", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No ahi rdi rei ini dx no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8845", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Positive airway pressure therapy prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pos airway press prescribed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8846", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mod or severe osa", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8848", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mild osa", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8849", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no pos air press", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Positive airway pressure therapy not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pap prescribed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8852", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Positive airway pressure therapy was prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pos air press prescribe", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8853", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Positive airway pressure therapy not prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pos air press not prescribe", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8854", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reas no adhere therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8855", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ther not assessed annually", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8856", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Referral to a physician for an otologic evaluation performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ref for oto eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8857", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No elig ref for oto eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8858", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Referral to a physician for an otologic evaluation not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not ref for oto eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8859", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Corticosteroids 10mg 60 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8860", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Corticosteroid 10 mg 60 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8861", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dxa ordered for osteo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8862", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No corticostrd 10mg 60 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8863", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patients not assessed for risk of bone loss, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No assess bone loss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8864", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumococcal vaccine administered or previously received", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pneumococcal vaccine admin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8865", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no pneumococcal", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8866", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt reas no pneumococcal", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8867", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumococcal vaccine not administered or previously received, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pneumococcal admin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8868", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patients receiving a first course of anti-tnf therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1st course antitnf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8869", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has documented immunity to hepatitis b and initiating anti-tnf therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc immune hep b antitnf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8870", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hepb admin 1st antitnf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8871", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not receiving a first course of anti-tnf therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No 1st antitnf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8872", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intraop image confirm excise", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8873", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Specimen not intraop image", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8874", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tissue not image intraop", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8875", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Breast cancer dx min invsive", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8876", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no min inv dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8877", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No brst cncr dx min invasive", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8878", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Sentinel lymph node biopsy procedure performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sent lymph node biopsy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8879", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Node neg inv brst cncr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8880", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sen lym p node biop not perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8881", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Stage of breast cancer is greater than t1n0m0 or t2n0m0", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Brst cncr stage > t1n0m0", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8882", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Sentinel lymph node biopsy procedure not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No sent lymph node biopsy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8883", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Biopsy results reviewed, communicated, tracked and documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rev, comm, track, doc biopsy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8884", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented reason that patient's biopsy results were not reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas biopsy not review", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8885", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Biopsy results not reviewed, communicated, tracked or documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rev, comm, track biopsy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8886", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent blood pressure under control", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp under control", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8887", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas bp not control", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8888", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent blood pressure not under control, results documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp not under control", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8889", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of blood pressure measurement, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc bp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent ldl-c under control, results documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl-c under control", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8891", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for whom treatment of hypertension with standard treatment goals is not clinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no ldl-c contrl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8892", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing ldl-c test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no ldl-c test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8893", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent ldl-c not under control, results documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl-c not under control", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8894", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Ldl-c not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl-c not performed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8895", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Oral aspirin or other antithrombotic therapy prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antrom prescribe", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8896", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing oral aspirin or other antithrombotic therapy (e.g., patient documented to be low risk or patient with terminal illness or treatment of hypertension with standard treatment goals is not clinically appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly controlled)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no antihtrom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8897", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Oral aspirin or other antithrombotic therapy was not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antithrom not prescribe", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8898", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the chronic obstructive pulmonary disease (copd) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Copd measures group", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8899", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the inflammatory bowel disease (ibd) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inflammatory bowel dis mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the sleep apnea measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Obstructive sleep apnea mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the dementia measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dementia measures group", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8903", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the parkinson's disease measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Parkinson's disease mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8904", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the hypertension (htn) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hypertension mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8905", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the cardiovascular prevention measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cardiovascular prevention mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8906", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the cataract measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cataract measures group", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8907", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc no events on discharg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8908", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented to have received a burn prior to discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc w burn prior to d/c", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8909", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented not to have received a burn prior to discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc no burn prior to d/c", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8910", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented to have experienced a fall within asc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc to have fall in asc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8911", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented not to have experienced a fall within ambulatory surgical center", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc no fall in asc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8912", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc with wrong event", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8913", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc no wrong event", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8914", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt trans to hosp post d/c", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8915", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not trans to hosp at d/c", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8916", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w iv ab given on time", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8917", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w iv ab not given on time", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8918", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/o preop order iv ab pro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8923", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Current or prior left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef <= 40% or lvsd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8924", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spirometry results documented (fev1/fvc < 70%)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spir res doc fev1/fvc<70%", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8925", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spir fev1/fvc>=60% & no copd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8926", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spirometry test not performed or documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spiro no perf or doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8927", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adj chem pres ajcc iii", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8928", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adj chem not pres rsn spec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8929", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Adjuvant chemotherapy not prescribed or previously received, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adj cmo not pres rsn not gvn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Assessment of depression severity at the initial evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Assess of dep @ initial eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8931", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Assessment of depression severity not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asses of dep not documented", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8932", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Suicide risk assessed at the initial evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Suicd rsk assessed init eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8933", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Suicide risk not assessed at the initial evaluation, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Suicide risk not assessed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8934", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Current or prior left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef <=40% or dep lv sys fcn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8935", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rx ace or arb therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8936", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not eligible ace/arb", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8937", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rx ace/arb therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8938", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmi doc onl fup nt doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8939", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pain as doc positive, no f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8940", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Screening for depression documented as positive, a follow-up plan not completed, documented reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scr dep pos, no plan done", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8941", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eld maltreatment doc as pos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8942", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc fcn/care plan w/30 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8943", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Ldl-c result not present or not within 12 months prior", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldlc not pres w/i 12 mo prir", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8944", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Ajcc melanoma cancer stage 0 through iic melanoma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ajcc mel cnr stg 0 - iic", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8946", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mibm but no dx of breast ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8947", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "One or more neuropsychiatric symptoms", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1 or more neuropsych", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8948", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "No neuropsychiatric symptoms", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No neuropsych symptoms", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8949", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt reas on counsel diet", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-htn or htn doc, f/u indc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8951", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-htn/htn doc, no pt f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8952", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-htn/htn, no f/u, not gvn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8953", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the oncology measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oncology mg qual act perform", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8955", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent assessment of adequacy of volume management documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Most recent assess vol mgmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8956", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving maintenance hemodialysis in an outpatient dialysis facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rcv hedia outpt dyls fac", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8957", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not receiving maintenance hemodialysis in an outpatient dialysis facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no hedia in outpt fac", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8958", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Assessment of adequacy of volume management not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Assess vol mgmt not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8959", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician treating major depressive disorder communicates to clinician treating comorbid condition", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Clin tx mdd comm to tx clin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Clin tx mdd not comm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8961", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Csit lowrisk surg pts preop", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8962", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Csit on pt any reas 30 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8963", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Csi per asx pt w/pci 2 yrs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8964", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Csi any other than pci 2 yr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8965", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Csit perf on low chd rsk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8966", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Csit perf sx or high chd rsk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8967", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Fda approved oral anticoagulant is prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Warf or other fda drug presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8968", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med not presb", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8969", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt rsn no presc warf/fda", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "No risk factors or one moderate risk factor for thromboembolism", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rsk fac or 1 mod risk te", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8971", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Warfrn or othr antcog no rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8972", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1>=risk or>= mod risk for te", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8973", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent hemoglobin (hgb) level < 10 g/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mst rcnt hbb < 10g/dl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8974", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Hemoglobin level measurement not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hgb not doc rns not gvn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8975", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hgb <10g/dl, med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8976", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent hemoglobin (hgb) level >= 10 g/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hgb >= 10 g/dl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8977", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the oncology measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oncology measures grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8978", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mobility current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8979", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mobility goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mobility d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Body pos current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Body pos goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8983", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Body pos d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8984", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Carry current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8985", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Carry goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8986", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Carry d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8987", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Self care functional limitation, current status, at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Self care current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8988", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Self care goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8989", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Self care functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Self care d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Other pt/ot current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8991", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Other pt/ot goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8992", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Other pt/ot d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8993", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sub pt/ot current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8994", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sub pt/ot goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8995", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sub pt/ot d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8996", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Swallowing functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Swallow current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8997", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Swallow goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8998", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Swallow d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G8999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Motor speech functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Motor speech current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, initial rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, initial rate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, maintenance rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd,maintenance rate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, risk adjusted high, initial", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, risk adj hi, initial", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, risk adjusted low, initial", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, risk adj lo, initial", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, risk adjusted maintenance", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, risk adj, maintenance", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, home monitoring", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, home monitoring", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, scheduled team conference", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, sch team conf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, physician coordinated care oversight services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd,phys coor-care ovrsght", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, risk adjusted maintenance, level 3", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, risk adj, level 3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, risk adjusted maintenance, level 4", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, risk adj, level 4", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Coordinated care fee, risk adjusted maintenance, level 5", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mccd, risk adj, level 5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Other specified case management service not elsewhere classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Other specified case mgmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2004", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Esrd demo basic bundle level i", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Esrd demo bundle level i", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2004", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Esrd demo expanded bundle including venous access and related services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Esrd demo bundle-level ii", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only]", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Demo-smoking cessation coun", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Amantadine hcl 100mg oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Zanamivir,inhalation pwd 10m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Oseltamivir phosphate 75mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Rimantadine hcl 100mg oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Amantadine hcl oral brand", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Zanamivir, inh pwdr, brand", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oseltamivir phosp, brand", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rimantadine hcl, brand", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9037", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Interprofessional telephone/internet/electronic health record clinical question/request for specialty recommendations by a treating/requesting physician or other qualified health care professional for the care of the patient (i.e. not for professional education or scheduling) and may include subsequent follow up on the specialist's recommendations; 30 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intrpro req fr rec phys/qhcp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9038", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Co-management services with the following elements: new diagnosis or acute exacerbation and stabilization of existing condition; condition which may benefit from joint care planning; condition for which specialist is taking a co-management role; condition expected to last at least 3 months; comprehensive care plan established, implemented, revised or monitored in partnership with co-managing clinicians; ongoing communication and care coordination between co-managing clinicians furnishing care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Co-management services", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oncology work-up evaluation", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oncology tx decision-mgmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc surveillance for disease", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc expectant management pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc supervision palliative", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc visit unspecified nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc prac mgmt adheres guide", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc pract mgmt differs trial", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc prac mgmt disagree w/gui", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9059", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc prac mgmt pt opt alterna", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc prac mgmt dif pt comorb", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc prac cond noadd by guide", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc prac guide differs nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9063", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nsclc stgi no progres", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9064", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nsclc stg2 no progres", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nsclc stg3a no progre", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9066", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nsclc stg3b-4 metasta", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9067", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nsclc dx unknown nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9068", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx sclc/nsclc limited", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9069", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx sclc/nsclc ext at dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx sclc/nsclc ext unknwn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx brst stg1-2b hr,nopro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9072", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx brst stg1-2 noprogres", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx brst stg3-hr, no pro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9074", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx brst stg3-noprogress", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9075", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx brst metastic/ recur", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9077", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx prostate t1no progres", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9078", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx prostate t2no progres", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9079", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx prostate t3b-t4noprog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx prostate w/rise psa", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx prostate unknwn nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9084", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx colon t1-3,n1-2,no pr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9085", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx colon t4, n0 w/o prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9086", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx colon t1-4 no dx prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9087", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx colon metas evid dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9088", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx colon metas noevid dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9089", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx colon extent unknown", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9091", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx rectal t3 n0 no prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9092", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx rectal t1-3,n1-2noprg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9093", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx rectal t4,n,m0 no prg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9094", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx rectal m1 w/mets prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9095", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx rectal extent unknwn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9096", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx esophag t1-t3 noprog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9097", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx esophageal t4 no prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9098", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx esophageal mets recur", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9099", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx esophageal unknown", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx gastric no recurrence", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx gastric p r1-r2noprog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx gastric unresectable", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx gastric recurrent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx gastric unknown nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx pancreatc p r0 res no", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx pancreatc p r1/r2 no", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9107", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx pancreatic unresectab", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx pancreatic unknwn nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9109", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx head/neck t1-t2no prg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx head/neck t3-4 noprog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx head/neck m1 mets rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx head/neck ext unknown", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx ovarian stg1a-b no pr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx ovarian stg1a-b or 2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx ovarian stg3/4 noprog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9116", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx ovarian recurrence", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx ovarian unknown nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9123", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx cml chronic phase", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9124", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx cml acceler phase", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9125", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx cml blast phase", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx cml remission", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx multi myeloma stage i", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx mult myeloma stg2 hig", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx multi myeloma unknown", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx brst unknown nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx prostate mets no cast", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9133", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx prostate clinical met", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9134", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc nhlstg 1-2 no relap no", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nhl stg 3-4 not relap", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nhl trans to lg bcell", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nhl relapse/refractor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx nhl stg unknown", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Onc dx cml dx status unknown", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Frontier extended stay demo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9143", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "August 03, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Warfarin respon genetic test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9147", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 23, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 23, 2009", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Outpt iv insulin tx any mea", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "G9148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "National committee for quality assurance - level 1 medical home", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical home level 1", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9149", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "National committee for quality assurance - level 2 medical home", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical home level ii", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "National committee for quality assurance - level 3 medical home", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical home level iii", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Mapcp demonstration - state provided services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mapcp demo state", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Mapcp demonstration - community health teams", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mapcp demo community", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Mapcp demonstration - physician incentive pool", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mapcp demo physician", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Evaluation for wheelchair requiring face to face visit with physician", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Evaluation for wheelchair", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transesoph doppl cardiac mon", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9158", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Motor speech d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9159", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lang comp current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lang comp goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lang comp d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lang express current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9163", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lang express goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lang express d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Attention functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Atten current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9166", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Atten goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9167", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Attention functional limitation, discharge status at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Atten d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Memory functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Memory current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9169", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Memory goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Memory functional limitation, discharge status at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Memory d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Voice functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Voice current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Voice goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9173", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Voice functional limitation, discharge status at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Voice d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9174", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Speech lang current status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Speech lang goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9176", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Speech lang d/c status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Motor speech goal status", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9187", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Bpci home visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9188", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Beta-blocker therapy not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Beta not given no reason", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9189", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Beta-blocker therapy prescribed or currently being taken", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Beta pres or already taking", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical reason for no beta", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9191", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt reason for no beta", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9192", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "System reason for no beta", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9193", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc not eligible for dep med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9194", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mdd pt treated for 180d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9195", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mdd pt not treated for 180d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9196", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med reason for no ceph", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Order for ceph", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9198", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No order for ceph no reason", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reason for no vte", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No reason for no vte", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vte given upon admission", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a positive hepatitis c antibody test", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep c aby pos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep c rna done prior to med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No reason for no hep c rna", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient starting antiviral treatmentfor hepatitis c during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep c antiviral started", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient starting antiviral treatment for hepatitis c during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep c therapy started", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep c genotype prior to med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No reason for no hep c geno", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep c rna 4to12 wk after med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No hepc rna after med docrsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No hepc rna after med no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of dsm-iv init eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc of dsm-iv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Cd4+ cell count or cd4+ cell percentage results documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cd4 count documented", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Cd4+ cell count or percentage not documented as performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No cd4 count no reason", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pcp proph at dx no reason", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pcp proph low cd4 norsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pcp prop low at cd4 norsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No oder pjp for med reason", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No order for pjp for medrsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumocystis jiroveci pneumonia prophlaxis prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pjp proph prescribed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pjp proph ordered low cd4", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pjp proph ordered cd4 low", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medrsn no foot exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Foot exam was not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Norsn no foot exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9226", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "3 comp foot exam completed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9227", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foa doc, care plan not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9228", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gc chl syp documented", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9229", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ptrsn no gc chl syp test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Chlamydia, gonorrhea, and syphilis not screened, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Norsn for gc chl syp test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc esrd dia trans preg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9232", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ptrsn no comm comorbid", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9233", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tkr composite", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9234", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the total knee replacement measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tkr intent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the general surgery measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gs mg composite", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9236", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Op rad mg composite", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9237", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the general surgery measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gs mg intent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9238", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the optimizing patient exposure to ionizing radiation measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Op rad mg intent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn hemod & cath acc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt w cath maint dia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9241", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt w out cath maint dia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9242", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc viral load >=200", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of viral load less than 200 copies/ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc viral load <200", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Antiretroviral thereapy not prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antiviral not ordered", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Antiretroviral therapy prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antiviral ordered", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No enc or enc/vir ld 90days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 enc enc/vir ld 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not have a medical visit in the last 6 months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No med visit 6mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had a medical visit in the last 6 months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med visit w in 6mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of pain comfort 48hr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc no pain comfort 48hr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Adenoma(s) or other neoplasm detected during screening colonoscopy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neo detect scrn colo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9253", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Adenoma(s) or other neoplasm not detected during screening colonoscopy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No neo detect scrn colo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9254", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient discharged to home later than post-operative day 2 following cea or cas", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt dischg >2d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient discharged to home no later than post operative day 2 following cea or cas", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dc home 2nd po day", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9256", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient death following cas", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of pat death after cas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient stroke following cas", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of pat stroke after cas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9258", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient stroke following cea", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of pat stroke after cea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient survival and absence of stroke following cas", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Survive/no stroke post cas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient death following cea", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of pat death after cea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient survival and absence of stroke following cea", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Survive/no stroke post cea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient death in the hospital following endovascular aaa repair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of death post-aaa repair", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9263", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient discharged alive following endovascular aaa repair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of disch post-aaa repair", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9264", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn hemod w/cath >=90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc cath >90d for maint dia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Norsn pt cath >=90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9267", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient with one or more complications or mortality within 30 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc comp or mort w in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9268", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient with one or more complications within 90 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc comp or mort w in 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9269", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient without one or more complications and without mortality within 30 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc no comp or mort w in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient without one or more complications within 90 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc no comp or mort w in 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ldl value < 100", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl under 100", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ldl value >= 100", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ldl 100 and over", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9273", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Blood pressure has a systolic value of < 140 and a diastolic value of < 90", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sys<140 and dia<90", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp out of nrml limits", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that patient is a current non-tobacco user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of non tobacco user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9276", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that patient is a current tobacco user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of tobacco user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9277", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc daily aspirin or contra", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9278", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that the patient is not on daily aspirin or anti-platelet regimen", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc no daily aspirin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9279", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumococcal screening performed and documentation of vaccination received prior to discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pne scrn done doc vac done", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumococcal vaccination not administered prior to discharge, reason not specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pne not given norsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Screening performed and documentation that vaccination not indicated/patient refusal", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pne scrn done doc not ind", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9282", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc medrsn no histo type", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9283", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hist type doc on report", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9284", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No hist type doc on report", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Site not small cell lung ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9286", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Antibiotic regimen prescribed within 10 days after onset of symptoms", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antibio rx w in 10d of sympt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9287", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Antibiotic regimen not prescribed within 10 days after onset of symptoms", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No antibio w in 10d of sympt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9288", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc medrsn no hist type rpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9289", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc type nsm lung ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc type nsm lung ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9291", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not nsm lung ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9292", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medrsn no pt category", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pt category on report", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9294", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt cat and thck on report", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic cutaneous location", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non cutaneous loc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9296", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc share dec prior proc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9297", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc share dec prior proc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9298", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eval risk vte card 30d prior", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No eval risk vte card prior", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc medrsn no compl antibio", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc compl inf antibio", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Norsn incomp inf antibio", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Norsn no pros info op rpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pros info op rpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Intervention for presence of leak of endoluminal contents through an anastomosis not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No interv req for leak", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Intervention for presence of leak of endoluminal contents through an anastomosis required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interv req for leak", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9307", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No ret for surg w in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9308", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unpl ret or w/compl w/in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9309", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "No unplanned hospital readmission within 30 days of principal procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No unplnd hosp readm in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Unplanned hospital readmission within 30 days of principal procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unplnd hosp readm in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical site infection", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surgical site infection", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Amoxic not presc as 1st line", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9314", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Norsn not first line amox", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Amox w/wo clav rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc comm risk calc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9317", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc comm risk calc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9318", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Imaging study named according to standardized nomenclature", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Image std nomenclature", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9319", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Imaging study not named according to standardized nomenclature, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Image not std nomenclature", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medrsn no std nomenclature", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies documented in the 12-month period prior to the current study", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prev ct nuc med cnt doc 12mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9322", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Count of previous ct and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies not documented in the 12-month period prior to the current study, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No cnt ct nuc med doc 12mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mdrsn no doc cnt of ct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9324", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "All necessary data elements not included, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not all data norsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medrsn no ct rpt to reg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ct done no rad ds index, nrg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ct done rad ds index", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medrsn no dicom format doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Norsn no dicom format doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dicom format doc on rpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Srch for ct w in 12 mos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9343", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medrsn no dicom srch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9344", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sysrsn no dicom srch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9345", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Follow up pulm nod", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9346", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No follow up pulm nod", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9347", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No follow up pulm nod norsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9348", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn for ord ct scan", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9349", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ct within 28 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc sinus ct 28d or dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc >1 sinus ct w 90d dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9352", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not >1 sinus ct w 90d dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medrsn >1 sinus ct w 90d dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1 or no ct sinus w/in 90d dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No early ind/delivery", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9356", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Early ind/delivery", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Post-partum screenings, evaluations and education performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pp eval/edu perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Post-partum screenings, evaluations and education not performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pp eval/edu not perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9359", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neg mgd pos tb notact", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of negative or managed positive tb screen", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc of neg or man pos tb", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn elect c-sec/induct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9362", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mac or pnb w/o genanes >60m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9363", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mac or pnb w/o genanes <60m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Sinusitis caused by, or presumed to be caused by, bacterial infection", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sinus caus bac inx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9365", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "One high-risk medication ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1high risk med ord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9366", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "One high-risk medication not ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1high risk no ord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9367", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "At least two orders for high-risk medications from the same drug class", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": ">= 2 same hi-rsk med ord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9368", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "At least two orders for high-risk medications from the same drug class not ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": ">= 2 same hi-rsk med not ord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9369", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fill 2 rx antipsych", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not fill 2 rx antipsych", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9376", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Contd ret attach at 6mth f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9377", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not have the retina attached after 6 months following only one surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No ret attach after 6mt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9378", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Contd ret attach f/u vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9379", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not achieve flat retinas six months post surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No acheive flat ret 6mth", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Off assis eol iss", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9381", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no offer eol", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9382", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No off assis eol", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9383", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received screening for hcv infection within the 12 month reporting period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Recd scrn hcv infec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9384", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no hcv scrn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9385", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt reas not rec hcv srn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9386", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Screening for hcv infection not received within the 12 month reporting period, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrn hcv infec not recd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9389", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unpln rup post cap", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No unpln rup post cap", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9391", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Achv refrac +1d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not achv refrac +1d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9393", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ini phq9 >9 remiss <5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dx bipol, death, nhres, hosp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9395", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ini phq9 >9 no remiss >=5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ini phq9 >9 not assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc disc tx choices", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no disc tx opt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No disc tx choices", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received follow-up within 30 days after discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Recd f/u w/in 30d disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9403", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no 30 day f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive follow-up within 30 days after discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No 30 day f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received follow-up within 7 days after discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Recd f/u w/in 7d dc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9406", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no 7d f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9407", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive follow-up within 7 days after discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No 7d f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9408", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Card tamp w/in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9409", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No card tamp e/in 30d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Admit w/in 180d req remov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No admit w/in 180d req remov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9412", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Admit w/in 180d req surg rev", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9413", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No admit req surg rev", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9414", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b) on or between the patient's 10th and 13th birthdays", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1dose menig vac btwn 10 & 13", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9415", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b), on or between the patient's 10th and 13th birthdays", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No 1dose meni vac btwn 10&13", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9416", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 1 tdap betw 10-13 yrs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9417", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not 1 tdap betw 10-13 yrs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9418", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lungcx bx rpt docs class", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9419", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med reas not incl histo type", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spec site no lung", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9421", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lung cx bx rpt no doc class", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9422", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rpt doc class histo type", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9423", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason for not including pt category, pn category and histologic type [for patient with appropriate exclusion criteria (e.g., metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)]", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med reas rpt no histo type", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic location of lung, or classified as nsclc-nos", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Site no lung or lung cx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spec rpt no doc class histo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9426", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Impr med time edarr pain med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No impro med time pain med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Patho rpt incl pt ctg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9429", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no pt cat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Specimen site other than anatomic cutaneous location", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spec site no cutaneous", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9431", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Patho rpt no pt ctg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9432", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asth controlled", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9433", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Death, nhres, hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9434", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asth not controlled", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Aspirin prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asp presc disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9436", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asp not presc doc reas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9437", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Aspirin not prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asp not presc disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9438", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "P2y inhibitor prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "P2y inhib presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9439", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "P2y inhib not presc doc reas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9440", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "P2y inhibitor not prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "P2y inhib not presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9441", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Statin prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Statin presc disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Statin not prescribed for documented reasons (e.g., allergy, medical intolerance)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Statin not presc doc reas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9443", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Statin not prescribed at discharge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Statin not presc disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9448", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were born in the years 1945 to 1965", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Born 1945-1965", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9449", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "History of receiving blood transfusions prior to 1992", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hx bld transf b/f 1992", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "History of injection drug use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hx injec drug use", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9451", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received one-time screening for hcv infection", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1x scrn hcv infect", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no hcv test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9453", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt reas no hcv infect", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9454", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No scr hcv inf 12 mth rp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Abd imag w/us, ct or mri", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9456", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med pt reas no hcc scrn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9457", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no abd img no doc rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9458", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tob user recd cess interv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9459", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Currently a tobacco non-user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tob non-user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Tobacco assessment or tobacco cessation intervention not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No tob assess or cess inter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9463", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the sinusitis measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sinusitis intent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9464", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sinusitis comp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the acute otitis externa (aoe) measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aoe intent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9466", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the aoe measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aoe comp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9467", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills within the last twelve months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Recd cortico >=10mg/day >60d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9468", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No recd cortico>=10mg/d >60d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9469", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rec cortico>90d or 1rx 900mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rec cortico>60d 1rx 600mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9471", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "W/in 2yr dxa not order", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No dxa no med hx no rv sx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9473", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by chaplain in the hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chap services at hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9474", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by dietary counselor in the hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diet counsel at hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9475", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by other counselor in the hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Other counselor at hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9476", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by volunteer in the hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Volun service at hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9477", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by care coordinator in the hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Care coord at hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9478", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by other qualified therapist in the hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Othe therapist at hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9479", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Services performed by qualified pharmacist in the hospice setting, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pharmacist at hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Admission to medicare care choice model program (mccm)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Admission to mccm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9481", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m new pt 10mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m new pt 20mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9483", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m new pt 30mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9484", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m new pt 45mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m new pt 60mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9486", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m est. pt 10mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9487", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m est. pt 15mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9488", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m est. pt 25mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9489", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remote e/m est. pt 40mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cmmi mod home visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9496", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn no adeno/neopl detec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9497", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rec inst no smoke day surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9498", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Antibiotic regimen prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Abx reg prescribed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No start/rec antvir tx hep c", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation exposure indices documented in final report for procedure using fluoroscopy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rad expos ind/exp tm doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rad expos ind/exp tm no doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med reas no perf foot exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient taking tamsulosin hydrochloride", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt tk tams hcl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn hep b stat not asses", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Abx pres w/in 10 dys of symp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Biologic immune response modifier prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bio imm resp mod presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas on statin or contra", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that the patient is not on a statin medication", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt not on statin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adit mdd dys rem 12 mnths", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Remis12m not phq-9 score <5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Idx evt dte phq>9 doc 12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Individual had a pdc of 0.8 or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Indiv pdc > 0.8", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Individual did not have a pdc of 0.8 or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Indiv pdc not > 0.8", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient required a return to the operating room within 90 days of surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Req ret or w/in 90d of surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not require a return to the operating room within 90 days of surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No reas, no ret or w/in 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Impr vis acuit w/in 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No impr vis acuit w/in 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of active injection drug use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc active inj drug use", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9519", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Final ref +/- 1.0 w/in 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refract not +/- 1.0 w/in 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Er and ip hosp <2 in 12 mos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Er/ip hosp =/>2 in 12 mos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient discontinued from hemodialysis or peritoneal dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "D/c hemo or perit dialysis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was referred to hospice care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refer to hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt reas no hospice refer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was not referred to hospice care, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No reason, no refer hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9529", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with minor blunt head trauma had an appropriate indication(s) for a head ct", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Minor blunt trauma w/head ct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt mbht hd ct ord ec prov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9532", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hd ct ord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9533", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Indic for head ct not valid", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9534", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Advanced brain imaging (cta, ct, mra or mri) was not ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adv brain image not ordered", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a normal neurological examination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Normal neuro exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9536", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas adv brain image", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9537", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Imaging needed as part of a clinical trial; or other clinician ordered the study", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Img hd clin trial", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9538", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Advanced brain imaging (cta, ct, mra or mri) was ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adv brain image ordered", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9539", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Intent for potential removal at time of placement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intent pot remv time placemt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient alive 3 months post procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt alive 3 mos post proc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Filter removed within 3 months of placement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Filter rem 3 mon plmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documented re-assessment for the appropriateness of filter removal within 3 months of placement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reass appr remo filt 3ms", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc 2x re-assess filt remov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9544", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No filt remov w/in 3mos plcm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9547", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Cystic renal lesion that is simple appearing (bosniak i or ii) , or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced ct or washout protocol ct, or mri with in- and opposed-phase sequences or other equivalent institutional imaging protocols", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cys ren les or adren", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9548", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports for imaging studies stating no follow-up imaging is recommended", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No f/u rec image study", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9549", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn for f/u imag", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Imag rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9551", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports for imaging studies without an incidentally found lesion noted", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Imag no les", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Incidental thyroid nodule < 1.0 cm noted in report", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inc thyr node <1.0 in rpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9553", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Prior thyroid disease diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prior thyroid dise dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9554", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ct/cta/mri/a chst foll rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn for follup image", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9556", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ct/cta/mri/a no follup imag", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9557", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ct/cta/mri/a no thyr <1.0cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient treated with a beta-lactam antibiotic as definitive therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tx beta-lactam abx therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9559", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med reas no abx therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No beta-lactam abx ther, rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients prescribed opiates for longer than six weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Presc opiates >6 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had a follow-up evaluation conducted at least every three months during opioid therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foll-up eval q3mo opiod tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No f/u eval q3mo opiod tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9572", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Index date phq-score greater than 9 documented during the twelve month denominator identification period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Phq-scr >9 doc in 12m time", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9573", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adl pt md or dys rem 6 mon", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9574", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adl pt md dys no rem 6 mon", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9577", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients prescribed opiates for longer than six weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Presc opiates >6 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9578", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of signed opioid treatment agreement at least once during opioid therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc opioid tx 1x during ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9579", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of signed an opioid treatment agreement at least once during opioid therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc opioid tx 1x at ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Door to puncture time of 90 minutes or less", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Door to punc time <2hrs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9581", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Md doc, door to punc tm >2hr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9582", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Door to puncture time of greater than 90 minutes, no reason given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Door to punc time >2hr, nrg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9583", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients prescribed opiates for longer than six weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Presc opiates >6 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9584", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eval opioid use instr/pt int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9585", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No eval opi use instr/intv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9593", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Low pecarn ped head trauma", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9594", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt mbht hd ct ord ec prov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has documentation of ventricular shunt, brain tumor, or coagulopathy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc shnt/tum/coag", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Pediatric patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped pt hd ct ord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No low pecarn ped head traum", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9598", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aor ane 5.5-5.9 cm max diam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aor ane >=6.0 cm max diam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Symptomatic aaas that required urgent/emergent (non-elective) repair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Symp aaa urgent repair", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient discharge to home no later than post-operative day #7", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dchg home post op day 7", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not discharged to home by post-operative day #7", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no dchg home postop day 7", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient survey score improved from baseline following treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt surv improv bsline tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9604", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient survey results not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt surv results not avail", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient survey score did not improve from baseline following treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surv score no improv w/tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Intraoperative cystoscopy performed to evaluate for lower tract injury", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intraop cyst eval trac inj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn not perf cystosc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Intraoperative cystoscopy not performed to evaluate for lower tract injury", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intraop cyst eval not done", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of an order for anti-platelet agents", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc order anti-plat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc md rsn no antipla", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Order for anti-platelet agents was not documented in the patient's record, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc order anti-plat rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Photodocumentation of two or more cecal landmarks to establish a complete examination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Phodoc 2 mr cec lndmk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc post surg anatomy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9614", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Photodoc < 2 cec lndmk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Preoperative assessment documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-op asst doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn no preop assmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9617", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Preoperative assessment not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-op asst not doc, rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9618", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc scr uter mal or us/samp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9619", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn no scr uter malig", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No scr utr malig/us/samp rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scr unheal etoh w/counsel", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No unheal etoh user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9623", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no scr etoh use", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not scrn or no counseling", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt bl srg 30 day pst srg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no rpt bladder inj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no bl srg 30 day pst srg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt bwli srg 30 day pst srg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documented medical reasons for not reporting bowel injury (e.g., gynecologic or other pelvic malignancy documented, planned (e.g., not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no rpt bowel inj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no bwli srg 30 day srg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ui srg 30 day pst srg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn for no rpt uret inj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9633", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no ui srg 30 day pst srg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Qual life tool 2x same/impr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9635", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc rsn do qual life assm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Health-related quality of life not assessed with tool during at least two visits or quality of life score declined", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No life asst 2x same/decr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc >1 dose reduc tech", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc >1 dose reduc tech", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Amp no reqd in48h ieler proc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of planned hybrid or staged procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc plan hybrid/stage proc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Amp reqd w/in 48h ieler proc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Current smoker", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9643", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Elective surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Elective surgery", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9644", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No smok b/4 anes day of surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9645", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Had smoke b/4 anes day surg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9646", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with 90 day mrs score of 0 to 2", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/90d mrs 0-2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9647", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients in whom mrs score could not be obtained at 90 day follow-up", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No mrs score in 90d followup", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9648", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with 90 day mrs score greater than 2", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/90d mrs >2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9649", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psor as doc spc bm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt no ther chg or contra", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9651", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psor as doc no spc bm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has been treated with a systemic or biologic medication for psoriasis for at least six months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt tx sys bio med psori 6mth", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9653", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no tx sys bio rx 6 mths", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9654", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Monitored anesthesia care (mac)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mon anesth care", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9655", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Toc tool incl key elem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9656", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient transferred directly from anesthetizing location to pacu or other non-icu location", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt trans from anest to pacu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9657", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Transfer of care during an anesthetic or to the intensive care unit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Toc dur aneth to icu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9658", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Toc tool incl elem not used", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9659", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": ">=86y scr colo nomed rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn colo pt >= 86y", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9661", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt >= 86 w/ hi risk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9662", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prior dx/active clin ascvd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9663", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Any ldl-c laboratory result >= 190 mg/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fast/dir ldl >= 190 mg/dl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9664", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are currently statin therapy users or received an order (prescription) for statin therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Taking statin or rec'd order", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9665", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No statin/no order statin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9666", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fas/dir ldl 70-189mg/dl mst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9667", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no stat tx/presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9669", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the multiple chronic conditions measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intend rpt mult chr msr grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Qty act mcc mg perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9671", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the diabetic retinopathy measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intend rpt dia retin msr grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9672", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Qty act diab retin mg perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9673", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "I intend to report the cardiovascular prevention measures group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intend rpt card prev msr grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9674", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical ascvd diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/clin ascvd dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9675", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/fast/dir lab ldl-c >190", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9676", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70-189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "40-75y w/type 1/2 w/ldl-c rs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9677", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Qty act card prev mg perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9678", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oncology care model service", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9679", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute care pneumonia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute care congestive heart", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9681", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute care chronic obstruct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9682", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute care skin infection", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9683", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute fluid/electro disorder", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9684", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute care urinary tract inf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9685", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute nursing facility care", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9686", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care team", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nursing facility conference", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9687", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services provided to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9688", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients using hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9689", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient admitted for performance of elective carotid intervention", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inpt elect carotid intervent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9690", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receiving hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt in hos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9691", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hosp dur msmt period", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9692", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services received by patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp recd by pt dur msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9693", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient use of hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt use hosp during msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9694", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services utilized by patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp srv used pt in msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9695", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Long-acting inhaled bronchodilator prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Long act inhal bronchdil pre", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9696", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no presc bronchdil", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9697", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rsn no presc bronchdil", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9698", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sys rsn no presc bronchdil", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Long inhal bronchdil no pres", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt is w/hosp during msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9701", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Child anbx 30 prior dx estab", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt use hosp during msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9703", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anbx 30 prior to episode", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9704", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Ajcc breast cancer stage i: t1 mic or t1a documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ajcc br ca stg i: t1 mic/t1a", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9705", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ajcc br ca stg ib", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9706", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Low (or very low) risk of recurrence, prostate cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Low recur prost ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9707", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt had hosp dur msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9708", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bilat mast/hx bi /unilat mas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9709", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services used by patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp srv used pt in msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was provided hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt prov hosp srv msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9711", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis or past history of total colectomy or colorectal cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hx tot col or colon ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9712", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn presc anbx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9713", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt use hosp during msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9714", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is using hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt is w/hosp during msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9715", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9716", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmi doc onl fup not cmpltd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9717", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating the patient has had a diagnosis of bipolar disorder", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt dx bipol", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9718", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services for patient provided any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9719", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not ambul/immob/wc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services for patient occurred any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not ambul/immob/wc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9722", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documented history of renal failure or baseline serum creatinine >= 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc hx renal fail or cr+ >=4", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9723", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services for patient received any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp recd by pt dur msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9724", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had documentation of use of anticoagulant medications overlapping the measurement year", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/doc use anticoag mst yr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9726", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9727", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt unable cmplt lepf prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9728", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9729", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt unbl cmplt lepf prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9731", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt unbl cmplt lepf prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9732", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9733", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the low back fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt unbl cmplt lb fs prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9734", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9735", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the shoulder fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt unbl cmplt shld fs prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9736", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9737", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt unbl cmplt ewh fs prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9738", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient refused to participate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Refused to participate", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9739", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the general orthopedic fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt unbl cmplt go fs prom", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services given to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp srv to pt dur msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9741", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9742", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Psychiatric symptoms assessed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psych sympt assessed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9743", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Psychiatric symptoms not assessed, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psych symp not assessed, rns", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9744", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not eligible due to active diagnosis of hypertension", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not eli d/t act dig htn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9745", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documented reason for not screening or recommending a follow-up for high blood pressure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn no hbp scrn or f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9746", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mit sten, valve or trans af", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9747", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is undergoing palliative dialysis with a catheter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall dialysis with catheter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9748", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "App transpl lvg kidney donor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9749", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is undergoing palliative dialysis with a catheter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall dialysis with catheter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "App transpl lvg kidney donor", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9751", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient died at any time during the 24-month measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died w/in 24 mos rpt time", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9752", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Emergency surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Urgent surgery", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9753", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason for not conducting a search for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of the essence)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc no dicom, ct other fac", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9754", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "A finding of an incidental pulmonary nodule", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Incid pulm nodule", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no fllw up", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9756", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical procedures that included the use of silicone oil", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surg proc w/silicone oil", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9757", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical procedures that included the use of silicone oil", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surg proc w/silicone oil", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9758", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient in hospice at any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt in hos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9759", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "History of preoperative posterior capsule rupture", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hx preop post cap rup", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9761", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9762", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt had >= 2-3 hpv vaccines", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9763", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not have 2-3 hpv vaccines", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9764", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has been treated with a systemic medication for psoriasis vulgaris", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt treatd w/oral syst or bio", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9765", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pat declined therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9766", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cva stroke dx tx transf fac", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9767", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp new dx cva consid evst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9768", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who utilize hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9769", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bn den 2yr/got ost med/ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Peripheral nerve block (pnb)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Perip nerve block", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9771", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anes end, 1 temp >35.5(95.9)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9772", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no temp >= 35.5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9773", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1 bod temp >=35.5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9774", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have had a hysterectomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt had hyst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9775", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Recd 2 anti-emet pre/intraop", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9776", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no proph antiem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9777", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no antiemet pre/intraop", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9778", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have a diagnosis of pregnancy at any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts dx w/pregn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9779", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are breastfeeding at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts breastfeeding", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have a diagnosis of rhabdomyolysis at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts dx w/rhabdomyolysis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease [esrd], or other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn no statin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9782", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "History of or active diagnosis of familial hypercholesterolemia", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hx dx fam/pure hypercholes", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9783", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc dx dm, fast <70, no stat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9784", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Pathologists/dermatopathologists providing a second opinion on a biopsy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Path/derm prov 2nd biop opin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Path report sent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9786", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) was not sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Path report not sent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9787", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient alive as of the last day of the measurement year", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt alive", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9788", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent bp is less than or equal to 130/80 mm hg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Most rct bp /= 130/80", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9791", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent tobacco status is tobacco free", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Most rct tob stat free", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9792", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent tobacco status is not tobacco free", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Most rct tob stat not free", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9793", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is currently on a daily aspirin or other antiplatelet", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt on daily asa/antiplat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9794", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no daily aspirin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9795", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is not currently on a daily aspirin or other antiplatelet", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no daily asa/antiplat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9796", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is currently on a high intensity statin therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt currently on statin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9797", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is not on a high intensity statin therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not currently on statin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9798", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "D/c ami btw 7/1-6/30 meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9799", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med disp evt indic hx asth", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are identified as having an intolerance or allergy to beta-blocker therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt id intol/alleg beta-block", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9801", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonacut transf from inpt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9802", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9803", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt presc 135 day trmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9804", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not presc 135 day trmt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9805", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who received cervical cytology or an hpv test", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd cerv cyto/hpv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9807", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not receive cervical cytology or an hpv test", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no recd cerv cyto/hpv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9808", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Any patients who had no asthma controller medications dispensed during the measurement year", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no asthm cont med mst per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9809", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient achieved a pdc of at least 75% for their asthma controller medication", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pdc 75% w/asth cont med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9811", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not achieve a pdc of at least 75% for their asthma controller medication", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pdc 75% w/asth cont med", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9812", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient died including all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died during inpt/30d aft", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9813", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not die within 30 days of the procedure or during the index hospitalization", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not died w/in 30d of proc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9814", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Death occurring during the index acute care hospitalization", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Death during index hosp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9815", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Death did not occur during the index acute care hospitalization", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Death not during index hosp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9816", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Death occurring after discharge from the hospital but within 30 days post procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Death <30 day post discharge", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9817", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Death did not occur after discharge from the hospital within 30 days post procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No death 30-days post-disch", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9818", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of sexual activity", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc sex activity", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9819", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/hosp anytime msmt per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9820", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of a chlamydia screening test with proper follow-up", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc chlam scr test w/follow", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9821", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of a chlamydia screening test with proper follow-up", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc chlam scr ts w/follow", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9822", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Endo abl proc yr prev ind dt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9823", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Endo smpl/hyst bx res doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9824", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Endo smpl/hyst bx res no doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9825", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Her-2/neu negative or undocumented/unknown", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Her-2 neg,undoc/unkn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9826", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient transferred to practice after initiation of chemotherapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transf pract aft init chemo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9827", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Her2-targeted therapies not administered during the initial course of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Her-2 targ ther no init tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9828", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Her2-targeted therapies administered during the initial course of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Her-2 targ ther dur init tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9829", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Breast adjuvant chemotherapy administered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Breast adj chemo admin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Her-2/neu positive", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Her-2 pos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9831", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Ajcc stage at breast cancer diagnosis = ii or iii", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ajcc stg brt ca dx ii or iii", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9832", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis = t1c", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Br ca stg = 1 t stg = t1c", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9833", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient transfer to practice after initiation of chemotherapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transf pract aft init chemo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9834", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has metastatic disease at diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt met dis at dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9835", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Trastuzumab administered within 12 months of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trastuz given w/in 12 mos dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9836", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rsn no trast given doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9837", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Trastuzumab not administered within 12 months of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trastuz not in 12 mos dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9838", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has metastatic disease at diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt met dis at dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9839", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Anti-egfr monoclonal antibody therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anti-egfr mon anti ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene testing performed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene testing not performed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9842", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has metastatic disease at diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt met dis at dx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9843", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Ras (kras or nras) gene mutation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Kras or nras gene mutation", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9844", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive anti-egfr monoclonal antibody therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no recd anti-egfr ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9845", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received anti-egfr monoclonal antibody therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd anti-egfr ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9846", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died from cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died from cancer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9847", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received systemic cancer-directed therapy in the last 14 days of life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd chemo last 14d life", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9848", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive systemic cancer-directed therapy in the last 14 days of life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no chemo last 14d life", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9849", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died from cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died from cancer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had more than one emergency department visit in the last 30 days of life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1/more ed last 30d life", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9851", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had one or less emergency department visits in the last 30 days of life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1/no ed visit last 30d life", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9852", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died from cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died from cancer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9853", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient admitted to the icu in the last 30 days of life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Icu stay last 30d life", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9854", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was not admitted to the icu in the last 30 days of life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No icu stay last 30d life", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9855", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died from cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died from cancer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9856", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was not admitted to hospice", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9857", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient admitted to hospice", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt admit hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9858", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient enrolled in hospice", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt enroll hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9859", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died from cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died from cancer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9860", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient spent less than three days in hospice care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt less 3d hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9861", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Patient spent greater than or equal to three days in hospice care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt more than 3d hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9862", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn no 10 yr follow", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9868", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cmmi asyntelehealth <10min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9869", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cmmi asyntelehealth 10-20min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9870", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cmmi asyntelehealth >20min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9871", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Behavioral counseling for diabetes prevention, online, 60 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bhv couns dm prev, onln 60 m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9873", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "First medicare diabetes prevention program (mdpp) core session was attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1 em core session", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9874", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "4 em core sessions", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9875", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Nine total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "9 em core sessions", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9876", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em core ms mo 7-9 no wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9877", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em core ms mo 10-12 no wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9878", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em core ms mo 7-9 wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9879", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em core ms mo 10-12 wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9880", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Em 5 percent wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9881", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her baseline weight in months 1-24 under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Em 9 percent wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9882", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em ongoing ms mo 13-15 wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9883", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em ongoing ms mo 16-18 wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9884", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em ongoing ms mo 19-21 wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9885", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 em ongoing ms mo 22-24 wl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9886", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Behavioral counseling for diabetes prevention, in-person, group, 60 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "In-person attendance g code", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9887", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Behavioral counseling for diabetes prevention, distance learning, 60 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Distance learning attendance", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9888", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Maintenance 5% wl from baseline weight in months 7-12", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "5% wl maintnd from bsline wt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Bridge payment: a one-time payment for the first medicare diabetes prevention program (mdpp) core session, core maintenance session, or ongoing maintenance session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 of the mdpp expanded model (em) who has previously received mdpp services from a different mdpp supplier under the mdpp expanded model. a supplier may only receive one bridge payment per mdpp beneficiary", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Em bridge payment", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9891", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Mdpp session reported as a line-item on a claim for a payable mdpp expanded model (em) hcpcs code for a session furnished by the billing supplier under the mdpp expanded model and counting toward achievement of the attendance performance goal for the payable mdpp expanded model hcpcs code (this code is for reporting purposes only)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Em session reporting", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9892", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not performing a dilated macular examination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt rsn no dil mac exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9893", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Dilated macular exam was not performed, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No mac exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9894", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adr dep thrpy prescribed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9895", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no adr dep thrpy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9896", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt rsn no adr dep thrpy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9897", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt nt prsc adr dep thrpy rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9898", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9899", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrn mam perf rslts doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrn mam perf rslts not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for tobacco use and identified as a tobacco user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scrn tbco and id as user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9903", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for tobacco use and identified as a tobacco non-user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scrn tbco id as non user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9904", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no tbco scrn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9905", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not screened for tobacco use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pt tbco scrn rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9906", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recv tbco cess interv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9907", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no tbco interv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9908", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pt tbco cess interv rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9909", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no tbco interv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9910", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9911", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Node neg pre/post syst ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9912", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hbv status assesed and int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9913", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No hbv status assesd and int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9914", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient initiated an anti-tnf agent", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt initiated anti-tnf agent", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9915", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "No record of hbv results documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No documntd hbv results rcd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9916", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status performed once in the last 12 months", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Funct status past 12 months", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9917", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of advanced stage dementia and caregiver knowledge is limited", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adv dem crgvr limited", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9918", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status not performed, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No funct stat perf, rsn nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9919", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "I = Not payable by Medicare", "longDescription": "Screening performed and positive and provision of recommendations", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrn nd pos nd prov of rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "I = Not payable by Medicare", "longDescription": "Screening performed and negative", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrning perf and negative", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9921", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No or part scrn nd rng or os", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9922", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Safety concerns screen provided and if positive then documented mitigation recommendations", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sfty cncrns scrn nd mit recs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9923", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Safety concerns screen provided and negative", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Safty cncrns scrn and neg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9924", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no scrn or recs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9925", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Safety concerns screening not provided, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No scrn prov rsn nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9926", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sfty cncrns scrn but no recs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9927", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc no warf /fda pt trial", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9928", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Fda-approved anticoagulant not prescribed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No warf or fda drug presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9929", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trs/rev af", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are receiving comfort care only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Com care", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9931", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No chad or chad scr 0 or 1", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9932", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt rsn no tb scrn recrds", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9933", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Adenoma(s) or colorectal cancer detected during screening colonoscopy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Canc detectd during col scrn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9934", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn not detecting cancer", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9935", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Adenoma(s) or colorectal cancer not detected during screening colonoscopy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Canc not detectd during srcn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9936", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pmh plyp/neo co/rect/jun/ans", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9937", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Diagnostic colonoscopy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dig or surv colsco", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9938", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9939", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Pathologists/dermatopathologists is the same clinician who performed the biopsy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Same path/derm perf biopsy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9940", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc reas no statin therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9941", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre and post vas wthn 3 mos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9942", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adtl spine proc on same date", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9943", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bk pn nt msr vas scl pre/pst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9944", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vas 3 mon pre and 1 yr post", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9945", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/cancer scoliosis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9946", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bk pain no vas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9947", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre and post vas wthn 3 mos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9948", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adtl spine proc on same date", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9949", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Leg pain no vas", "typeOfServiceCode": "B = High risk screening mammography (obsolete 1/1/98)", "year": "2026" }, { "code": "G9954", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient exhibits 2 or more risk factors for post-operative vomiting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt >2 rsk fac post-op vomit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9955", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Cases in which an inhalational anesthetic is used only for induction", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inhlnt anesth only for induc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9956", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Combo thrpy of >= 2 prophly", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9957", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no combo thrpy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9958", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No combo prohpyl thrp for pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9959", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Systemic antimicrobials not prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Systemic antimicro not presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for prescribing systemic antimicrobials", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn sys antimi nt rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9961", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Systemic antimicrobials prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Systemic antimicro presc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9962", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Embolization doc separatly", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9963", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Embolization not doc separat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9964", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received at least one well-child visit with a pcp during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recv >=1 well-chld visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9965", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive at least one well-child visit with a pcp during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No well-chld vist recv by pt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9966", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrn, inter, report child", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9967", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No scrn, inter, reprt child", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9968", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was referred to another clinician or specialist during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt refrd 2 pvdr/spclst in pp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9969", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pvdr rfrd pt rprt rcvd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pvdr rfrd pt no rprt rcvd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9974", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mac exam perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9975", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing a dilated macular examination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no dil mac exam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9978", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m new pt 10mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9979", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m new pt 20mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m new pt 30 mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m new pt 45mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m new pt 60mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9983", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m est. pt 10mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9984", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m est. pt 15mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9985", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m est. pt 25mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9986", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Remote e/m est. pt 40mins", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9987", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Bpci advanced in home visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9988", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Palliative care services provided to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9989", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no pneum vax", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pneum vax admin 19+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9991", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pneum vax admin 19+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9992", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Palliative care services used by patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9993", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was provided palliative care services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9994", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is using palliative care services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9995", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use palliative care services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9996", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating the patient has received or is currently receiving palliative or hospice care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt pal or hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9997", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt preg dur msrmt pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9998", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn <3 colon", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "G9999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc sys rsn <3 colon", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "H0001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug assess", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health screening to determine eligibility for admission to treatment program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug screenin", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug screenin", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health counseling and therapy, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; group counseling by a clinician", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; case management", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; crisis intervention (outpatient)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; sub-acute detoxification (hospital inpatient)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; acute detoxification (hospital inpatient)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; acute detoxification (residential addiction program inpatient)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; acute detoxification (residential addiction program outpatient)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; ambulatory detoxification", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health; residential (hospital residential treatment program), without room and board, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug training service (for staff and personnel not employed by providers)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug training", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug intervention service (planned facilitation)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug interven", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health outreach service (planned approach to reach a targeted population)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug outreach", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health prevention information dissemination service (one-way direct or non-direct contact with service audiences to affect knowledge and attitude)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug preventi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug preventi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug prevention process service, community-based (delivery of services to develop skills of impactors)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug preventi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug prevention environmental service (broad range of external activities geared toward modifying systems in order to mainstream prevention through policy and law)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug preventi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug prevention problem identification and referral service (e.g., student assistance and employee assistance programs), does not include assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug preventi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other drug use e.g., alcohol free social events)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug preventi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health hotline service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol and/or drug hotline", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mental health assessment, by non-physician", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mh health assess by non-md", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mental health service plan development by non-physician", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mh svc plan dev by non-md", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oral medication administration, direct observation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oral med adm direct observe", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medication training and support, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med trng & support per 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mental health partial hospitalization, treatment, less than 24 hours", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mh partial hosp tx under 24h", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Community psychiatric supportive treatment, face-to-face, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comm psy face-face per 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Community psychiatric supportive treatment program, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comm psy sup tx pgm per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Self-help/peer services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Self-help/peer svc per 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Assertive community treatment, face-to-face, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asser com tx face-face/15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Assertive community treatment program, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Assert comm tx pgm per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Foster care, child, non-therapeutic, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fos c chld non-ther per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Foster care, child, non-therapeutic, per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fos c chld non-ther per mon", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supported housing, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supported housing, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supported housing, per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supported housing, per month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Respite care services, not in the home, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Respite not-in-home per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mental health services, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mental health service, nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or other drug abuse services, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol/drug abuse svc nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or other drug testing: collection and handling only, specimens other than blood", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spec coll non-blood:a/d test", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol/drug screening", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug services, brief intervention, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol/drug service 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "I = Not payable by Medicare", "longDescription": "Traditional healing service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Traditional healing service", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "I = Not payable by Medicare", "longDescription": "Missing and murdered indigenous persons (mmip) mental health and clinical care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mmip mental health and care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H0053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "I = Not payable by Medicare", "longDescription": "Historical trauma (ht) mental health and clinical care for indigenous persons", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht mental health and care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prenatal care, at-risk assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prenatal care atrisk assessm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prenatal care, at-risk enhanced service; antepartum management", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antepartum management", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prenatal care, at risk enhanced service; care coordination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Carecoordination prenatal", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prenatal care, at-risk enhanced service; education", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prenatal at risk education", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prenatal care, at-risk enhanced service; follow-up home visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Follow up home visit/prental", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prenatal care, at-risk enhanced service package (includes h1001-h1004)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prenatalcare enhanced srv pk", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-medical family planning education, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonmed family planning ed", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H1011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Family assessment by licensed behavioral health professional for state defined purposes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Family assessment", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive multidisciplinary evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comp multidisipln evaluation", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Rehabilitation program, per 1/2 day", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rehabilitation program 1/2 d", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive medication services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comprehensive med svc 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Crisis intervention service, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Crisis interven svc, 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health day treatment, per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Behav hlth day treat, per hr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Psychiatric health facility service, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psych hlth fac svc, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Skills training and development, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Skills train and dev, 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive community support services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comp comm supp svc, 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive community support services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comp comm supp svc, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Psychosocial rehabilitation services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psysoc rehab svc, per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Psychosocial rehabilitation services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psysoc rehab svc, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Therapeutic behavioral services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ther behav svc, per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Therapeutic behavioral services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ther behav svc, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Community-based wrap-around services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Com wrap-around sv, 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Community-based wrap-around services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Com wrap-around sv, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supported employment, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supported employ, per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supported employment, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supported employ, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ongoing support to maintain employment, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supp maint employ, 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ongoing support to maintain employment, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supp maint employ, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Psychoeducational service, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psychoed svc, per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sexual offender treatment service, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sex offend tx svc, 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sexual offender treatment service, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sex offend tx svc, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mental health clubhouse services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mh clubhouse svc, per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mental health clubhouse services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mh clubhouse svc, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Activity therapy, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Activity therapy, per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Multisystemic therapy for juveniles, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Multisys ther/juvenile 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or drug abuse halfway house services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "A/d halfway house, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or other drug treatment program, per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "A/d tx program, per hour", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or other drug treatment program, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "A/d tx program, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Developmental delay prevention activities, dependent child of client, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dev delay prev dp ch, 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Skills training and development, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Skill train and dev/diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "I = Not payable by Medicare", "longDescription": "Coordinated specialty care, team-based, for first episode psychosis, per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Coord specialty care, month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "H2041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "I = Not payable by Medicare", "longDescription": "Coordinated specialty care, team-based, for first episode psychosis, per encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Coord special care encounter", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J0013", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "I = Not payable by Medicare", "longDescription": "Esketamine, nasal spray, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Esketamine, nasal spray", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tetracycline, up to 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tetracyclin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, omadacycline, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., omadacycline, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eravacycline, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., eravacycline, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Abatacept injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection abciximab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Abciximab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, acetaminophen, not otherwise specified,10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, acetaminophen (nos)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, acetylcysteine, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Acetylcysteine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0133", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, acyclovir, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Acyclovir injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0134", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj acetaminophen -fresenius", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab, 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Adalimumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, acetaminophen (b braun)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, acetaminophen (hikma)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, acetaminophen 10 mg and ibuprofen 3 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj acetaminoph 10mg/ibu 3mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, adalimumab, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection adenosine 6 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj adenosine diag 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Adenosine inj 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0162", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj epinephrine (fresenius)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0163", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine in sodium chloride (endo), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Epinephrine in nacl (endo)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0164", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine in sodium chloride (baxter), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Epinephrine in nacl (baxter)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0165", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine, not otherwise specified, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj epinephrine nos 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0166", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj epinephrine (bpi)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0167", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj epinephrine (hospira)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0168", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Epinephrine (intl med sys)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0169", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj epinephrine (adrenalin)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0171", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, adrenalin, epinephrine, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Adrenalin epinephrine inject", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0172", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aducanumab-avwa, 2 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj, aducanumab-avwa, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0173", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, epinephrine (belcher)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0174", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 06, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Lecanemab-irmb, for intravenous injection, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lecanemab-irmb, for iv inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 02, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 02, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, donanemab-azbt, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, donanemab-azbt, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aflibercept hd, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aflibercept hd, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0178", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aflibercept, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aflibercept injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0179", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, brolucizumab-dbll, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, brolucizumab-dbll, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, agalsidase beta, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Agalsidase beta injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0184", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, amisulpride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, amisulpride, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aprepitant, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., aprepitant, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0190", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, biperiden lactate, per 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj biperiden lactate/5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0200", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, alatrofloxacin mesylate, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alatrofloxacin mesylate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, alemtuzumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, alemtuzumab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0205", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, alglucerase, per 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alglucerase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, allopurinol sodium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj allopurinol sodium 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amifostine, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amifostine", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sodium thiosulfate (pedmark), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pedmark, 100 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0209", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sodium thiosulfate (hope), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, sod thiosulfate (hope)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methyldopate hcl, up to 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methyldopate hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (nithiodote)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nithiodote, 3mg / 125mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0215", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, alefacept, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alefacept", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J0216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, alfentanil hydrochloride, 500 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, alfentanil hcl, 500mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, velmanase alfa-tycv, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj velmanase alfa-tycv 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, olipudase alfa-rpcp, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj olipudase alfa-rpcp 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, avalglucosidase alfa-ngpt, 4 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj aval alfa-nqpt 4mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, alglucosidase alfa, 10 mg, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alglucosidase alfa injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, alglucosidase alfa, (lumizyme), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lumizyme injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, patisiran, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., patisiran, 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, givosiran, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj givosiran 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lumasiran, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. lumasiran, 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, vutrisiran, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vutrisiran, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0248", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 23, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, remdesivir, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, remdesivir, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0256", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alpha 1 proteinase inhibitor", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Glassia injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, alprostadil, 1.25 mcg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alprostadil for injection", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Alprostadil urethral suppository (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alprostadil urethral suppos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0278", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, amikacin sulfate, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amikacin sulfate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aminophyllin, up to 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aminophyllin 250 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aminocaproic acid, 1 gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj aminocaproic acid 1 gram", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0282", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amiodarone hydrochloride, 30 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amiodarone hcl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0283", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amiodarone hydrochloride (nexterone), 30 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, amiodarone (nexterone)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amphotericin b, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amphotericin b", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0287", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amphotericin b lipid complex, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amphotericin b lipid complex", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0288", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amphotericin b cholesteryl sulfate complex, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ampho b cholesteryl sulfate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0289", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amphotericin b liposome, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amphotericin b liposome inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ampicillin sodium, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ampicillin 500 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0291", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, plazomicin, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., plazomicin, 5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ampicillin sulbactam 1.5 gm", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amobarbital, up to 125 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amobarbital 125 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, succinylcholine chloride, up to 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Succinycholine chloride inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0348", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, anidulafungin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Anidulafungin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0349", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, rezafungin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, rezafungin, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0350", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, anistreplase, per 30 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection anistreplase 30 u", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydralazine hcl, up to 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydralazine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, apomorphine hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Apomorphine hydrochloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0365", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aprotonin, 10,000 kiu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aprotonin, 10,000 kiu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0380", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, metaraminol bitartrate, per 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj metaraminol bitartrate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chloroquine hydrochloride, up to 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chloroquine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0391", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, artesunate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, artesunate, 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0395", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, arbutamine hcl, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Arbutamine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aripiprazole, intramuscular, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aripiprazole injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aripiprazole (abilify maintena), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, abilify maintena, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aripiprazole (abilify asimtufii), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, abilify asimtufii, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0456", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, azithromycin, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Azithromycin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0457", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aztreonam, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, aztreonam, 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0458", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aztreonam/avibactam 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0461", "actionCode": "T = Miscellaneous change (BETOS, type of service)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, atropine sulfate, 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Atropine sulfate injection", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0462", "actionCode": "T = Miscellaneous change (BETOS, type of service)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Atropine sulf, nte, 0.01 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0463", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, atropine sulfate (fresenius and therapeutically equivalent), 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj atropine (fresenius te)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dimercaprol, per 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dimecaprol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0475", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, baclofen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Baclofen 10 mg injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0476", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, baclofen, 50 mcg for intrathecal trial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Baclofen intrathecal trial", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, basiliximab, 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Basiliximab", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J0485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, belatacept, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Belatacept injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, belimumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Belimumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0491", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, anifrolumab-fnia, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj anifrolumab-fnia 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dicyclomine hcl, up to 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dicyclomine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, benztropine mesylate, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj benztropine mesylate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, benralizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., benralizumab, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bethanechol chloride inject", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0525", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cefotetan disodium, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cefotetan disodium 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, penicillin g benzathine and penicillin g procaine, 100,000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Peng benzathine/procaine inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, penicillin g benzathine, 100,000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Penicillin g benzathine inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bezlotoxumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bezlotoxumab, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0567", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cerliponase alfa, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., cerliponase alfa 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0570", "actionCode": "R = Re-activate discontinued / deleted procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Buprenorphine implant, 74.2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Buprenorphine implant 74.2mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0571", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Buprenorphine, oral, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Buprenorphine oral 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0572", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bupren/nal up to 3mg bupreno", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0573", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bupren/nal 3.1 to 6mg bupren", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0574", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bupren/nal 6.1 to 10mg bupre", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bupren/nal over 10mg bupreno", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0576", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, buprenorphine extended-release (brixadi), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj buprenorph (brixadi) 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0577", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, brixadi, 7 days or less", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0578", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, buprenorphine extended release (brixadi), greater than 7 days and up to 28 days of therapy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj brixadi, more than 7 day", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0582", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bivalirudin (endo), not therapeutically equivalent to j0583, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bivalirudin (endo) 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0583", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bivalirudin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bivalirudin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0584", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, burosumab-twza 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, burosumab-twza 1m", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0585", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, onabotulinumtoxina, 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection,onabotulinumtoxina", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0586", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, abobotulinumtoxina, 5 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Abobotulinumtoxina", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0587", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rimabotulinumtoxinb, 100 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, rimabotulinumtoxinb", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0588", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, incobotulinumtoxin a, 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Incobotulinumtoxin a", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0589", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, daxibotulinumtoxina-lanm, 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj daxibotulinumtoxina-lanm", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0591", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, deoxycholic acid, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj deoxycholic acid, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0592", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, buprenorphine hydrochloride, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Buprenorphine hydrochloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0593", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., lanadelumab-flyo, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0594", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "injection, busulfan, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Busulfan injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, butorphanol tartrate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Butorphanol tartrate 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, ruconest", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, c-1 esterase inhibitor (human), berinert, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "C-1 esterase, berinert", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0598", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, c-1 esterase inhibitor (human), cinryze, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "C-1 esterase, cinryze", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, c-1 esterase inhibitor (human), (haegarda), 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., haegarda 10 units", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, edetate calcium disodium, up to 1000 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Edetate calcium disodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Sevelamer carbonate 20 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Sevelamer carbonate pdr 20mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Sevelamer hydrochloride 20mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cinacalcet, oral, 1 mg, (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cinacalcet, esrd on dialysis", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Sucroferric oxyhydroxide 5mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, etelcalcetide, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, etelcalcetide, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Lanthanum carbonate, oral, 5 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Lanthanum carbonate oral 5mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Lanthanum carbonate pwdr 5mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Ferric citrate orl 3 mg iron", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, calcium gluconate (fresenius kabi), per 10 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Calcium glucon (fresenius)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, calcium gluconate (wg critical care), per 10 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Calcium glucon (wg critical)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, calcium gluconate, not otherwise specified, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, calcium gluconate, nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Calcium glucon (wg critical)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0614", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, treosulfan, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, treosulfan, 50 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Calcium acetate, oral, 23 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Calcium acetate, oral, 23 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0616", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, metoprolol tartrate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj metoprolol tartrate 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0618", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, calcium chloride, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, calcium chloride, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, calcium glycerophosphate and calcium lactate, per 10 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Calcium glycer & lact/10 ml", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, calcitonin salmon, up to 400 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Calcitonin salmon injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, calcitriol, 0.1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj calcitriol per 0.1 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, caspofungin acetate, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Caspofungin acetate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, canakinumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Canakinumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, leucovorin calcium, per 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Leucovorin calcium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, levoleucovorin, not otherwise specified, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj levoleucovorin nos 0.5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, levoleucovorin (khapzory), 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, khapzory, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, levothyroxine sodium, not otherwise specified, 10 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, levothyroxine nos 10mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0651", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, levothyroxine sodium (fresenius kabi), not therapeutically equivalent to j0650, 10 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, levothyroxine, freskabi", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, levothyroxine sodium (hikma), not therapeutically equivalent to j0650, 10 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, levothyroxine, hikma", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0654", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, liothyronine, 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, liothyronine, 1 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0665", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bupivicaine, not otherwise specified, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bupivacaine, nos, 0.5mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0666", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bupivacaine liposome, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bupivacaine liposome", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0668", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Instill, bupivac and meloxic", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mepivacaine hydrochloride, per 10 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj mepivacaine hcl/10 ml", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0675", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, carboprost tromethamine, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, carboprost, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0681", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ceftobiprole medocaril sodium, 3 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ceftobipole medocarl 3mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0687", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cefazolin sodium (wg critical care), not therapeutically equivalent to j0690, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cefazolin (wg crit care)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0688", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cefazolin sodium, hikma", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0689", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cefazolin sodium, baxter", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0690", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cefazolin sodium, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cefazolin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0691", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lefamulin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj lefamulin 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0692", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cefepime hydrochloride, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cefepime hcl for injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0693", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cefiderocol, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., cefiderocol, 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0694", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q0090", "longDescription": "Injection, cefoxitin sodium, 1 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cefoxitin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0695", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ceftolozane 50 mg and tazobactam 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ceftolozane tazobactam", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0696", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ceftriaxone sodium, per 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ceftriaxone sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0697", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sterile cefuroxime sodium, per 750 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sterile cefuroxime injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0698", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cefotaxime sodium, per gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cefotaxime sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cefiderocol, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cefiderocol, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0701", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. cefepime hcl (baxter)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Betamethasone acet&sod phosp", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0703", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cefepime hcl (b braun)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0706", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, caffeine citrate, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Caffeine citrate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0710", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cephapirin sodium, up to 1 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cephapirin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0712", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ceftaroline fosamil, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ceftaroline fosamil inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0713", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ceftazidime, per 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ceftazidime per 500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0714", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ceftazidime and avibactam, 0.5 g/0.125 g", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ceftazidime and avibactam", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0715", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ceftizoxime sodium, per 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ceftizoxime sodium / 500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0716", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, centruroides immune f(ab)2, up to 120 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Centruroides immune f(ab)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0717", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Certolizumab pegol inj 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0720", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chloramphenicol sodium succinate, up to 1 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chloramphenicol sodium injec", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chorionic gonadotropin, per 1,000 usp units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chorionic gonadotropin/1000u", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0735", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, clonidine hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Clonidine hydrochloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0736", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, clindamycin phosphate, 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, clindamycin phosp 300mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0737", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, clindamycin (baxter)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0738", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Hiv prep, inj, lenacapavir", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0739", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 02, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Hiv prep, inj, cabotegravir", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cidofovir, 375 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cidofovir injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0741", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cabotegravir and rilpivirine, 2mg/3mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cabote rilpivir 2mg 3mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0742", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj imip 4 cilas 4 releb 2mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0743", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cilastatin sodium; imipenem, per 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cilastatin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0744", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ciprofloxacin for intravenous infusion, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ciprofloxacin iv", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0745", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, codeine phosphate, per 30 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj codeine phosphate /30 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Hiv prep, ftc/tdf 200/300mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0751", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Hiv prep, ftc/taf 200/25mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0752", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Hiv prep, oral lenacapavir", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0759", "actionCode": "S = Change in short description of procedure code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, clevidipine butyrate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, clevidipine, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, colchicine, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Colchicine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, colistimethate sodium, up to 150 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Colistimethate sodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0775", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, collagenase, clostridium histolyticum, 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Collagenase, clost hist inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, prochlorperazine, up to 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Prochlorperazine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0791", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, crizanlizumab-tmca, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj crizanlizumab-tmca 5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0795", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, corticorelin ovine triflutate, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Corticorelin ovine triflutal", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0799", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 02, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Hiv prep, fda approved, noc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, corticotropin, up to 40 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Corticotropin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0801", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, corticotropin (acthar gel), up to 40 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. acthar gel to 40 units", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0802", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, corticotropin (ani), up to 40 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. (ani), up to 40 units", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0833", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cosyntropin, not otherwise specified, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cosyntropin injection nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0834", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cosyntropin, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., cosyntropin, 0.25 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Crotalidae poly immune fab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, crotalidae immune f(ab')2 (equine), 120 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj crotalidae im f(ab')2 eq", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cytomegalovirus immune globulin intravenous (human), per vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cytomegalovirus imm iv /vial", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0870", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, imetelstat, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, imetelstat, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0872", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Daptomycin (xellia) unrefrig", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0873", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj daptomycin (xellia)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0874", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, daptomycin (baxter)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0875", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, dalbavancin, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, dalbavancin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0877", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, daptomycin (hospira)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0878", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, daptomycin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Daptomycin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0879", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Difelikefalin, esrd on dialy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0881", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, darbepoetin alfa, 1 microgram (non-esrd use)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Darbepoetin alfa, non-esrd", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0882", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Darbepoetin alfa, esrd use", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0883", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, argatroban, 1 mg (for non-esrd use)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Argatroban nonesrd use 1mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J0884", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, argatroban, 1 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Argatroban esrd dialysis 1mg", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0885", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoetin alfa, (for non-esrd use), 1000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Epoetin alfa, non-esrd", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J0886", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoetin alfa, 1000 units (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Epoetin alfa 1000 units esrd", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0887", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoetin beta, 1 microgram, (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Epoetin beta esrd use", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0888", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoetin beta, 1 microgram, (for non esrd use)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Epoetin beta non esrd", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J0889", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Daprodustat, oral, 1 mg, (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Daprodustat oral 1mg esrd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, peginesatide, 0.1 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Peginesatide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0891", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Argatroban nonesrd (accord)", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J0892", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Argatroban dialysis (accord)", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0893", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, decitabine (sun pharma)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0894", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, decitabine, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Decitabine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0895", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q0087", "longDescription": "Injection, deferoxamine mesylate, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Deferoxamine mesylate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0896", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, luspatercept-aamt, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj luspatercept-aamt 0.25mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J0897", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denosumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Denosumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0898", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Argatroban nonesrd (auromed)", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J0899", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Argatroban dialysis, auromed", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone enanthate and estradiol valerate, up to 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone enanthate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J0901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Vadadustat, oral, 1 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vadadustat oral 1mg for esrd", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0911", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Instillation, taurolidine 1.35 mg and heparin sodium 100 units (central venous catheter lock for adult patients receiving chronic hemodialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inst tauro 1.35mg/hep 100u", "typeOfServiceCode": "L = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J0945", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, brompheniramine maleate, per 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Brompheniramine maleate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, depo-estradiol cypionate, up to 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Depo-estradiol cypionate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylprednisolone acetate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, methylpred acetate 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylprednisolone acetate, 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylprednisolone 20 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylprednisolone acetate, 40 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylprednisolone 40 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylprednisolone acetate, 80 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylprednisolone 80 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, medroxyprogesterone acetate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Medroxyprogesterone acetate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone cypionate and estradiol cypionate, up to 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone cypionate 1 ml", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone cypionate, up to 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone cypionat 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone cypionate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj testosterone cypionate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1072", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone cypionate (azmiro), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, testosterone, azmiro", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1073", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Testosterone pellet, implant, 75 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone pellet 75 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone cypionate, 1 cc, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone cypionat 200 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1094", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dexamethasone acetate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj dexamethasone acetate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1095", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dexamethasone 9 percent, intraocular, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, dexamethasone 9%", "typeOfServiceCode": "9 = Other medical items or services\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "J1096", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Dexamethasone, lacrimal ophthalmic insert, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dexametha opth insert 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1097", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Phenylep ketorolac opth soln", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1098", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Articaine ophthalmic, 8% solution, 0.4 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Articaine ophthalmi 8% 0.4ml", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dexamethasone sodium phosphate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dexamethasone sodium phos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dexmedetomidine, oral, 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dexmedetomidine film, 1 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dihydroergotamine mesylate, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj dihydroergotamine mesylt", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, acetazolamide sodium, up to 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Acetazolamid sodium injectio", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, diclofenac sodium, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj diclofenac sodium 0.5mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, digoxin, up to 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Digoxin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, digoxin immune fab (ovine), per vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Digoxin immune fab (ovine)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1163", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, diltiazem hydrochloride, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, diltiazem hcl, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1164", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj diltiazem in 0.72% nacl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, phenytoin sodium, per 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Phenytoin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydromorphone, up to 4 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydromorphone injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydromorphone, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, hydromorphone, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dyphylline, up to 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dyphylline injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dexrazoxane hydrochloride, per 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dexrazoxane hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, diphenhydramine hcl, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Diphenhydramine hcl injectio", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cetirizine hydrochloride, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. cetirizine hcl 0.5mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "I = Not payable by Medicare", "longDescription": "Miglustat, oral, 65 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Miglustat oral 65 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cipaglucosidase alfa-atga, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cipaglucosidase, 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chlorothiazide sodium, per 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chlorothiazide sodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dmso, dimethyl sulfoxide, 50%, 50 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dimethyl sulfoxide 50% 50 ml", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methadone hcl, up to 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methadone injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dimenhydrinate, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dimenhydrinate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dipyridamole, per 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dipyridamole injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dobutamine hydrochloride, per 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj dobutamine hcl/250 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dolasetron mesylate, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dolasetron mesylate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, dopamine hcl, 40 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dopamine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1267", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, doripenem, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Doripenem injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, doxercalciferol, 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, doxercalciferol", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, doxycycline hyclate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj doxycycline hyclate 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ecallantide, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ecallantide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eculizumab, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, eculizumab, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eculizumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Eculizumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, edaravone, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, edaravone, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sutimlimab-jome, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, sutimlimab-jome, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ravulizumab-cwvz, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., ravulizumab-cwvz 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tofersen, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj tofersen intrathec 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, evinacumab-dgnb, 5mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, evinacumab-dgnb, 5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, inclisiran, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, inclisiran, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1307", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, crovalimab-akkz, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, crovalimab-akkz, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1308", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, famotidine, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, famotidine, 0.25 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, amitriptyline hcl, up to 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Amitriptyline injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1322", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, elosulfase alfa, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Elosulfase alfa, injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, elranatamab-bcmm, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, elranatamab-bcmm, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1324", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, enfuvirtide, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Enfuvirtide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoprostenol, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Epoprostenol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1326", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, zolbetuximab-clzb, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, zolbetuximab-clzb, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, eptifibatide, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Eptifibatide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1330", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ergonovine maleate, up to 0.2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ergonovine maleate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1335", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ertapenem sodium, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ertapenem injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, erythromycin lactobionate, per 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Erythro lactobionate /500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1370", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, esomeprazole sodium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, esomeprazole sod, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, estradiol valerate, up to 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Estradiol valerate 10 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, estrogen conjugated, per 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj estrogen conjugate 25 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, etranacogene dezaparvovec-drlb, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, hemgenix, per tx dose", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1412", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj roctavian ml 2x10^13vc g", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1413", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj delandistrogene mox rokl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1414", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, beqvez, per tx dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1426", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, casimersen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, casimersen, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, viltolarsen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. viltolarsen", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eteplirsen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, eteplirsen, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1429", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, golodirsen, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj golodirsen 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ethanolamine oleate, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ethanolamine oleate 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1434", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fosaprepitant (focinvez), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, focinvez, 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, estrone, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection estrone per 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1436", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, etidronate disodium, per 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Etidronate disodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1437", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferric derisomaltose, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. fe derisomaltose 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1438", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Etanercept injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1439", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferric carboxymaltose, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ferric carboxymaltos 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1440", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Fecal microbiota, live - jslm, 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fecal microbiota jslm 1 ml", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj filgrastim excl biosimil", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1443", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferric pyrophosphate citrate solution (triferic), 0.1 mg of iron", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ferric pyrophosphate cit", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J1444", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fe pyro cit pow 0.1 mg iron", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J1445", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj triferic avnu 0.1mg iron", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1446", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tbo-filgrastim, 5 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tbo-filgrastim, 5 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1447", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tbo-filgrastim, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj tbo filgrastim 1 microg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1448", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trilaciclib, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, trilaciclib, 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1449", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eflapegrastim-xnst, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj eflapegrastim-xnst 0.1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection fluconazole, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fluconazole", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1451", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fomepizole, 15 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fomepizole, 15 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1452", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fomivirsen sodium, intraocular, 1.65 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Intraocular fomivirsen na", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1453", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fosaprepitant, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fosaprepitant injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1454", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fosnetupitant 235 mg and palonosetron 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj fosnetupitant, palonoset", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, foscarnet sodium, per 1000 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Foscarnet sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1456", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, fosaprepitant (teva)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1457", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gallium nitrate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gallium nitrate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1458", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, galsulfase, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Galsulfase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1459", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ivig privigen 500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, gamma globulin, intramuscular, 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gamma globulin 1 cc inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1551", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (cutaquig), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cutaquig 100 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (alyglo), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, alyglo, 500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1553", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (yimmugo), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj yimmugo 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1554", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (asceniv), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. asceniv", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1555", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (cuvitru), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cuvitru, 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1556", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (bivigam), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, imm glob bivigam, 500mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1557", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gammaplex injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (xembify), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. xembify, 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1559", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (hizentra), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hizentra injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, gamma globulin, intramuscular, over 10 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gamma globulin > 10 cc inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gamunex-c/gammaked", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1562", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin (vivaglobin), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vivaglobin, inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1566", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Immune globulin, powder", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1568", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Octagam injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1569", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gammagard liquid injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ganciclovir sodium, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ganciclovir sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1571", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hepagam b im injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1572", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Flebogamma injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1573", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hepagam b intravenous, inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1574", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, ganciclovir (exela)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1575", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hyqvia 100mg immuneglobulin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1576", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, panzyga, 500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, garamycin, gentamicin, up to 80 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Garamycin gentamicin inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gatifloxacin, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gatifloxacin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, glatiramer acetate, 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection glatiramer acetate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, glycopyrrolate, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, glycopyrrolate, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, glycopyrrolate (glyrx-pf), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj glycopyrrolate, glyrx-pf", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1598", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj glycopyrrolate fres kabi", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ivig non-lyophilized, nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, gold sodium thiomalate, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gold sodium thiomaleate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, golimumab, 1 mg, for intravenous use", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Golimumab for iv use 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, glucagon hydrochloride, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Glucagon hydrochloride/1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj glucagon hcl, fresenius", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1612", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, glucagon (gvoke), 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj glucagon (gvoke) 0.01 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1620", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, gonadorelin hydrochloride, per 100 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gonadorelin hydroch/ 100 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, granisetron hydrochloride, 100 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Granisetron hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, granisetron, extended-release, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, granisetron, xr, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, guselkumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., guselkumab, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, haloperidol, up to 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Haloperidol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, haloperidol decanoate, per 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Haloperidol decanoate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, brexanolone, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., brexanolone, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hemin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hemin, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, heparin sodium, (heparin lock flush), per 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj heparin sodium per 10 u", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1643", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj heparin, pfizer, 1000u", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "J1644", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, heparin sodium, per 1000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj heparin sodium per 1000u", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95) P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1645", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dalteparin sodium, per 2500 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dalteparin sodium", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, enoxaparin sodium, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj enoxaparin sodium", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fondaparinux sodium, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fondaparinux sodium", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1655", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tinzaparin sodium, 1000 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tinzaparin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tetanus immune globulin, human, up to 250 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tetanus immune globulin inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1675", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, histrelin acetate, 10 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Histrelin acetate", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J1700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydrocortisone acetate, up to 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydrocortisone acetate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1710", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydrocortisone sodium phosphate, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydrocortisone sodium ph inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydrocortisone sodium succinate, up to 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydrocortisone sodium succ i", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, hydroxyprogesterone caproate, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hydroxyprogesterone caproate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1726", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, hydroxyprogesterone caproate, (makena), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Makena, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1729", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj hydroxyprogst capoat nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, diazoxide, up to 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Diazoxide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1736", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, meloxicam (delova), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj meloxicam (delova) 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1737", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, meloxicam (azurity), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj meloxicam (azurity) 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1738", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, meloxicam, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. meloxicam 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ibandronate sodium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ibandronate sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1741", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ibuprofen, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ibuprofen injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1742", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ibutilide fumarate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ibutilide fumarate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1743", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, idursulfase, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Idursulfase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1744", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, icatibant, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Icatibant injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1745", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, infliximab, excludes biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Infliximab not biosimil 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1746", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ibalizumab-uiyk, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., ibalizumab-uiyk, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1747", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, spesolimab-sbzo, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, spesolimab-sbzo, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1748", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, infliximab-dyyb (zymfentra), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, zymfentra, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1749", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, iloprost, 0.1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, iloprost, 0.1 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 31, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, iron dextran, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj iron dextran", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1756", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, iron sucrose, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Iron sucrose injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1786", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, imiglucerase, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Imuglucerase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1790", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, droperidol, up to 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Droperidol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, propranolol hcl, up to 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Propranolol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1805", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, esmolol hydrochloride, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, esmolol hcl, 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj esmolol hcl wg crit care", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1807", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ethacrynate sodium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, ethacrynate sod, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1808", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, folic acid, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, folic acid, 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1809", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fosdenopterin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, fosdenopterin, 0.1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, droperidol and fentanyl citrate, up to 2 ml ampule", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Droperidol/fentanyl inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1811", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fiasp for insulin pump use", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1812", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insulin (fiasp), per 5 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. insulin (fiasp)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1813", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lyumjev for insulin pump use", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1814", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Insulin (lyumjev), per 5 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. insulin (lyumjev)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1815", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, insulin, per 5 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Insulin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1817", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Insulin for administration through dme (i.e., insulin pump) per 50 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Insulin for insulin pump use", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1823", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, inebilizumab-cdon, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. inebilizumab-cdon, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1826", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, interferon beta-1a, 30 mcg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interferon beta-1a inj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, interferon beta-1b, 0.25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Interferon beta-1b / .25 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1833", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, isavuconazonium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, isavuconazonium", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1834", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, isoniazid, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, isoniazid, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1835", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, itraconazole, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Itraconazole injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1836", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, metronidazole, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, metronidazole, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1837", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, posaconazole, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, posaconazole, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, kanamycin sulfate, up to 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Kanamycin sulfate 500 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, kanamycin sulfate, up to 75 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Kanamycin sulfate 75 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1885", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ketorolac tromethamine, per 15 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ketorolac tromethamine inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cephalothin sodium, up to 1 gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cephalothin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, labetalol hydrochloride, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, labetalol hcl, 5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1921", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj labetalol hcl hikma, 5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lanreotide, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lanreotide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1931", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, laronidase, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Laronidase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1932", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lanreotide, (cipla), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, lanreotide, (cipla) 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1938", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, furosemide, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, furosemide, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1939", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bumetanide, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bumetanide, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1940", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, furosemide, up to 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Furosemide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1941", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, furosemide (furoscix), 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, furoscix, 20 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1942", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aripiprazole lauroxil, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aripiprazole lauroxil 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1943", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aripiprazole lauroxil, (aristada initio), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., aristada initio, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1944", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aripiprazole lauroxil, (aristada), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aripiprazole lauroxil 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1945", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lepirudin, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lepirudin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, leuprolide acetate (for depot suspension), per 3.75 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Leuprolide acetate /3.75 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1951", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj fensolvi 0.25 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1952", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Leuprolide injectable, camcevi, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Leuprolide inj, camcevi, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1953", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, levetiracetam, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Levetiracetam injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1954", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj leu acet lutr dpt 7.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J1955", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, levocarnitine, per 1 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj levocarnitine per 1 gm", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1956", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, levofloxacin, 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Levofloxacin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, levorphanol tartrate, up to 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Levorphanol tartrate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1961", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "June 18, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lenacapavir (only for use as hiv treatment), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj lenacapavir (hiv tx) 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hyoscyamine sulfate, up to 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hyoscyamine sulfate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J1990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chlordiazepoxide hcl, up to 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chlordiazepoxide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lidocaine hcl for intravenous infusion, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lidocaine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lidocaine hcl in 5% dextrose, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, lidocaine in d5w, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lidocaine hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, lidocaine hcl, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lidocaine hcl with epinephrine, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, lidocaine w epinephrine", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lincomycin hcl, up to 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lincomycin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, linezolid, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Linezolid injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, linezolid (hospira)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, lorazepam, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lorazepam injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Loxapine for inhalation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Loxapine for inhalation 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2150", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mannitol, 25% in 50 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mannitol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2151", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mannitol, 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, mannitol, 250 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, mecasermin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mecasermin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, meperidine hydrochloride, per 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Meperidine hydrochl /100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, meperidine and promethazine hcl, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Meperidine/promethazine inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, mepolizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, mepolizumab, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2183", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, meropenem (wg critical care), not therapeutically equivalent to j2185, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj meropenem (wg crit care)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2184", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, meropenem (b. braun), not therapeutically equivalent to j2185, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, meropenem (b. braun)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, meropenem, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Meropenem", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, meropenem and vaborbactam, 10mg/10mg (20mg)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., meropenem, vaborbactam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylergonovine maleate, up to 0.2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylergonovin maleate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, methylnaltrexone, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylnaltrexone injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, micafungin in sodium (baxter), not therapeutically equivalent to j2248, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, micafungin (baxter)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, micafungin (par pharm)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, micafungin sodium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Micafungin sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, remimazolam, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, remimazolam, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, midazolam hydrochloride, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj midazolam hydrochloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj midazolam in 0.9% nacl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, midazolam in 0.8% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj midazolam in 0.8% nacl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2253", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, midazolam (seizalam), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj midazolam (seizalam)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, milrinone lactate, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj milrinone lactate / 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, minocycline hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Minocycline hydrochloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2267", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, mirikizumab-mrkz, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, mirikizumab-mrkz, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, morphine sulfate, up to 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Morphine sulfate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, morphine sulfate, 100mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Morphine so4 injection 100mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, morphine (fresenius)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj morphine pf epid ithc", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, morphine sulfate (preservative-free sterile solution), per 10 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Morphine sulfate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2277", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, motixafortide, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, motixafortide, 0.25 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2278", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ziconotide, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ziconotide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, moxifloxacin, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, moxifloxacin 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj moxifloxacin (fres kabi)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nafcillin sodium, 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nafcillin sodium, 20 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2291", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nafcillin sodium (baxter), 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nafcillin (baxter) 20mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nalbuphine hydrochloride, per 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj nalbuphine hydrochloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, nitroglycerin, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nitroglycerin, 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2310", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, naloxone hydrochloride, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj naloxone hydrochloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2311", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, naloxone hydrochloride (zimhi), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, naloxone hcl (zimhi)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2312", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj naloxone hcl nos, 0.01mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2313", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, naloxone hydrochloride (zimhi), 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, naloxone (zimhi) 0.01mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, naltrexone, depot form, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Naltrexone, depot form", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nandrolone decanoate, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Nandrolone decanoate 50 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, natalizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Natalizumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nesiritide, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Nesiritide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, nusinersen, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nusinersen, 0.1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, risankizumab-rzaa, intravenous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj risankizumab-rzaa 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ublituximab-xiiy, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ublituximab-xiiy, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ocrelizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, ocrelizumab, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ocrelizumab 1mg hya-ocsq", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, octreotide, depot form for intramuscular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Octreotide injection, depot", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Octreotide inj, non-depot", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, oprelvekin, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oprelvekin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2356", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tezepelumab-ekko, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj tezepelumab-ekko, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, omalizumab, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Omalizumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, olanzapine, long-acting, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Olanzapine long-acting inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2359", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, olanzapine, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. olanzapine, 0.5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, orphenadrine citrate, up to 60 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Orphenadrine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, phenylephrine hcl, up to 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Phenylephrine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2371", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, phenylephrine hydrochloride, 20 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj phenylephrine hcl 20 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, phenylephrine hydrochloride (biorphen), 20 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, biorphen, 20 micrograms", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2373", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, phenylephrine hydrochloride (immphentiv), 20 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, immphentiv, 20 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chloroprocaine hydrochloride, per 30 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chloroprocaine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chloroprocaine hydrochloride, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chloroprocaine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chloroprocaine (clorotekal)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2403", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Chloroprocaine hcl ophthalmic, 3% gel, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chloroprocaine opht gel, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nicardipine, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nicardipine 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ondansetron hydrochloride, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ondansetron hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2406", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, oritavancin (kimyrsa), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, oritavancin 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2407", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, oritavancin (orbactiv), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, oritavancin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, oxymorphone hcl, up to 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oxymorphone hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, palifermin, 50 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Palifermin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2426", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, paliperidone palmitate extended release (invega sustenna), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, invega sustenna, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, invega hafyera/trinza", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, paliperidone palmitate extended release (erzofri), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, erzofri, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pamidronate disodium, per 30 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pamidronate disodium /30 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2440", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, papaverine hcl, up to 60 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Papaverin hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, oxytetracycline hcl, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oxytetracycline injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2468", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, palonosetron hydrochloride (posfrea), 25 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, palonosetron (posfrea)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2469", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, palonosetron hcl, 25 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Palonosetron hcl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pantoprazole sodium, 40 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pantoprazole sodium 40mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2471", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pantoprazole (hikma), not therapeutically equivalent to j2470, 40 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pantoprazole(hikma) 40mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pantoprazole sodium in sodium chloride (baxter), 40 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pantoprazole sodium chl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, paricalcitol, 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Paricalcitol", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pasireotide long acting, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pasireotide long acting", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2503", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegaptanib sodium, 0.3 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pegaptanib sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2504", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pegademase bovine, 25 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pegademase bovine, 25 iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim, 6 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Injection, pegfilgrastim 6mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim, excludes biosimilar, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pegfilgrast ex bio 0.5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegloticase, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pegloticase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegunigalsidase alfa-iwxj, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pegunigalsidase alfa-iwxj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, penicillin g procaine, aqueous, up to 600,000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Penicillin g procaine inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2513", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pentastarch, 10% solution, 100 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pentastarch 10% solution", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2515", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pentobarbital sodium, per 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pentobarbital sodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2516", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pentamidine isethionate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pentamidine isethionate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, penicillin g potassium, up to 600,000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Penicillin g potassium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Piperacillin/tazobactam", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pentamidine non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2547", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, peramivir, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, peramivir", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, promethazine hcl, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Promethazine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, phenobarbital sodium, up to 120 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Phenobarbital sodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, phenobarbital sodium (sezaby), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, sezaby, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, plerixafor, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Plerixafor injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, oxytocin, up to 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oxytocin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2596", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vasopressin (long grove) 1 u", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, desmopressin acetate, per 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj desmopressin acetate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2598", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, vasopressin, 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vasopressin, 1 unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj vasopressin (am reg) 1 u", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, vasopressin (baxter), 1 unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vasopressin (baxter)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, prednisolone acetate, up to 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Prednisolone acetate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tolazoline hcl, up to 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Totazoline hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2675", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, progesterone, per 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj progesterone per 50 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2679", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fluphenazine hcl, 1.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj fluphenazine hcl 1.25 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fluphenazine decanoate, up to 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fluphenazine decanoate 25 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2690", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, procainamide hcl, up to 1 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Procainamide hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, oxacillin sodium, up to 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oxacillin sodium injeciton", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2704", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, propofol, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, propofol, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, neostigmine methylsulfate, up to 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Neostigmine methylslfte inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2711", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, neostigmine methylsulfate 0.1 mg and glycopyrrolate 0.02 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj neostigmin/glycopyrrolat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, protamine sulfate, per 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj protamine sulfate/10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2724", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, protein c concentrate, intravenous, human, 10 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Protein c concentrate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2725", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, protirelin, per 250 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj protirelin per 250 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pralidoxime chloride, up to 1 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pralidoxime chloride inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, phentolamine mesylate, up to 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Phentolaine mesylate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2765", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, metoclopramide hcl, up to 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Metoclopramide hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, quinupristin/dalfopristin, 500 mg (150/350)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Quinupristin/dalfopristin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2777", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, faricimab-svoa, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, faricimab-svoa, 0.1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2778", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ranibizumab, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ranibizumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2779", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, susvimo 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ranitidine hydrochloride, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ranitidine hydrochloride inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegcetacoplan, intravitreal, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pegcetacoplan, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2782", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, avacincaptad pegol, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj avacincaptad pegol 0.1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2783", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, rasburicase, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rasburicase", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, regadenoson, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Regadenoson injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2786", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, reslizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, reslizumab, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2787", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Riboflavin 5'phos opth<=3ml", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2788", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rho d immune globulin 50 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2790", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rho d immune globulin inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2791", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rhophylac injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2792", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rho(d) immune globulin h, sd", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2793", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rilonacept, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rilonacept injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2794", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, risperidone (risperdal consta), 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj risperdal consta, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2795", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ropivacaine hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ropivacaine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2796", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, romiplostim, 10 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Romiplostim injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2797", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rolapitant, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., rolapitant, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2798", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, risperidone, (perseris), 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., perseris, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2799", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, risperidone (uzedy), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, uzedy, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methocarbamol, up to 10 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methocarbamol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2801", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, risperidone (rykindo), 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, rykindo, 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2802", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, romiplostim, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, romiplostim 1 microgram", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2804", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rifampin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, rifampin, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2805", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sincalide, 5 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sincalide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj sincalide, maia, 5 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, theophylline, per 40 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj theophylline per 40 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2820", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sargramostim (gm-csf), 50 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sargramostim injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sebelipase alfa, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj sebelipase alfa 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J2850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, secretin, synthetic, human, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj secretin synthetic human", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2860", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, siltuximab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, siltuximab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2865", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj sulfameth/trim 5 mg/1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2910", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aurothioglucose, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aurothioglucose injeciton", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2916", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Na ferric gluconate complex", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2919", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylprednisolone sodium succinate, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, methylpred sod succ 5mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J2920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylprednisolone sodium succinate, up to 40 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylprednisolone injection", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J2930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methylprednisolone sodium succinate, up to 125 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylprednisolone injection", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J2940", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, somatrem, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Somatrem injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2941", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, somatropin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Somatropin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, promazine hcl, up to 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Promazine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2993", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, reteplase, 18.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Reteplase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2995", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, streptokinase, per 250,000 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj streptokinase /250000 iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2997", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, alteplase recombinant, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Alteplase recombinant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J2998", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, plasminogen, human-tvmh, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj plasminogen tvmh 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, streptomycin, up to 1 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Streptomycin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fentanyl citrate, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fentanyl citrate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sumatriptan succinate / 6 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fremanezumab-vfrm, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., fremanezumab-vfrm 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eptinezumab-jjmr, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. eptinezumab-jjmr 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, talquetamab-tgvs, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj talquetamab-tgvs 0.25 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, taliglucerase alfa, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, taliglucerase alfa 10 u", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pentazocine, 30 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pentazocine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tedizolid phosphate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj tedizolid phosphate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3095", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, telavancin, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Telavancin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tenecteplase, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tenecteplase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, terbutaline sulfate, up to 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Terbutaline sulfate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, teriparatide, 10 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Teriparatide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, romosozumab-aqqg, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. romosozumab-aqqg 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone enanthate, up to 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone enanthate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone enanthate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj testostero enanthate 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone enanthate, up to 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone enanthate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone suspension, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone suspension inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone undecanoate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosterone undecanoate 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, testosterone propionate, up to 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Testosteron propionate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, chlorpromazine hcl, up to 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chlorpromazine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Thyrotropin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3241", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, teprotumumab-trbw, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. teprotumumab-trbw 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tigecycline, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tigecycline injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tigecycline (accord), not therapeutically equivalent to j3243, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. tigecycline (accord)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tildrakizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., tildrakizumab, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tirofiban hcl, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tirofiban hcl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, secukinumab, intravenous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj secukinumab intrav 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, trimethobenzamide hcl, up to 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Trimethobenzamide hcl inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, tobramycin sulfate, up to 80 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tobramycin sulfate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tocilizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tocilizumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3263", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, toripalimab-tpzi, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, toripalimab-tpzi, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, torsemide, 10 mg/ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection torsemide 10 mg/ml", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3280", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, thiethylperazine maleate, up to 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Thiethylperazine maleate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, treprostinil, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Treprostinil injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3290", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, tranexamic acid, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj, tranexamic acid 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3291", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, tranexamic acid in sodium chloride, 5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tranexamic acid in sod chlor", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, triamcinolone acetonide (xipere), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj xipere 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triamcinolone acetonide, preservative free, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triamcinolone a inj prs-free", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triamcinolone acetonide, not otherwise specified, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triamcinolone acet inj nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triamcinolone diacetate, per 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triamcinolone diacetate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triamcinolone hexacetonide, per 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triamcinolone hexacetonl inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj triamcinolone ace xr 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3305", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, trimetrexate glucuronate, per 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj trimetrexate glucoronate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3310", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, perphenazine, up to 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Perphenazine injeciton", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triptorelin pamoate, 3.75 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triptorelin pamoate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triptorelin, extended-release, 3.75 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., triptorelin xr 3.75 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3320", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, spectinomycin dihydrochloride, up to 2 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Spectinomycn di-hcl inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, urea, up to 40 gm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Urea injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3355", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, urofollitropin, 75 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Urofollitropin, 75 iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Ustekinumab, for subcutaneous injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ustekinumab sub cu inj, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "Q9989", "longDescription": "Ustekinumab, for intravenous injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ustekinumab, iv inject, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, diazepam, up to 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Diazepam injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3364", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, urokinase, 5000 iu vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Urokinase 5000 iu injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3365", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q0089", "longDescription": "Injection, iv, urokinase, 250,000 i.u. vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Urokinase 250,000 iu inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3370", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vancomycin hcl, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vancomycin hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3371", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vancomycin hcl (mylan)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3372", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vancomycin hcl (xellia), not therapeutically equivalent to j3370, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vancomycin hcl (xellia)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3373", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vancomycin hydrochloride, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vancomycin hcl, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3374", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vancomycin (mylan) 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3375", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to j3373, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj vancomycin (xellia) 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3376", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj vancomycin (hikma) 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3379", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, valproate sodium, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, valproate sod, 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vedolizumab, intravenous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj vedolizumab iv 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3385", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, velaglucerase alfa, 100 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Velaglucerase alfa", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3387", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, elivaldogene autotemcel, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj elivaldogene autotemecel", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3389", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Topical administration, prademagene zamikeracel, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Topi adm prad zami per treat", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3391", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, atidarsagene autotemcel, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, atidarsagene autotemcel", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, exagamglogene autotemcel, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, exagamglogene autotem", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3393", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, betibeglogene autotemcel, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, betibeglogene autotemce", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lovotibeglogene autotemcel, per treatment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, lovotibeglogene autotem", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, verteporfin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Verteporfin injection", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J3397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, vestronidase alfa-vjbk, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., vestronidase alfa-vjbk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, voretigene neparvovec-rzyl, 1 billion vector genomes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj luxturna 1 billion vec g", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj onase abepar-xioi treat", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3400", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, triflupromazine hcl, up to 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triflupromazine hcl inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vyjuvek 5x10^9pfu/ml, 0.1 ml", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3402", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, remestemcel-l-rknd, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. remestemcel-l-rknd/ td", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3403", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Revakinagene taroretcel-lwey, per implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Revakinagene, per implant", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3404", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, zopapogene imadenovec-drba suspension, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj zopapogene per ther dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydroxyzine hcl, up to 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydroxyzine hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, thiamine hcl, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Thiamine hcl 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3415", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pyridoxine hcl, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pyridoxine hcl 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vitamin b12 injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, hydroxocobalamin, intravenous, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj hydroxocobalamin iv 25mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J3425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hydroxocobalamin, intramuscular, 10 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydroxocobalamin im 10mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, phytonadione (vitamin k), per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vitamin k phytonadione inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, voriconazole, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, voriconazole", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hyaluronidase, up to 150 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hyaluronidase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3471", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ovine, up to 999 usp units", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hyaluronidase, ovine, preservative free, per 1000 usp units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ovine, 1000 usp units", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3473", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, hyaluronidase, recombinant, 1 usp unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hyaluronidase recombinant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3475", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, magnesium sulfate, per 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj magnesium sulfate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, potassium chloride, per 2 meq", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj potassium chloride", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3485", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, zidovudine, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Zidovudine", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3486", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ziprasidone mesylate, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ziprasidone mesylate", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3489", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, zoledronic acid, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Zoledronic acid 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Unclassified drugs", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Drugs unclassified injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Edetate disodium, per 150 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Edetate disodium per 150 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Nasal vaccine inhalation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Nasal vaccine inhalation", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Drug administered through a metered dose inhaler", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Metered dose inhaler drug", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Laetrile, amygdalin, vitamin b17", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Laetrile amygdalin vit b17", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Unclassified biologics", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Unclassified biologics", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J3591", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Unclassified drug or biological used for esrd on dialysis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Esrd on dialysi drug/bio noc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion, normal saline solution , 1000 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Normal saline solution infus", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion, normal saline solution, sterile (500 ml = 1 unit)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Normal saline solution infus", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "5% dextrose/normal saline (500 ml = 1 unit)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "5% dextrose/normal saline", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion, normal saline solution, 250 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Normal saline solution infus", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "5% dextrose/water (500 ml = 1 unit)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "5% dextrose/water", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion, d5w, 1000 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "D5w infusion", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion, dextran 40, 500 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dextran 40 infusion", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion, dextran 75, 500 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dextran 75 infusion", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ringers lactate infusion, up to 1000 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ringers lactate infusion", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "5% dextrose in lactated ringers infusion, up to 1000 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "5% dextrose in lac ringers", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hypertonic saline solution, 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hypertonic saline sol", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, human-lans, per i.u", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Prothrombin complex kcentra", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7169", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj andexxa, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, emicizumab-kxwh, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., emicizumab-kxwh 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adamts13, recombinant-krhn, 10 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, adzynma, 10 iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7172", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, marstacimab-hncq, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj marstacim-hncq, 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7173", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, concizumab-mtci, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. concizumab-mtci, 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7174", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fitusiran, 0.04 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection fitusiran 0.04 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor x, (human), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, factor x, (human), 1iu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, human fibrinogen concentrate (fibryga), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., fibryga, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7178", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, human fibrinogen concentrate, not otherwise specified, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj human fibrinogen con nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7179", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vonvendi inj 1 iu vwf:rco", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor xiii (antihemophilic factor, human), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor xiii anti-hem factor", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor xiii a-subunit, (recombinant), per iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor xiii recomb a-subunit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii recomb novoeight", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7183", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Wilate injection", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Xyntha inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Antihemophilic viii/vwf comp", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7187", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, von willebrand factor complex (humate-p), per iu vwf:rco", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Humate-p, inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7188", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii recomb obizur", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7189", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viia recomb novoseven", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Factor viii (antihemophilic factor, human) per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7191", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Factor viii (antihemophilic factor (porcine)), per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii (porcine)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7192", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii recombinant nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7193", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Factor ix (antihemophilic factor, purified, non-recombinant) per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor ix non-recombinant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7194", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Factor ix, complex, per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor ix complex", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7195", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor ix recombinant nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7196", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, antithrombin recombinant, 50 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Antithrombin recombinant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Antithrombin iii (human), per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Antithrombin iii injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7198", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Anti-inhibitor, per i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Anti-inhibitor", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hemophilia clotting factor, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hemophilia clot factor noc", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor ix recombinan rixubis", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor ix alprolix recomb", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor ix idelvion inj", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor ix recomb gly rebinyn", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj recombin esperoct per iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor viii fc fusion protein (recombinant), per iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii fc fusion recomb", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii pegylated recomb", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. jivi 1 iu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii nuwiq recomb 1iu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, afstyla, 1 i.u.", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, kovaltry, 1 i.u.", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viia recomb sevenfact", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, ixinity, 1 i.u.", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u.", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Altuviiio per factor viii iu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7294", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Seg acet and eth estr yearly", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eth estr and eton monthly", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7296", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "S = Non-covered by Medicare statute", "crossReferenceCode": "Q9984", "longDescription": "Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Kyleena, 19.5 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7297", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Liletta, 52 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7298", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mirena, 52 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7299", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Intrauterine copper contraceptive (miudella)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intraut copp cont (miudella)", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7300", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Intrauterine copper contraceptive (paragard)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intra copp contra (paragard)", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Skyla, 13.5 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Levonorgestrel-releasing intrauterine contraceptive system, 52 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Levonorgestrel iu 52 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Contraceptive supply, hormone containing vaginal ring, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Contraceptive vaginal ring", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Contraceptive supply, hormone containing patch, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Contraceptive hormone patch", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Levonorgestrel (contraceptive) implant system, including implants and supplies", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Levonorgestrel implant sys", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7307", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "I = Not payable by Medicare", "longDescription": "Etonogestrel (contraceptive) implant system, including implant and supplies", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Etonogestrel implant system", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7308", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aminolevulinic acid hcl top", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7309", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methyl aminolevulinate, top", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7310", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ganciclovir, 4.5 mg, long-acting implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ganciclovir long act implant", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7311", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., retisert, 0.01 mg", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "J7312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, dexamethasone, intravitreal implant, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dexamethasone intra implant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., iluvien, 0.01 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7314", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., yutiq, 0.01 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Mitomycin, ophthalmic, 0.2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ophthalmic mitomycin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ocriplasmin, 0.125 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, ocriplasmin, 0.125 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7318", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, durolane 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Genvisc 850, inj, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hyalgan supartz visco-3 dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7322", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hyaluronan, hymo or hymo one", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Euflexxa inj per dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7324", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Orthovisc inj per dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Synvisc or synvisc-one", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, gel-one, for intra-articular injection, per dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gel-one", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, monovisc, for intra-articular injection, per dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Monovisc inj per dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gelsyn-3 injection 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, trivisc 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Autologous cultured chondrocytes, implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Cultured chondrocytes implnt", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7331", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Synojoynt, inj., 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7332", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., triluron, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7333", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, visco-3, for intra-articular injection, per dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Visco-3 inj dose", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7335", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Capsaicin 8% patch, per 10 square centimeters", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Capsaicin 8% patch", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7336", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Capsaicin 8% patch, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Capsaicin 8% patch", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J7340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Carbidopa levodopa ent 100ml", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Instillation, ciprofloxacin otic suspension, 6 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ciprofloxacin otic susp 6 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7345", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aminolevulinic acid, 10% gel", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bimatoprost, intracameral implant, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj bimatoprost itc imp1mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7352", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Afamelanotide implant, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Afamelanotide implant, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Anacaulase-bcdb, 8.8% gel, 1 gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Anacaulase-bcdb 8.8% gel 1 g", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cantharidin top, applicator", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, travoprost, intracameral implant, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj travoprost intra impl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7356", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj foscarb/foslevodopa 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Mometasone furoate sinus implant, 10 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mometasone furoate sinus imp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Mometasone furoate sinus implant, (sinuva), 10 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mometasone sinus sinuva", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Azathioprine, oral, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Azathioprine oral 50mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Azathioprine, parenteral, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Azathioprine parenteral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cyclosporine, oral, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Cyclosporine oral 100 mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tacrol envarsus ex rel oral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lymphocyte immune globulin", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7505", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Muromonab-cd3, parenteral, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Monoclonal antibodies", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prednisone, oral, per 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Prednisone oral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tacrolimus, immediate release, oral, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tacrolimus imme rel oral 1mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tacrol astagraf ex rel oral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Methylprednisolone oral, per 4 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methylprednisolone oral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prednisolone oral, per 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Prednisolone oral per 5 mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Antithymocyte globuln rabbit", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prednisone, immediate release or delayed release, oral, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Prednisone ir or dr oral 1mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7513", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Daclizumab, parenteral, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Daclizumab, parenteral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Mycophenolate mofetil (myhibbin), oral suspension, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mycophenol (myhibbin) 100 mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Cyclosporine, oral, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cyclosporine oral 25 mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cyclosporine, 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cyclosporine 250mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Mycophenolate mofetil, oral, 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mycophenolate mofetil oral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mycophenolic acid, oral, 180 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mycophenolic acid", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7519", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, mycophenolate mofetil, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. mycophenolate mofetil", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sirolimus, oral, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sirolimus, oral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tacrolimus, granules, oral suspension, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tacrolim granules oral susp", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tacrolimus, parenteral, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tacrolimus injection", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7527", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Everolimus, oral, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral everolimus", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7528", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Mycophenolate mofetil, for suspension, oral, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mycophen mofetil for susp", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Immunosuppressive drug, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Immunosuppressive drug noc", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J7601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ensifentrine inh 3 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Acetylcysteine comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Arformoterol non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Formoterol fumarate, inh", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Levalbuterol, inhalation solution, compounded product, administered through dme, concentrated form, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Levalbuterol comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Acetylcysteine non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Albuterol comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Albuterol comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Albuterol non-comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Levalbuterol non-comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Albuterol non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7614", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Levalbuterol non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Levalbuterol, inhalation solution, compounded product, administered through dme, unit dose, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Levalbuterol comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Albuterol ipratrop non-comp", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Beclomethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Beclomethasone comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Betamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Betamethasone comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Budesonide non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Budesonide comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bitolterol mesylate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bitolterol mesylate comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bitolterol mesylate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bitolterol mesylate comp unt", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cromolyn sodium noncomp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Cromolyn sodium, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cromolyn sodium comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7633", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 0.25 milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Budesonide non-comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Budesonide, inhalation solution, compounded product, administered through dme, concentrated form, per 0.25 milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Budesonide comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7635", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Atropine, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Atropine comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Atropine, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Atropine comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dexamethasone comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dexamethasone comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dornase alfa non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Formoterol, inhalation solution, compounded product, administered through dme, unit dose form, 12 micrograms", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Formoterol comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Flunisolide, inhalation solution, compounded product, administered through dme, unit dose, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Flunisolide comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Glycopyrrolate comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7643", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Glycopyrrolate comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7644", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ipratropium bromide non-comp", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7645", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Ipratropium bromide, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ipratropium bromide comp", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7647", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Isoetharine hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoetharine comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7648", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoetharine non-comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7649", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoetharine non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Isoetharine hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoetharine comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7657", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Isoproterenol hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoproterenol comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7658", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoproterenol non-comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7659", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoproterenol non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Isoproterenol hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Isoproterenol comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7665", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Mannitol, administered through an inhaler, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mannitol for inhaler", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J7667", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Metaproterenol sulfate, inhalation solution, compounded product, concentrated form, per 10 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Metaproterenol comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7668", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 10 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Metaproterenol non-comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7669", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Metaproterenol non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Metaproterenol sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Metaproterenol comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7674", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methacholine chloride, neb", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7676", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pentamidine comp unit dose", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7677", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Revefenacin inh non-com 1mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Terbutaline sulfate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Terbutaline sulf comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7681", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Terbutaline sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Terbutaline sulf comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7682", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tobramycin non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7683", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Triamcinolone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triamcinolone comp con", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7684", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Triamcinolone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Triamcinolone comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7685", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tobramycin comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7686", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Treprostinil, non-comp unit", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Noc drugs, inhalation solution administered through dme", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inhalation solution for dme", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7799", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Noc drugs, other than inhalation drugs, administered through dme", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Non-inhalation drug for dme", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J7999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compounded drug, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Compounded drug, noc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8498", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Antiemetic drug, rectal/suppository, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Antiemetic rectal/supp nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Prescription drug, oral, non chemotherapeutic, nos", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oral prescrip drug non chemo", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Aprepitant, oral, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral aprepitant", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8502", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aprepitant (aponvie), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aponvie, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Busulfan; oral, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral busulfan", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Cabergoline, oral, 0.25 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cabergoline, oral 0.25mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Capecitabine, oral, 150 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Capecitabine, oral, 150 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Capecitabine, oral, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Capecitabine, oral, 500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Capecitabine, oral, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Capecitabine, oral, 50 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "August 31, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cyclophosphamide; oral, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cyclophosphamide oral 25 mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dexamethasone, oral, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral dexamethasone", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Dexamethasone (hemady), oral, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral, hemady, 0.25 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Etoposide; oral, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Etoposide oral 50 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8562", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Fludarabine phosphate, oral, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral fludarabine phosphate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J8565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Gefitinib, oral, 250 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gefitinib oral", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "J8597", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Antiemetic drug, oral, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Antiemetic drug oral nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Melphalan; oral, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Melphalan oral 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "August 31, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Methotrexate; oral, 2.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methotrexate oral 2.5 mg", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Methotrexate (jylamvo), oral, 2.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral methotrexate (jylamvo)", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Methotrexate (xatmep), oral, 2.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral methotrexate (xatmep)", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8650", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Nabilone, oral, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Nabilone oral", "typeOfServiceCode": "1 = Medical care\n\nG = Immunosuppressive drugs", "year": "2026" }, { "code": "J8655", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Netupitant 300 mg and palonosetron 0.5 mg, oral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral netupitant, palonosetro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Rolapitant, oral, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rolapitant, oral, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J8700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Temozolomide, oral, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Temozolomide", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8705", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Topotecan, oral, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Topotecan oral", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J8999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prescription drug, oral, chemotherapeutic, nos", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oral prescription drug chemo", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, doxorubicin hydrochloride, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Doxorubicin hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9003", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Leuprolide injectable (camcevi etm), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Leupro inj, camcevi etm, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "J0202", "longDescription": "Injection, alemtuzumab, 10 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alemtuzumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9011", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, datopotamab deruxtecan-dlnk, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Datopotamab deruxtecan, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, aldesleukin, per single use vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Aldesleukin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, arsenic trioxide, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Arsenic trioxide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9019", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, asparaginase (erwinaze), 1,000 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Erwinaze injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9020", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, asparaginase, not otherwise specified, 10,000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Asparaginase, nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, asparaginase, recombinant, (rylaze), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aspara, rylaze, 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, atezolizumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, atezolizumab,10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, avelumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, avelumab, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, atezolizumab, 5 mg and hyaluronidase-tqjs", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj atezolizumb 5mg hya-tqjs", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, azacitidine, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Azacitidine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tarlatamab-dlle, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tarlatamab-dlle, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, clofarabine, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Clofarabine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nogapendekin pmln, 1mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Instill adstiladrin, tx dose", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9030", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bcg live intravesical instillation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bcg live intravesical 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Bcg (intravesical) per instillation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bcg live intravesical vac", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, belinostat, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, belinostat, 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bendamustine hydrochloride, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bendamustine hcl, 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bendamustine hcl (bendeka), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., bendeka 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bevacizumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bevacizumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. belrapzo/bendamustine", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, belantamab mafodotin-blmf, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj belantamab mafodot blmf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9038", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, axatilimab-csfr, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj axatilimab-csfr 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, blinatumomab, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, blinatumomab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bleomycin sulfate, 15 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bleomycin sulfate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bortezomib, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, bortezomib, 0.1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, brentuximab vedotin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Brentuximab vedotin inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cabazitaxel, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cabazitaxel injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bortezomib, not otherwise specified, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bortezomib, nos, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, carboplatin, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Carboplatin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bortezomib (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bortezomib, dr. reddy's", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, carfilzomib, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, carfilzomib, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bortezomib freseniuskab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bortezomib, hospira", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, carmustine, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Carmustine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bortezomib (maia), not therapeutically equivalent to j9041, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, bortezomib (maia)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, carmustine (accord), not therapeutically equivalent to j9050, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, carmustine (accord)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bortezomib (boruzu), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj bortezomib boruzu 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cetuximab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cetuximab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bendamustine hydrochloride (vivimusta), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vivimusta, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, copanlisib, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., copanlisib, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bendamustine hydrochloride (apotex), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj apotex/bendamustine 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9059", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bendamustine hydrochloride (baxter), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj bendamustine, baxter 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cisplatin, powder or solution, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cisplatin 10 mg injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, amivantamab-vmjw, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, amivantamab-vmjw", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9063", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, mirvetuximab soravtansine-gynx, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, elahere, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9064", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cabazitaxel (sandoz), not therapeutically equivalent to j9043, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cabazitaxel (sandoz)", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cladribine, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cladribine per 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cyclophosphamide, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cyclophosphamide 100 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cyclophosphamide (auromedics), 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cyclophosphamd auromedic", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9072", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cyclophosphamide (frindovyx), 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cyclophos frindovyx 5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cyclophosphamide (dr. reddy's), 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cyclophos dr reddys 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9074", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cyclophosphamide (sandoz), 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cyclophosphamd, sandoz", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9075", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cyclophosphamide, not otherwise specified, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cyclophosphamide, nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9076", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cyclophosphamide (baxter), 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cyclophos (baxter) 5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9098", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cytarabine liposome, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cytarabine liposome inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, cytarabine, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Cytarabine hcl 100 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9118", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, calaspargase pegol-mknl, 10 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. calaspargase pegol-mknl", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9119", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cemiplimab-rwlc, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., cemiplimab-rwlc, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, dactinomycin, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dactinomycin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dacarbazine, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dacarbazine 100 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, daratumumab, 10 mg and hyaluronidase-fihj", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Daratumumab, hyaluronidase", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, daratumumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, daratumumab 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, daunorubicin, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Daunorubicin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9151", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, daunorubicin citrate, liposomal formulation, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Daunorubicin citrate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj daunorubicin, cytarabine", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, degarelix, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Degarelix injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denileukin diftitox, 300 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Denileukin diftitox inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denileukin diftitox-cxdl, 1 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj denileuk difti-cxdl 1mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9165", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, diethylstilbestrol diphosphate, 250 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Diethylstilbestrol injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, docetaxel, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Docetaxel injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, docetaxel (docivyx), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Docetaxel (docivyx), 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9173", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, durvalumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., durvalumab, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9174", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, docetaxel (beizray), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, docetaxel (beizray) 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, elliotts' b solution, 1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Elliotts b solution per ml", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9176", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, elotuzumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, elotuzumab, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, enfortumab vedotin-ejfv, 0.25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj enfort vedo-ejfv 0.25mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9178", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, epirubicin hcl, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, epirubicin hcl, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9179", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eribulin mesylate, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Eribulin mesylate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, etoposide, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Etoposide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9183", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Gemcitabine intravesical system, 225 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gemcitabine intravesical sys", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9184", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, gemcitabine hydrochloride (avyxa), 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj gemcitabin (avyxa) 200mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fludarabine phosphate, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fludarabine phosphate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fluorouracil, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fluorouracil injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9196", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj gemcitabine hcl (accord)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9198", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gemcitabine hydrochloride, (infugem), 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. infugem, 100 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gemcitabine hydrochloride (infugem), 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, infugem, 200 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, floxuridine, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Floxuridine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "In gemcitabine hcl nos 200mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Goserelin acetate implant, per 3.6 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Goserelin acetate implant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gemtuzumab ozogamicin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gemtuzumab ozogamicin 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, mogamulizumab-kpkc, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj mogamulizumab-kpkc, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, irinotecan liposome, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj irinotecan liposome 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, irinotecan, 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Irinotecan injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ixabepilone, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ixabepilone injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, ifosfamide, 1 gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ifosfamide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mesna, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mesna injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, emapalumab-lzsg, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., emapalumab-lzsg, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, idarubicin hydrochloride, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Idarubicin hcl injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9212", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, interferon alfacon-1, recombinant, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Interferon alfacon-1 inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, interferon, alfa-2a, recombinant, 3 million units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Interferon alfa-2a inj", "typeOfServiceCode": "G = Immunosuppressive drugs", "year": "2026" }, { "code": "J9214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, interferon, alfa-2b, recombinant, 1 million units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Interferon alfa-2b inj", "typeOfServiceCode": "G = Immunosuppressive drugs", "year": "2026" }, { "code": "J9215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Interferon alfa-n3 inj", "typeOfServiceCode": "G = Immunosuppressive drugs", "year": "2026" }, { "code": "J9216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, interferon, gamma 1-b, 3 million units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Interferon gamma 1-b inj", "typeOfServiceCode": "G = Immunosuppressive drugs", "year": "2026" }, { "code": "J9217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1991", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Leuprolide acetate (for depot suspension), 7.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Leuprolide acetate suspnsion", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Leuprolide acetate, per 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Leuprolide acetate injeciton", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Leuprolide acetate implant, 65 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Leuprolide acetate implant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9220", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, indigotindisulfonate sodium, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Indigotindisulfonate sod 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, lurbinectedin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. lurbinectedin, 0.1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Histrelin implant (vantas), 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vantas implant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9226", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Histrelin implant (supprelin la), 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Supprelin la implant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9227", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, isatuximab-irfc, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. isatuximab-irfc 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9228", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ipilimumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ipilimumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9229", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, inotuzumab ozogamicin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj inotuzumab ozogam 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mechlorethamine hcl inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, melphalan hydrochloride, not otherwise specified, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj melpha hydroch nos 50 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, melphalan (evomela), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., evomela, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, melphalan flufenamide, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, melphalan flufenami 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, melphalan (hepzato), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj melphalan (hepzato) 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9249", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, melphalan (apotex), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, melphalan (apotex) 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Methotrexate sodium, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Methotrexate sodium inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, methotrexate (accord)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9256", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, nipocalimab-aahu, 3 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nipocalimab-aahu, 3 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9258", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, paclitaxel protein-bound particles (teva), not therapeutically equivalent to j9264, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Paclitaxel (teva)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, paclitaxel protein-bound particles (american regent), not therapeutically equivalent to j9264, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Paclitaxel (american regent)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, methotrexate sodium, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj methotrexate sodium 50mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, nelarabine, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Nelarabine injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, omacetaxine mepesuccinate, 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, omacetaxine mep, 0.01mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9263", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, oxaliplatin, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Oxaliplatin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9264", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, paclitaxel protein-bound particles, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Paclitaxel protein bound", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, paclitaxel, 30 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Paclitaxel injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pegaspargase, per single dose vial", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pegaspargase injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9267", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, paclitaxel, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Paclitaxel injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9268", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, pentostatin, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pentostatin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9269", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tagraxofusp-erzs, 10 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. tagraxofusp-erzs 10 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9270", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, plicamycin, 2.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Plicamycin (mithramycin) inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pembrolizumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pembrolizumab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, dostarlimab-gxly, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, dostarlimab-gxly, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9273", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tisotumab vedotin-tftv, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj tisotu vedotin-tftv, 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tebentafusp-tebn, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tebentafusp-tebn, 1 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9275", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, cosibelimab-ipdl, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj cosibelimab-ipdl, 2 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9276", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, zanidatamab-hrii, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj zanidatamab-hrii, 2 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9277", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pembrolizumab, 1 mg and berahyaluronidase alfa-pmph", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pembrolizumab 1mg berahyalur", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9278", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, carboplatin (avyxa), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, carboplatin (avyxa)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mitomycin, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mitomycin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Mitomycin pyelocalyceal instillation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mitomycin instillation", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9282", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Mitomycin, intravesical instillation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mitomycin intravesical inst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, olaratumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, olaratumab, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9286", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, glofitamab-gxbm, 2.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj glofitamab gxbm, 2.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9289", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, nivolumab, 2 mg and hyaluronidase-nvhy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj nivolumab 2 mg hyaluron", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9292", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed dipotassium, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pemetrexed dipotassium", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, mitoxantrone hydrochloride, per 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Mitoxantrone hydrochl / 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9294", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pemetrexed, hospira 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, necitumumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, necitumumab, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9296", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pemetrexed (accord) 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9297", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pemetrexed (sandoz) 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9298", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj nivol relatlimab 3mg/1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, nivolumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, nivolumab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, gemtuzumab ozogamicin, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Gemtuzumab ozogamicin inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, obinutuzumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Obinutuzumab inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ofatumumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ofatumumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, panitumumab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Panitumumab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed (pemfexy), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. pemetrexed, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed, not otherwise specified, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. pemetrexed nos 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pertuzumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, pertuzumab, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9307", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pralatrexate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pralatrexate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9308", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ramucirumab, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, ramucirumab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9309", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, polatuzumab vedotin-piiq, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, polatuzumab vedotin 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rituximab, 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rituximab injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9311", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rituximab 10 mg and hyaluronidase", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj rituximab, hyaluronidase", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rituximab, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., rituximab, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, moxetumomab pasudotox-tdfk, 0.01 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., lumoxiti, 0.01 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9314", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pemetrexed (teva) 10mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, romidepsin, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Romidepsin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Pertuzu, trastuzu, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9317", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sacituzumab govitecan-hziy, 2.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sacituzumab govitecan-hziy", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9318", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, romidepsin, non-lyophilized, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj romidepsin non-lyo 0.1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9319", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, romidepsin, lyophilized, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj romidepsin lyophil 0.1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, streptozocin, 1 gram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Streptozocin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, epcoritamab-bysp, 0.16 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj epcoritamab-bysp 0.16 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9322", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed (bluepoint), not therapeutically equivalent to j9305, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pemetrexed (bluepoint)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed ditromethamine, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pemetrexed ditromethamin", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9324", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemetrexed (pemrydi rtu), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, pemrydi rtu, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, talimogene laherparepvec, per 1 million plaque forming units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj talimogene laherparepvec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9326", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, telisotuzumab vedotin-tllv, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Telisotuzumab vedotin-tllv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, temozolomide, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Temozolomide injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tislelizumab-jsgr, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tislelizumab-jsgr", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, temsirolimus, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Temsirolimus injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9331", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sirolimus protein-bound particles, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj sirolimus prot part 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9332", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, efgartigimod alfa-fcab, 2mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj efgartigimod 2mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9333", "actionCode": "S = Change in short description of procedure code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, rozanolixizumab-noli, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj rozanolixizum-noli 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9334", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj efgart-alfa 2mg hya-qvfc", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9340", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, thiotepa, 15 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Thiotepa injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9341", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, thiotepa (tepylute), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj thiotepa (tepylute) 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9342", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, thiotepa, not otherwise specified, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj thiotepa nos 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9345", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, retifanlimab-dlwr, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, retifanlimab-dlwr, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9347", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tremelimumab-actl, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tremelimumab-actl, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9348", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, naxitamab-gqgk, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. naxitamab-gqgk, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9349", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tafasitamab-cxix, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., tafasitamab-cxix", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, mosunetuzumab-axgb, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj mosunetuzumab-axgb, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, topotecan, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Topotecan injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9352", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trabectedin, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection trabectedin 0.1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, margetuximab-cmkb, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. margetuximab-cmkb, 5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ado-trastuzumab emtansine, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, ado-trastuzumab emt 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab, excludes biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj trastuzumab excl biosimi", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9356", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab, 10 mg and hyaluronidase-oysk", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. herceptin hylecta, 10mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, valrubicin, intravesical, 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Valrubicin injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fam-trastuzumab deruxtecan-nxki, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj fam-trastu deru-nxki 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9359", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, loncastuximab tesirine-lpyl, 0.075 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj lon tesirin-lpyl 0.075mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vinblastine sulfate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vinblastine sulfate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, efbemalenograstim alfa-vuxw, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, efbemalenograstim alfa-", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Vincristine sulfate, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vincristine sulfate 1 mg inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9371", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, vincristine sulfate liposome, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vincristine sul lip 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9376", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pozelimab-bbfg, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pozelimab-bbfg, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, teclistamab-cqyv, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj teclistamab cqyv 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9381", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, teplizumab-mzwv, 5 mcg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj teplizumab mzwv 5 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9382", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, zenocutuzumab-zbco, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj zenocutuzumab-zbco 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, vinorelbine tartrate, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Vinorelbine tartrate inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9393", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fulvestrant (teva), not therapeutically equivalent to j9395, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, fulvestrant (teva)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, fulvestrant (fresenius)", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9395", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, fulvestrant, 25 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, fulvestrant", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ziv-aflibercept, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, ziv-aflibercept, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "J9600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, porfimer sodium, 75 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Porfimer sodium injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9601", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, linvoseltamab-gcpt, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj linvoseltamab-gcpt 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "J9999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Not otherwise classified, antineoplastic drugs", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chemotherapy drug", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K0001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Standard wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Standard wheelchair", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Standard hemi (low seat) wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Stnd hemi (low seat) whlchr", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Lightweight wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Lightweight wheelchair", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "High strength, lightweight wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "High strength ltwt whlchr", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Heavy duty wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Heavy duty wheelchair", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Extra heavy duty wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Extra heavy duty wheelchair", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Custom manual wheelchair/base", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "45 = Customized DME items", "shortDescription": "Cstm manual wheelchair/base", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Other manual wheelchair/base", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Other manual wheelchair/base", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 05, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Standard - weight frame motorized/power wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Stnd wt frame power whlchr", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 05, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Stnd wt pwr whlchr w control", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 05, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Lightweight portable motorized/power wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ltwt portbl power whlchr", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Custom motorized/power wheelchair base", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "45 = Customized DME items", "shortDescription": "Custom power whlchr base", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Other motorized/power wheelchair base", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Other power whlchr base", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Detachable, non-adjustable height armrest, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Detach non-adj ht armrst rep", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Detachable, adjustable height armrest, base, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Detach adjust armrest base", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Detachable, adjustable height armrest, upper portion, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Detach adjust armrst upper", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Arm pad, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Arm pad repl, each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Fixed, adjustable height armrest, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Fixed adjust armrest pair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "High mount flip-up footrest, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Hi mount flip-up footrest ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Leg strap, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Leg strap each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Leg strap, h style, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Leg strap h style each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Adjustable angle footplate, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Adjustable angle footplate", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Large size footplate, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Large size footplate each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Standard size footplate, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Standard size ftplate rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Footrest, lower extension tube, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Ftrst lowr exten tube rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Footrest, upper hanger bracket, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Ftrst upr hanger brac rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Footrest, complete assembly, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Ftrst compl assembly repl ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Elevating legrest, lower extension tube, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Elev lgrst lwr exten repl ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Elevating legrest, upper hanger bracket, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Elev legrst upr hangr rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Ratchet assembly, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Ratchet assembly replacement", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Cam release assembly, footrest or legrest, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Cam rel asm ft/legrst rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Swingaway, detachable footrests, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Swingaway detach ftrest repl", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Elevating footrests, articulating (telescoping), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Elevate footrest articulate", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Seat height less than 17\" or equal to or greater than 21\" for a high strength, lightweight, or ultralightweight wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seat ht <17 or >=21 ltwt wc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Spoke protectors, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Spoke protectors", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0069", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Rr whl compl sol tire rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Rr whl compl pne tire rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Front caster assembly, complete, with pneumatic tire, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Fr cstr comp pne tire rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0072", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Front caster assembly, complete, with semi-pneumatic tire, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Fr cstr semi-pne tire rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Caster pin lock, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Caster pin lock each", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0077", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Front caster assembly, complete, with solid tire, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Fr cstr asmb sol tire rep ea", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0098", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Drive belt for power wheelchair, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Drive belt for pwc, repl", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Iv hanger, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Iv hanger", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair component or accessory, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "W/c component-accessory nos", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0195", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Elevating leg rests, pair (for use with capped rental wheelchair base)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Elevating whlchair leg rests", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "31 = Frequently serviced DME (price subject to floors and ceilings)", "shortDescription": "Pump uninterrupted infusion", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0462", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Temporary replacement for patient owned equipment being repaired, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Temporary replacement eqpmnt", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K0552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Sup/ext non-ins inf pump syr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K0553", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Ther cgm supply allowance", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K0554", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Ther cgm receiver/monitor", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl batt silver oxide 1.5 v", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0602", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl batt silver oxide 3 v", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl batt alkaline 1.5 v", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl batt lithium 3.6 v", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl batt lithium 4.5 v", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Automatic external defibrillator, with integrated electrocardiogram analysis, garment type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Aed garment w elec analysis", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement battery for automated external defibrillator, garment type only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Repl batt for aed", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement garment for use with automated external defibrillator, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Repl garment for aed", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement electrodes for use with automated external defibrillator, garment type only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Repl electrode for aed", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K0669", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Seat/back cus no dmepdac ver", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0672", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Removable soft interface le", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K0730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Controlled dose inhalation drug delivery system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ctrl dose inh drug deliv sys", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0733", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "12-24hr sealed lead acid", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0738", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "33 = Oxygen and oxygen equipment (price subject to floors and ceilings)", "shortDescription": "Portable gas oxygen system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "K0739", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Repair/svc dme non-oxygen eq", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K0740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2009", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Repair/svc oxygen equipment", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K0743", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Suction pump, home model, portable, for use on wounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Portable home suction pump", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K0744", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Absorp drg <= 16 suc pump", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "K0745", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Absorp drg >16<=48 suc pump", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "K0746", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Absorp drg >48 suc pump", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "K0800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pov group 1 std up to 300lbs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0801", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pov group 1 hd 301-450 lbs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0802", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pov group 1 vhd 451-600 lbs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pov group 2 std up to 300lbs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0807", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pov group 2 hd 301-450 lbs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0808", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Pov group 2 vhd 451-600 lbs", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0812", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power operated vehicle, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings)", "shortDescription": "Power operated vehicle noc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0813", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 1 std port seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0814", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 1 std port cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0815", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 1 std seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0816", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 1 std cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0820", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 std port seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0821", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 std port cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0822", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 std seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0823", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 std cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0824", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 hd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0825", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 hd cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0826", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 vhd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0827", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp vhd cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0828", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 xtra hd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0829", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 xtra hd cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 std seat elevate s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0831", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 std seat elevate cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0835", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 std sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0836", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 std sing pow opt cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0837", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 hd sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0838", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 2 hd sing pow opt cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0839", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 vhd sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 xhd sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 std mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0842", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 std mult pow opt cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0843", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp2 hd mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0848", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 std seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0849", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 std cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 hd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0851", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 hd cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0852", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 vhd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0853", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 vhd cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0854", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 xhd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0855", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 3 xhd cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0856", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 std sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0857", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 std sing pow opt cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0858", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 hd sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0859", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 hd sing pow opt cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0860", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 vhd sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0861", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 std mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0862", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 hd mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0863", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 vhd mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0864", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp3 xhd mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0868", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 4 std seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0869", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 4 std cap chair", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0870", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 4 hd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0871", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp 4 vhd seat/back", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0877", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp4 std sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0878", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp4 std sing pow opt cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0879", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp4 hd sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0880", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp4 vhd sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0884", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp4 std mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0885", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp4 std mult pow opt cap", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0886", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp4 hd mult pow s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp5 ped sing pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0891", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Pwc gp5 ped mult pow opt s/b", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0898", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power wheelchair, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Power wheelchair noc", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0899", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Power mobility device, not coded by dme pdac or does not meet criteria", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pow mobil dev no dmepdac", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Customized durable medical equipment, other than wheelchair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "45 = Customized DME items", "shortDescription": "Cstm dme other than wheelchr", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "K0901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "L1851", "longDescription": "Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko single upright pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K0902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "L1852", "longDescription": "Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko double upright pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K0903", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mult den insert dir carv/cam", "typeOfServiceCode": "J = Diabetic shoes (eff 04/95)", "year": "2026" }, { "code": "K1001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Electronic posa treatment", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Cranial electrotherapy stimulation (ces) system, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ces system", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Whirlpool tub, walk-in, portable", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Whirlpool tub walkin portabl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Low frequency ultrasonic diathermy treatment device for home use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lo freq us diathermy device", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Disposable collection and storage bag for breast milk, any size, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Disp col sto bag breast milk", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Suct pum ext urine mgmt sys", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bil hkaf pc s/d micro sensor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K1009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Speech volume modulation system, any type, including all components and accessories", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Speech volume modulation sys", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Intraurethral drainag device", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Activation device for intraurethral drainage device with valve, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Acti intraurethral drainage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Charger and base station for intraurethral activation device, replacement only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Charger base station intraur", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Enema tube, with or without adapter, any type, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Enema tube any type repl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak 4 bar link hydl swg/stanc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K1015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Foot, adductus positioning device, adjustable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Foot, adductus position, adj", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Trans elec nerv for trigemin", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Monthly supplies for use of device coded at k1016", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Monthly supp use with k1016", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K1018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "External upper limb tremor stimulator of the peripheral nerves of the wrist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Ext up limb tremor stim wris", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "34 = DME supplies(price subject to floors and ceilings)", "shortDescription": "Supp ext up limb tremor stim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K1020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Non-invasive vagus nerve stimulator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non-invasive vagus nerv stim", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Exsufflation belt, includes all supplies and accessories", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Exsuff belt incl all sup acc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endoskel posit rotat unit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "K1023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trans elec nerv periph nerv", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic compression controller with sequential calibrated gradient pressure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum comp control cal", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic sequential compression garment, full arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum compress full arm", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mech allergen parti barrier", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Oral dev without fix mech", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Control unit nm stim w phone", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oral dv/app neuromus mouthpi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Ext recharge bat replacement", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic compression controller without calibrated gradient pressure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneu comp control w/o ca", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic sequential compression garment, full leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum seq comp full leg", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Non-pneumatic sequential compression garment, half leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "36 = Capped rental DME (price subject to floors and ceilings)", "shortDescription": "Non pneum seq comp half leg", "typeOfServiceCode": "R = Rental of DME", "year": "2026" }, { "code": "K1034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 12, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 04, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Covid test self-admn/collect", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Molecular diagnostic test reader, nonprescription self-administered and self-collected use, fda approved, authorized or cleared", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mol diag reader self-admn", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supplies for ultra diatherm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "K1037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Docking station for use with oral device/appliance used to reduce upper airway collapsibility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Docking station for oral dev", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "L0112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cranial cervical orthosis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cranial cervical torticollis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cerv flex n/adj foam pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, flexible, thermoplastic collar, molded to patient", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flex thermoplastic collar mo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, semi-rigid, adjustable (plastic collar)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cervical semi-rigid adjustab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cerv semi-rig adj molded chn", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cerv sr wire occ/man pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, collar, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cervical collar molded to pt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cerv col sr foam 2pc pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0174", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cerv sr 2pc thor ext pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, multiple post collar, occipital/mandibular supports, adjustable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cer post col occ/man sup adj", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cerv collar supp adj cerv ba", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cerv col supp adj bar & thor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Thoracic, rib belt, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thor rib belt custom fabrica", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso flex trunk/thor pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso flex custom fab thoraci", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0454", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso trnk sj-t9 pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso flex trnk sj-t9 pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0456", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso flex trnk sj-ss pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0457", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso flex trnk sj-ss pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0458", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso 2mod symphis-xipho pre", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso 2 shl symphys-stern cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0462", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso 3mod sacro-scap pre", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0464", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso 4mod sacro-scap pre", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0466", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso r fram soft ant pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0467", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso r fram soft pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0468", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rig fram pelvic pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0469", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rig fram pelvic pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigid frame pre subclav", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigid frame hyperex pre", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigid plastic custom fa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigid lined custom fab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0484", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigid plastic cust fab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0486", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigidlined cust fab two", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0488", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigid lined pre one pie", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso rigid plastic pre one", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0491", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso 2 piece rigid shell", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0492", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso 3 piece rigid shell", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sio flex pelvic/sacr pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sio flex pelvisacral custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0623", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sio rig pnl pelv/sac pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sio panel custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lo flex l1-below l5 pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lo sag rig pnl stays pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lo sag ri an/pos pnl pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso flex no ri stays pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso flex w/rigid stays cust", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso r post pnl sj-t9 pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sag r an/pos pnl pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sag rigid frame cust", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0633", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sc r pos/lat pnl pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso flexion control custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0635", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sagit rigid panel prefab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0636", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sagittal rigid panel cus", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sc r ant/pos pnl pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sag-coronal panel custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso s/c shell/panel prefab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso s/c shell/panel custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lo rig pos pnl l1-l5 pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lo sag ri an/pos pnl pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0643", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sag ctr rigi pos pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0648", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sag r an/pos pnl pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0649", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sc r pos/lat pnl pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sc r ant/pos pnl pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0651", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso sag-co shell pnl pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ctlso a-p-l control molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ctlso a-p-l control w/ inter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ctlso a-p-l control custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0810", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Halo procedure, cervical halo incorporated into jacket vest", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Halo cervical into jckt vest", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0820", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Halo procedure, cervical halo incorporated into plaster body jacket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Halo cervical into body jack", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0830", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Halo procedure, cervical halo incorporated into milwaukee type orthosis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Halo cerv into milwaukee typ", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0859", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mri compatible system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0861", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to halo procedure, replacement liner/interface material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Halo repl liner/interface", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, corset front", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso corset front", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0972", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Lso, corset front", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso corset front", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0974", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Tlso, full corset", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tlso full corset", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0976", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Lso, full corset", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lso full corset", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0978", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Axillary crutch extension", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Axillary crutch extension", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Peroneal straps, prefabricated, off-the-shelf, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Peroneal straps pair pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Stocking sup grips 4 pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0984", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Protective body sock, prefabricated, off-the-shelf, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Protect body sock ea pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L0999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to spinal orthosis, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Add to spinal orthosis nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ctlso milwauke initial model", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ctlso infant immobilizer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tension based scoliosis orth", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla to trochanter, includes all accessory pads, straps and interface, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Scoliosis orth sag/ cor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1007", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Scoliosis orth s-c custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ctlso axilla sling", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, kyphosis pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kyphosis pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, kyphosis pad, floating", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kyphosis pad floating", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, lumbar bolster pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lumbar bolster pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lumbar or lumbar rib pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, sternal pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sternal pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, thoracic pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thoracic pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, trapezius sling", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Trapezius sling", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1080", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, outrigger", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Outrigger", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1085", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Outrigger bil w/ vert extens", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, lumbar sling", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lumbar sling", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ring flange plastic/leather", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ring flange plas/leather mol", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to ctlso, scoliosis orthosis, cover for upright, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Covers for upright each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Furnsh initial orthosis only", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), lateral thoracic extension", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lateral thoracic extension", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), anterior thoracic extension", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Anterior thoracic extension", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), milwaukee type superstructure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Milwaukee type superstructur", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), lumbar derotation pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lumbar derotation pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), anterior asis pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Anterior asis pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), anterior thoracic derotation pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Anterior thoracic derotation", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), abdominal pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Abdominal pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), rib gusset (elastic), each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Rib gusset (elastic) each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to tlso, (low profile), lateral trochanteric pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lateral trochanteric pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Other scoliosis procedure, body jacket molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Body jacket mold to patient", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1310", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Other scoliosis procedure, post-operative body jacket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Post-operative body jacket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Thoracic, pectus carinatum orthosis, sternal compression, rigid circumferential frame with anterior and posterior rigid pads, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Pectus carinatum ortho cust", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Spinal orthosis, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Spinal orthosis nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho flex frejka w/cov pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho frejka cov only pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho flex pavlik harns pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Abduct control hip semi-flex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelv band/spread bar thigh c", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho abduction hip adjustable", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho bi thighcuffs w sprdr bar", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1653", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho abduction static ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho abduction static plastic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelvic & hip control thigh c", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1681", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, bilateral hip joints and thigh cuffs, adjustable flexion, extension, abduction control of hip joint, postoperative hip abduction type, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho bilateral hip abduction", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1685", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Post-op hip abduct custom fa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1686", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho post-op hip abduction", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1690", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Combination bilateral ho", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Legg perthes orthosis, (toronto type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Leg perthes orth toronto typ", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Legg perthes orthosis, (newington type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Legg perthes orth newington", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Legg perthes orthosis trilat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Legg perthes orthosis, (scottish rite type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Legg perthes orth scottish r", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Legg perthes orthosis, (patten bottom type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Legg perthes patten bottom t", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko elastic with joints", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1812", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, elastic with joints, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko elastic w/joints pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1820", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko elas w/ condyle pads & jo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1821", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko elas w/ condyle pads otf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko immob canvas long pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1831", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee orth pos locking joint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1832", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko adj jnt pos r sup pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1833", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko adj jnt pos r sup pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1834", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, without knee joint, rigid, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko w/0 joint rigid molded to", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1836", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko rigid w/o joints pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko derot ant cruciate custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1843", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko single upright pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1844", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko w/adj jt rot cntrl molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1845", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko double upright pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1846", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko w adj flex/ext rotat mold", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1847", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko dbl upright w/air pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1848", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko dbl upright w/air pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, swedish type, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko swedish type pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1851", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko single upright prefab ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1852", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko double upright prefab ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1860", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ko supracondylar socket mold", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo sprng wir drsflx calf bd", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo ankle gauntlet pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1904", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo molded ankle gauntlet", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1906", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo multilig ank sup pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1907", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo supramalleolar custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1910", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo sing bar clasp attach sh", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo sing upright w/ adjust s", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo plastic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1932", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo rig ant tib tcf/= custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1933", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo rig ant tib tcf/= ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1940", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, plastic or other material, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo molded to patient plasti", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1945", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo molded plas rig ant tib", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo spiral molded to pt plas", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1951", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo spiral prefab custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1952", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo spiral prefab ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo pos solid ank plastic mo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, plastic with ankle joint, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo plastic molded w/ankle j", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1971", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo w/ankle joint, prefab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo sing solid stirrup calf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L1990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo doub solid stirrup calf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo sing fre stirr thi/calf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo sng/dbl mechanical act", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kaf sng/dbl swg/stn mcpr cus", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo sng solid stirrup w/o j", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo dbl solid stirrup band/", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo dbl solid stirrup w/o j", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo pla sin up w/wo k/a cus", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo plastic pediatric size", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo plas doub free knee mol", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo plas sing free knee mol", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo w/o joint multi-axis an", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hkafo torsion bil rot straps", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hkafo torsion cable hip pelv", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hkafo torsion ball bearing j", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hkafo torsion unilat rot str", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hkafo unilat torsion cable", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hkafo unilat torsion ball br", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo tib fx cast plaster mold", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo tib fx cast molded to pt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo tibial fracture soft", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo tib fx semi-rigid", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2116", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo tibial fracture rigid", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo fem fx cast thermoplas", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo fem fx cast molded to p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo femoral fx cast soft", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2134", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo fem fx cast semi-rigid", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kafo femoral fx cast rigid", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Plas shoe insert w ank joint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity fracture orthosis, drop lock knee joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Drop lock knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2184", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity fracture orthosis, limited motion knee joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Limited motion knee joint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Adj motion knee jnt lerman t", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2188", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity fracture orthosis, quadrilateral brim", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Quadrilateral brim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity fracture orthosis, waist belt", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Waist belt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2192", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelvic band & belt thigh fla", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, limited ankle motion, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Limited ankle motion ea jnt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Dorsiflexion assist each joi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Dorsi & plantar flex ass/res", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2221", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ank mcrop plant & dorsi flex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, split flat caliper stirrups and plate attachment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Split flat caliper stirr & p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2232", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Rocker bottom, contact afo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, round caliper and plate attachment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Round caliper and plate atta", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2250", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, foot plate, molded to patient model, stirrup attachment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Foot plate molded stirrup at", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2260", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, reinforced solid stirrup (scott-craig type)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Reinforced solid stirrup", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, long tongue stirrup", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Long tongue stirrup", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2270", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Varus/valgus strap padded/li", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Plastic mod low ext pad/line", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2280", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, molded inner boot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Molded inner boot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2300", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Abduction bar jointed adjust", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2310", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, abduction bar-straight", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Abduction bar-straight", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Non-molded lacer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lacer molded to patient mode", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2335", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, anterior swing band", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Anterior swing band", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2340", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pre-tibial shell, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pre-tibial shell molded to p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2350", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prosthetic type socket molde", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2360", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, extended steel shank", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Extended steel shank", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, patten bottom", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Patten bottom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2375", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, torsion control, ankle joint and half solid stirrup", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Torsion ank & half solid sti", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2380", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, torsion control, straight knee joint, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Torsion straight knee joint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2385", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, straight knee joint, heavy duty, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Straight knee joint heavy du", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2387", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add le poly knee custom kafo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2390", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, offset knee joint, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Offset knee joint each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2395", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, offset knee joint, heavy duty, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Offset knee joint heavy duty", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, suspension sleeve", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Suspension sleeve lower ext", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to knee joint, drop lock, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee joint drop lock ea jnt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2415", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee joint cam lock each joi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee disc/dial lock/adj flex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to knee joint, ratchet lock for active and progressive knee extension, each joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee jnt ratchet lock ea jnt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2492", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to knee joint, lift loop for drop lock ring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee lift loop drop lock rin", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thi/glut/ischia wgt bearing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Th/wght bear quad-lat brim m", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2520", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Th/wght bear quad-lat brim c", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Th/wght bear nar m-l brim mo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Th/wght bear nar m-l brim cu", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2530", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh-weight bearing, lacer, non-molded", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thigh/wght bear lacer non-mo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2540", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thigh/wght bear lacer molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2550", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thigh/weight bearing, high roll cuff", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thigh/wght bear high roll cu", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip clevis type 2 posit jnt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, pelvic sling", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelvic control pelvic sling", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip clevis/thrust bearing fr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip clevis/thrust bearing lo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, hip joint, heavy duty, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelvic control hip heavy dut", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip joint adjustable flexion", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip adj flex ext abduct cont", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Plastic mold recipro hip & c", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Metal frame recipro hip & ca", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, band and belt, unilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelvic control band & belt u", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic control, band and belt, bilateral", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelvic control band & belt b", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, pelvic and thoracic control, gluteal pad, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pelv & thor control gluteal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thoracic control, thoracic band", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thoracic control thoracic ba", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thoracic control, paraspinal uprights", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thorac cont paraspinal uprig", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, thoracic control, lateral support uprights", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thorac cont lat support upri", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, plating chrome or nickel, per bar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Plating chrome/nickel pr bar", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Carbon graphite lamination", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Extension per extension per", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2768", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Orthotic side bar disconnect device, per bar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ortho sidebar disconnect", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, non-corrosive finish, per bar", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Non-corrosive finish", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, drop lock retainer, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Drop lock retainer each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2795", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, knee control, full kneecap", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee control full kneecap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee cap medial or lateral p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, knee control, condylar pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee control condylar pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2820", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, soft interface for molded plastic, below knee section", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Soft interface below knee se", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, soft interface for molded plastic, above knee section", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Soft interface above knee se", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, tibial length sock, fracture or equal, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tibial length sock fx or equ", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity orthosis, femoral length sock, fracture or equal, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Femoral lgth sock fx or equa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2861", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "I = Not payable by Medicare", "longDescription": "Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Torsion mechanism knee/ankle", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L2999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Lower extremity orthoses, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Lower extremity orthosis nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ft insert ucb berkeley shell", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, insert, removable, molded to patient model, spenco, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot insert remov molded spe", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, insert, removable, molded to patient model, plastazote or equal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot insert plastazote or eq", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, insert, removable, molded to patient model, silicone gel, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot insert silicone gel eac", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, insert, removable, molded to patient model, longitudinal arch support, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot longitudinal arch suppo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot longitud/metatarsal sup", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, insert, removable, formed to patient foot, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot arch support remov prem", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot lamin/prepreg composite", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, arch support, removable, premolded, longitudinal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ft arch suprt premold longit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, arch support, removable, premolded, metatarsal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot arch supp premold metat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, arch support, removable, premolded, longitudinal/ metatarsal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot arch supp longitud/meta", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, arch support, non-removable attached to shoe, longitudinal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Arch suprt att to sho longit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, arch support, non-removable attached to shoe, metatarsal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Arch supp att to shoe metata", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Arch supp att to shoe long/m", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hallus-valgus night dynamic splint, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hallus-valgus nt dyn pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, abduction rotation bar, including shoes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Abduction rotation bar shoe", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, abduction rotation bar, without shoes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Abduct rotation bar w/o shoe", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Foot, adjustable shoe-styled positioning device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe styled positioning dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Foot, adductus positioning device, adjustable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Foot, adductus position, adj", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "L3170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Foot plas heel stabi pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe, oxford with supinator or pronator, infant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxford w supinat/pronat inf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe, oxford with supinator or pronator, child", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxford w/ supinat/pronator c", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe, oxford with supinator or pronator, junior", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oxford w/ supinator/pronator", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe, hightop with supinator or pronator, infant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hightop w/ supp/pronator inf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe, hightop with supinator or pronator, child", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hightop w/ supp/pronator chi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe, hightop with supinator or pronator, junior", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hightop w/ supp/pronator jun", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Surgical boot, each, infant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surgical boot each infant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Surgical boot, each, child", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surgical boot each child", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Surgical boot, each, junior", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surgical boot each junior", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Benesch boot, pair, infant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Benesch boot pair infant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Benesch boot, pair, child", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Benesch boot pair child", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Benesch boot, pair, junior", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Benesch boot pair junior", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Orthopedic footwear, ladies shoe, oxford, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orthopedic ftwear ladies oxf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Orthopedic footwear, ladies shoe, depth inlay, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orthoped ladies shoes dpth i", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Orthopedic footwear, ladies shoe, hightop, depth inlay, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ladies shoes hightop depth i", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Orthopedic footwear, mens shoe, oxford, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orthopedic mens shoes oxford", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Orthopedic footwear, mens shoe, depth inlay, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orthopedic mens shoes dpth i", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Orthopedic footwear, mens shoe, hightop, depth inlay, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mens shoes hightop depth inl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Woman's shoe oxford brace", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Man's shoe oxford brace", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic footwear, custom shoe, depth inlay, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom shoes depth inlay", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom mold shoe remov prost", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, shoe molded to patient model, silicone shoe, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe molded to pt silicone s", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe molded plastazote cust", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3253", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Foot, molded shoe plastazote (or similar) custom fitted, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe molded plastazote cust", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3254", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-standard size or width", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orth foot non-stndard size/w", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Non-standard size or length", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orth foot non-standard size/", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic footwear, additional charge for split size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orth foot add charge split s", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Surgical boot/shoe, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ambulatory surgical boot eac", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Plastazote sandal, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Plastazote sandal each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lift, elevation, heel, tapered to metatarsals, per inch", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sho lift taper to metatarsal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lift, elevation, heel and sole, neoprene, per inch", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe lift elev heel/sole neo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lift, elevation, heel and sole, cork, per inch", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe lift elev heel/sole cor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lift, elevation, metal extension (skate)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lifts elevation metal extens", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3332", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lift, elevation, inside shoe, tapered, up to one-half inch", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe lifts tapered to one-ha", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3334", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lift, elevation, heel, per inch", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe lifts elevation heel /i", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel wedge, sach", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe wedge sach", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel wedge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel wedge", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sole wedge, outside sole", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe sole wedge outside sole", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sole wedge, between sole", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe sole wedge between sole", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Clubfoot wedge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe clubfoot wedge", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Outflare wedge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe outflare wedge", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Metatarsal bar wedge, rocker", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe metatarsal bar wedge ro", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Metatarsal bar wedge, between sole", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe metatarsal bar between", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Full sole and heel wedge, between sole", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Full sole/heel wedge btween", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, counter, plastic reinforced", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sho heel count plast reinfor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3440", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, counter, leather reinforced", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Heel leather reinforced", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, sach cushion type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel sach cushion type", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, new leather, standard", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel new leather standa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, new rubber, standard", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel new rubber standar", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, thomas with wedge", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel thomas with wedge", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, thomas extended to ball", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel thomas extend to b", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, pad and depression for spur", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel pad & depress for", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Heel, pad, removable for spur", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe heel pad removable for", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, insole, leather", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ortho shoe add leather insol", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, insole, rubber", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orthopedic shoe add rub insl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, insole, felt covered with leather", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O shoe add felt w leath insl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, sole, half", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ortho shoe add half sole", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, sole, full", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ortho shoe add full sole", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, toe tap standard", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O shoe add standard toe tap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, toe tap, horseshoe", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O shoe add horseshoe toe tap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, special extension to instep (leather with eyelets)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O shoe add instep extension", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, convert instep to velcro closure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O shoe add instep velcro clo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, convert firm shoe counter to soft counter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O shoe convert to sof counte", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe addition, march bar", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ortho shoe add march bar", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer of an orthosis from one shoe to another, caliper plate, existing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trans shoe calip plate exist", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer of an orthosis from one shoe to another, caliper plate, new", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trans shoe caliper plate new", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer of an orthosis from one shoe to another, solid stirrup, existing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trans shoe solid stirrup exi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer of an orthosis from one shoe to another, solid stirrup, new", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trans shoe solid stirrup new", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shoe dennis browne splint bo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3649", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Orthopedic shoe, modification, addition or transfer, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orthopedic shoe modifica nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "So 8 abd restraint pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3660", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "So 8 ab rstr can/web pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "So acro/clav can web pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3671", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "So cap design w/o jnts cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3674", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "So airplane w/wo joint cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3675", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "So vest canvas/web pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3677", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "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", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "So hard plas stabili pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3678", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "So hard plas stabili pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Eo w/o joints cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Eo elas w/metal jnts pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Forearm/arm cuffs free motio", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Forearm/arm cuffs ext/flex a", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3740", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cuffs adj lock w/ active con", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Eo adj jt prefab custom fit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3761", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Eo, adj lock joint prefab ot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3762", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Eo rigid w/o joints pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3763", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ewho rigid w/o jnts cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3764", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ewho w/joint(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3765", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ewhfo rigid w/o jnts cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3766", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ewhfo w/joint(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3806", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Whfo w/joint(s) custom fab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3807", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Whfo w/o joints pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3808", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Whfo, rigid w/o joints", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3809", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Whfo w/o joints pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3891", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "I = Not payable by Medicare", "longDescription": "Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Torsion mechanism wrist/elbo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hinge extension/flex wrist/f", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hinge ext/flex wrist finger", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3904", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, external powered, electric, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Whfo electric custom fitted", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3905", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Who w/nontorsion jnt(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3906", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Who w/o joints cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3908", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Who cock-up nonmolde pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3912", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hfo flexion glove pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3913", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hfo w/o joints cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3915", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, 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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Who nontorsion jnts pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3916", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Who nontorsion jnts pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3917", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Metacarp fx orthosis pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3918", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Metacarp fx orthosis pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3919", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ho w/o joints cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3921", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hfo w/joint(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3923", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Hand finger orthosis, 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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hfo without joints pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3924", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hfo without joints pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3925", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Fo pip dip jnt/sprng pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3927", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Fo pip dip no jt spr pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3929", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hfo nontorsion jnts pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hfo nontorsion jnts pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3931", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Whfo nontorsion joint prefab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3933", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Fo w/o joints cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3935", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Fo nontorsion joint cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3956", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Addition of joint to upper extremity orthosis, any material; per joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add joint upper ext orthosis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewho airplan desig abdu pos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3961", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewho cap design w/o jnts cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3962", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewho erbs palsey design abd", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3967", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewho airplane w/o jnts cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3971", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewho cap design w/jnt(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3973", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewho airplane w/jnt(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3975", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewhfo cap design w/o jnt cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3976", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewhfo airplane w/o jnts cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3977", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewhfo cap desgn w/jnt(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3978", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "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, custom fabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sewhfo airplane w/jnt(s) cf", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Up ext fx orthos humeral nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ue fx orth shoul cap forearm", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Upper ext fx orthosis rad/ul", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3984", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Upper ext fx orthosis wrist", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3995", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity orthosis, sock, fracture or equal, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sock fracture or equal each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L3999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Upper limb orthosis, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Upper limb orthosis nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace girdle for spinal orthosis (ctlso or so)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl girdle milwaukee orth", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement strap, any orthosis, includes all components, any length, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace strap, any orthosis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace trilateral socket brim", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace trilateral socket br", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace quadrilateral socket brim, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace quadlat socket brim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace quadrilateral socket brim, custom fitted", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace socket brim cust fit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace molded thigh lacer, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace molded thigh lacer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Replace non-molded thigh lacer, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace non-molded thigh lac", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace molded calf lacer, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace molded calf lacer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Replace non-molded calf lacer, for custom fabricated orthosis only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace non-molded calf lace", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace high roll cuff", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace high roll cuff", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Replace proximal and distal upright for kafo", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace prox & dist upright", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Replace metal bands kafo, proximal thigh", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl met band kafo-afo prox", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace metal bands kafo-afo, calf or distal thigh", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl met band kafo-afo calf/", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Replace leather cuff kafo, proximal thigh", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl leath cuff kafo prox th", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Replace leather cuff kafo-afo, calf or distal thigh", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl leath cuff kafo-afo cal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Replace pretibial shell", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace pretibial shell", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Repair of orthotic device, labor component, per 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ortho dvc repair per 15 min", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Repair of orthotic device, repair or replace minor parts", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Orth dev repair/repl minor p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ankle control ortho pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pneumat walking boot pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pneuma/vac walk boot pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Pneumatic full leg splint, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pneum full leg splnt pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4386", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Non-pneum walk boot pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4387", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Non-pneum walk boot pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement, soft interface material, static afo", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace afo soft interface", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Replace soft interface material, foot drop splint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace foot drop spint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Static or dynami afo pre cst", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Static or dynami afo pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Foot drop splint pre ots", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L4631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Afo, walk boot type, cus fab", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Partial foot, shoe insert with longitudinal arch, toe filler", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sho insert w arch toe filler", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Partial foot, molded socket, ankle height, with toe filler", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mold socket ank hgt w/ toe f", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Partial foot, molded socket, tibial tubercle height, with toe filler", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tibial tubercle hgt w/ toe f", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle, symes, molded socket, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ank symes mold sckt sach ft", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle, symes, metal frame, molded leather socket, articulated ankle/foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Symes met fr leath socket ar", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Below knee, molded socket, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Molded socket shin sach foot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Below knee, plastic socket, joints and thigh lacer, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Plast socket jts/thgh lacer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mold sckt ext knee shin sach", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mold socket bent knee shin s", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Above knee, molded socket, single axis constant friction knee, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kne sing axis fric shin sach", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "No knee/ankle joints w/ ft b", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "No knee joint with artic ali", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Fem focal defic constant fri", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip canad sing axi cons fric", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tilt table locking hip sing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hemipelvect canad sing axis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Below knee, molded socket, shin, sach foot, endoskeletal system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk mold socket sach ft endo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee disart, sach ft, endo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak open end sach", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5331", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip disart canadian sach ft", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hemipelvectomy canadian sach", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dress & 1 cast chg bk", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dsg bk ea add cast ch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dsg & 1 cast chg ak/d", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dsg ak ea add cast ch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop app non-wgt bear dsg", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop app non-wgt bear dsg", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Init bk ptb plaster direct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Init ak ischal plstr direct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep bk ptb plaster molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Perp bk ptb thermopls direct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep bk ptb thermopls molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep bk ptb open end socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep bk ptb laminated socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep ak ischial plast molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep ak ischial direct form", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep ak ischial thermo mold", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5585", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep ak ischial open end", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prep ak ischial laminated", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip disartic sach thermopls", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip disart sach laminat mold", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, endoskeletal system, above knee, hydracadence system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above knee hydracadence", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak 4 bar link w/fric swing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak 4 bar ling w/hydraul swig", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5614", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "4-bar link above knee w/swng", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak 4 bar link hydl swg/stanc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak univ multiplex sys frict", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5617", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak/bk self-aligning unit ea", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5618", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, test socket, symes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test socket symes", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, test socket, below knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test socket below knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, test socket, knee disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test socket knee disarticula", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, test socket, above knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test socket above knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, test socket, hip disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test socket hip disarticulat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, test socket, hemipelvectomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test socket hemipelvectomy", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, acrylic socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee acrylic socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, symes type, expandable wall socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Syme typ expandabl wall sckt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee or knee disarticulation, acrylic socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak/knee disartic acrylic soc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5632", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, symes type, 'ptb' brim design socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Symes type ptb brim design s", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5634", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, symes type, posterior opening (canadian) socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Symes type poster opening so", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5636", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, symes type, medial opening socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Symes type medial opening so", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5637", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, total contact", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee total contact", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5638", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, leather socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee leather socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5639", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, wood socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee wood socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5640", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, knee disarticulation, leather socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee disarticulat leather so", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5642", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee, leather socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above knee leather socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5643", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, hip disarticulation, flexible inner socket, external frame", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip flex inner socket ext fr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5644", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee, wood socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above knee wood socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5645", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, flexible inner socket, external frame", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk flex inner socket ext fra", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5646", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee cushion socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5647", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee suction socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee suction socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5648", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above knee cushion socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5649", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, ischial containment/narrow m-l socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Isch containmt/narrow m-l so", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Additions to lower extremity, total contact, above knee or knee disarticulation socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tot contact ak/knee disart s", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5651", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee, flexible inner socket, external frame", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak flex inner socket ext fra", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5652", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, suction suspension, above knee or knee disarticulation socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Suction susp ak/knee disart", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5653", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, knee disarticulation, expandable wall socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee disart expand wall sock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5654", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Socket insert symes", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5655", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Socket insert below knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5656", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Socket insert knee articulat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5657", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add low ext man aut vol any", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5658", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Socket insert above knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5661", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, socket insert, multi-durometer symes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multi-durometer symes", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5665", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, socket insert, multi-durometer, below knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multi-durometer below knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5666", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, cuff suspension", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee cuff suspension", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5668", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, molded distal cushion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk molded distal cushion", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5670", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk molded supracondylar susp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5671", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk/ak locking mechanism", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5672", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, removable medial brim suspension", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk removable medial brim sus", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5673", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Socket insert w lock mech", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5676", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Additions to lower extremity, below knee, knee joints, single axis, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk knee joints single axis p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5677", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Additions to lower extremity, below knee, knee joints, polycentric, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk knee joints polycentric p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5678", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Additions to lower extremity, below knee, joint covers, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk joint covers pair", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5679", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Socket insert w/o lock mech", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5680", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, thigh lacer, nonmolded", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk thigh lacer non-molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5681", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee/above knee, 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 l5673 or l5679)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Intl custm cong/latyp insert", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5682", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk thigh lacer glut/ischia m", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5683", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee/above knee, 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 l5673 or l5679)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Initial custom socket insert", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5684", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, fork strap", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk fork strap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5685", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee sus/seal sleeve", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5686", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, back check (extension control)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk back check", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5688", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, waist belt, webbing", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk waist belt webbing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5690", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, below knee, waist belt, padded and lined", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bk waist belt padded and lin", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5692", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee, pelvic control belt, light", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak pelvic control belt light", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5694", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee, pelvic control belt, padded and lined", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak pelvic control belt pad/l", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5695", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak sleeve susp neoprene/equa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5696", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee or knee disarticulation, pelvic joint", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak/knee disartic pelvic join", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5697", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee or knee disarticulation, pelvic band", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak/knee disartic pelvic band", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5698", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, above knee or knee disarticulation, silesian bandage", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak/knee disartic silesian ba", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, shoulder harness", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shoulder harness", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement, socket, below knee, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace socket below knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5701", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace socket above knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement, socket, hip disarticulation, including hip joint, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replace socket hip", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5703", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Symes ankle w/o (sach) foot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5704", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Custom shaped protective cover, below knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Custom shape cover bk", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5705", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Custom shaped protective cover, above knee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Custom shape cover ak", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5706", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Custom shaped protective cover, knee disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Custom shape cvr knee disart", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5707", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Custom shaped protective cover, hip disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Custom shape cvr hip disart", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5710", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, manual lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Kne-shin exo sng axi mnl loc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5711", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin exo mnl lock ultra", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5712", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin exo frict swg & st", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5714", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin exo variable frict", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5716", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin exo mech stance ph", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5718", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin exo frct swg & sta", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5722", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin pneum swg frct exo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5724", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, fluid swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin exo fluid swing ph", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5726", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin ext jnts fld swg e", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5728", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin fluid swg & stance", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5780", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin pneum/hydra pneum", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lower limb pros vacuum pump", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5782", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hd low limb pros vacuum pump", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5783", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity, user adjustable, mechanical, residual limb volume management system (with or without lamination kit)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add low ext mec limb vol lam", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Exoskeletal bk ultralt mater", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5790", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Exoskeletal ak ultra-light m", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5795", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Exoskel hip ultra-light mate", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, manual lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endoskel knee-shin mnl lock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5811", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin mnl lck ultra", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5812", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin frct swg & st", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5814", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin hydral swg ph", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5816", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin polyc mch sta", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5818", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin frct swg & st", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5822", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin pneum swg frc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5824", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, fluid swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin fluid swing p", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5826", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Miniature knee joint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5827", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee shin single axis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5828", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin fluid swg/sta", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5830", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo knee-shin pneum/swg pha", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multi-axial knee/shin system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Addition endoskletl knee-shi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5845", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin sys stance flexion", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5848", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin sys hydraul stance", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5850", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo ak/hip knee extens assi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5855", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mech hip extension assist", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5856", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elec knee-shin swing/stance", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5857", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elec knee-shin swing only", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5858", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Stance phase only", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5859", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Knee-shin pro flex/ext cont", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5910", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, below knee, alignable system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo below knee alignable sy", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, above knee or hip disarticulation, alignable system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo ak/hip alignable system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5925", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above knee manual lock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5926", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endoskel posit rotat unit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, high activity knee control frame", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "High activity knee frame", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5940", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo bk ultra-light material", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5950", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo ak ultra-light material", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5960", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo hip ultra-light materia", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5961", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endo poly hip, pneu/hyd/rot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5962", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, below knee, flexible protective outer surface covering system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below knee flex cover system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5964", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, above knee, flexible protective outer surface covering system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above knee flex cover system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5966", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hip flexible cover system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5968", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multiaxial ankle w dorsiflex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5969", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ak/ft power asst incl motors", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, foot, external keel, sach foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Foot external keel sach foot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5971", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sach foot, replacement", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5972", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, foot, flexible keel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flexible keel foot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5973", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ank-foot sys dors-plant flex", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5974", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, foot, single axis ankle/foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Foot single axis ankle/foot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5975", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prosthesis, combination single axis ankle and flexible keel foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Combo ankle/foot prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5976", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Energy storing foot", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5978", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, foot, multiaxial ankle/foot", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ft prosth multiaxial ankl/ft", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5979", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multi-axial ankle/ft prosth", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, flex foot system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flex foot system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, flex-walk system or equal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flex-walk sys low ext prosth", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All exoskeletal lower extremity prostheses, axial rotation unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Exoskeletal axial rotation u", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5984", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Endoskeletal axial rotation", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5985", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "All endoskeletal lower extremity prostheses, dynamic prosthetic pylon", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lwr ext dynamic prosth pylon", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5986", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multi-axial rotation unit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5987", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prosthesis, shank foot system with vertical loading pylon", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shank ft w vert load pylon", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5988", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower limb prosthesis, vertical shock reducing pylon feature", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Vertical shock reducing pylo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prosthesis, user adjustable heel height", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "User adjustable heel height", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5991", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to lower extremity prostheses, osseointegrated external prosthetic connector", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Low pros ext osseo connector", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5992", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "All lower extremity prosthesis, foot shell for modular foot/non-solid ankle cushion heel (sach) replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Low prosth foot shell repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L5999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Lower extremity prosthesis, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Lowr extremity prosthes nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6000", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Partial hand, thumb remaining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part hand thumb rem", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6010", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Partial hand, little and/or ring finger remaining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part hand little/ring", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6020", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Partial hand, no finger remaining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part hand no fingers", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part hand disart myoelectric", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part hand myo exclu term dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6028", "actionCode": "B = Change in both administrative data field and long description of procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "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, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part hand finger metacar amp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6029", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, test socket/interface, partial hand including fingers", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test interface part handfing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6030", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, external frame, partial hand including fingers", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "External frame part handfing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6031", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Rep interface handfng molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6032", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part handfng ultralite tcf/=", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6033", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, partial hand including fingers, acrylic material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part handfing acrylic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6034", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at distal to metacarpal joint, including flexible or non-flexible interface, molded to patient model, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Part hand finger distal amp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6035", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Single prosthetic digit, mechanical, can include metacarpophalangeal (mcp), proximal interphalangeal (pip), and/or distal interphalangeal (dip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prosthetic digit mechanical", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6036", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Prosthetic thumb, mechanical, can include metacarpophalangeal (mcp), interphalangeal (ip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prosthetic thumb mechanical", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6037", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dsg cast chg handfing", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6038", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to single prosthetic digit or thumb, mechanical, attachment, multiaxial and/or internal/external rotation/abduction/adduction mechanism, with or without locking feature, any material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multiax rotation attachment", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6039", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Passive prosthetic digit or thumb prosthesis not including hand restoration partial hand, full or partial, custom made, any material, initial or replacement, per single passive prosthetic digit or thumb", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Passive custom digit/thumb", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Wrst mld sck flx hng tri pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Wrst mold sock w/exp interfa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Below elbow, molded socket, flexible elbow hinge, triceps pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elb mold sock flex hinge pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Below elbow, molded socket, (muenster or northwestern suspension types)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow mold sock suspension t", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Below elbow, molded double wall split socket, step-up hinges, half cuff", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow mold doub splt soc ste", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Below elbow, molded double wall split socket, stump activated locking hinge, half cuff", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow stump activated lock h", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow disarticulation, molded socket, outside locking hinge, forearm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow mold outsid lock hinge", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow molded w/ expand inter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Above elbow, molded double wall socket, internal locking elbow, forearm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow inter loc elbow forarm", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shlder disart int lock elbow", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder disarticulation, passive restoration (complete prosthesis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shoulder passive restor comp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder disarticulation, passive restoration (shoulder cap only)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shoulder passive restor cap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thoracic intern lock elbow", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Interscapular thoracic, passive restoration (complete prosthesis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thoracic passive restor comp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Interscapular thoracic, passive restoration (shoulder cap only)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Thoracic passive restor cap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dsg cast chg wrst/elb", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6382", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dsg cast chg elb dis/", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6384", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop dsg cast chg shlder/t", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6386", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, each additional cast change and realignment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop ea cast chg & realign", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6388", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Immediate post surgical or early fitting, application of rigid dressing only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Postop applicat rigid dsg on", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below elbow prosth tiss shap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elb disart prosth tiss shap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above elbow prosth tiss shap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shldr disar prosth tiss shap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Scap thorac prosth tiss shap", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Wrist/elbow bowden cable mol", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6582", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Wrist/elbow bowden cbl dir f", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6584", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow fair lead cable molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6586", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow fair lead cable dir fo", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6588", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shdr fair lead cable molded", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shdr fair lead cable direct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity additions, polycentric hinge, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Polycentric hinge pair", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity additions, single pivot hinge, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Single pivot hinge pair", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity additions, flexible metal hinge, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flexible metal hinge pair", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6611", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, external powered, additional switch, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Additional switch, ext power", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6615", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, disconnect locking wrist unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Disconnect locking wrist uni", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, additional disconnect insert for locking wrist unit, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Disconnect insert locking wr", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, flexion/extension wrist unit, with or without friction", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flexion/extension wrist unit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flex/ext wrist w/wo friction", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6623", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, spring assisted rotational wrist unit with latch release", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spring-ass rot wrst w/ latch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, flexion/extension and rotation wrist unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Flex/ext/rotation wrist unit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6625", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, rotation wrist unit with cable lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Rotation wrst w/ cable lock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6628", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, quick disconnect hook adapter, otto bock or equal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Quick disconn hook adapter o", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6629", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lamination collar w/ couplin", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6630", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, stainless steel, any wrist", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Stainless steel any wrist", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6632", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, latex suspension sleeve, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Latex suspension sleeve each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6635", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, lift assist for elbow", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lift assist for elbow", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6637", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, nudge control elbow lock", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Nudge control elbow lock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6638", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elec lock on manual pw elbow", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6640", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity additions, shoulder abduction joint, pair", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shoulder abduction joint pai", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6641", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, excursion amplifier, pulley type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Excursion amplifier pulley t", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6642", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, excursion amplifier, lever type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Excursion amplifier lever ty", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6645", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, shoulder flexion-abduction joint, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shoulder flexion-abduction j", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6646", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Multipo locking shoulder jnt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6647", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, shoulder lock mechanism, body powered actuator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shoulder lock actuator", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6648", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, shoulder lock mechanism, external powered actuator", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ext pwrd shlder lock/unlock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6650", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, shoulder universal joint, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shoulder universal joint", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6655", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, standard control cable, extra", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Standard control cable extra", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6660", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, heavy duty control cable", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Heavy duty control cable", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6665", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, teflon, or equal, cable lining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Teflon or equal cable lining", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6670", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, hook to hand, cable adapter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hook to hand cable adapter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6672", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, harness, chest or shoulder, saddle type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Harness chest/shlder saddle", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6675", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, harness, (e.g., figure of eight type), single cable design", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Harness figure of 8 sing con", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6676", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, harness, (e.g., figure of eight type), dual cable design", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Harness figure of 8 dual con", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6677", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ue triple control harness", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6680", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, test socket, wrist disarticulation or below elbow", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test sock wrist disart/bel e", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6682", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, test socket, elbow disarticulation or above elbow", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test sock elbw disart/above", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6684", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Test socket shldr disart/tho", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6686", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, suction socket", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Suction socket", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6687", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, frame type socket, below elbow or wrist disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Frame typ socket bel elbow/w", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6688", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, frame type socket, above elbow or elbow disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Frame typ sock above elb/dis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6689", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, frame type socket, shoulder disarticulation", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Frame typ socket shoulder di", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6690", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, frame type socket, interscapular-thoracic", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Frame typ sock interscap-tho", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6691", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, removable insert, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Removable insert each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6692", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Silicon gel insert w/wo lock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6693", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, locking elbow, forearm counterbalance", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lockingelbow forearm cntrbal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6694", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow socket ins use w/lock", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6695", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow socket ins use w/o lck", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6696", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "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)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cus elbo skt in for con/atyp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6697", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "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)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cus elbo skt in not con/atyp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6698", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, lock mechanism, excludes socket insert", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add up-ex prosthes lock mech", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ue add ext power myoel", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6703", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, passive hand/mitt, any material, any size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev, passive hand mitt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6704", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, sport/recreational/work attachment, any material, any size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev, sport/rec/work att", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6706", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev mech hook vol open", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6707", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev mech hook vol close", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6708", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hand, mechanical, voluntary opening, any material, any size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev mech hand vol open", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6709", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hand, mechanical, voluntary closing, any material, any size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev mech hand vol close", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6711", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ped term dev, hook, vol open", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6712", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ped term dev, hook, vol clos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6713", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ped term dev, hand, vol open", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6714", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ped term dev, hand, vol clos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6715", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term device, multi art digit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hook/hand, hvy dty, vol open", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6722", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hook/hand, hvy dty, vol clos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6805", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Addition to terminal device, modifier wrist unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev modifier wrist unit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Addition to terminal device, precision pinch device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev precision pinch dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6880", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elec hand ind art digits", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6881", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Automatic grasp feature, addition to upper limb electric prosthetic terminal device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Term dev auto grasp feature", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6882", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Microprocessor control feature, addition to upper limb prosthetic terminal device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Microprocessor control uplmb", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6883", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replc sockt below e/w disa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6884", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replc sockt above elbow disa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6885", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replc sockt shldr dis/interc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prefab glove for term device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6895", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Custom glove for term device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hand restorat thumb/1 finger", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6905", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "C = Carrier judgment", "longDescription": "Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hand restoration multiple fi", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6910", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hand restoration no fingers", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6915", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Hand restoration (shading, and measurements included), replacement glove for above", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hand restoration replacmnt g", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6920", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Wrist disarticul switch ctrl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6925", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Wrist disart myoelectronic c", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below elbow switch control", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6935", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Below elbow myoelectronic ct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6940", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow disarticulation switch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6945", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow disart myoelectronic c", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above elbow switch control", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6955", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Above elbow myoelectronic ct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shldr disartic switch contro", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6965", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shldr disartic myoelectronic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Interscapular-thor switch ct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L6975", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "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", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Interscap-thor myoelectronic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Electric hand, switch or myoelectric controlled, adult", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Adult electric hand", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Electric hand, switch or myoelectric, controlled, pediatric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pediatric electric hand", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Electric hook, switch or myoelectric controlled, adult", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Adult electric hook", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Prehensile actuator, switch controlled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prehensile actuator", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Electric hook, switch or myoelectric controlled, pediatric", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pediatric electric hook", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic elbow, hosmer or equal, switch controlled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electronic elbow hosmer swit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic elbow, microprocessor sequential control of elbow and terminal device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electronic elbow sequential", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic elbow, microprocessor simultaneous control of elbow and terminal device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electronic elbo simultaneous", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic elbow, adolescent, variety village or equal, switch controlled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electron elbow adolescent sw", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic elbow, child, variety village or equal, switch controlled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electron elbow child switch", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic elbow, adolescent, variety village or equal, myoelectronically controlled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow adolescent myoelectron", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7191", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic elbow, child, variety village or equal, myoelectronically controlled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Elbow child myoelectronic ct", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Electronic wrist rotator, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electronic wrist rotator any", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "L7259", "longDescription": "Electronic wrist rotator, otto bock or equal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electron wrist rotator otto", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "L7259", "longDescription": "Electronic wrist rotator, for utah arm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Electron wrist rotator utah", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Six volt battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Six volt bat otto bock/eq ea", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7362", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Battery charger, six volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Battery chrgr six volt otto", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Twelve volt battery, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Twelve volt battery utah/equ", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7366", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "C = Carrier judgment", "longDescription": "Battery charger, twelve volt, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Battery chrgr 12 volt utah/e", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7367", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Lithium ion battery, rechargeable, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Replacemnt lithium ionbatter", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7368", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "C = Carrier judgment", "longDescription": "Lithium ion battery charger, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lithium ion battery charger", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add ue prost be/wd, ultlite", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add ue prost a/e ultlite mat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add ue prost s/d ultlite mat", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7403", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add ue prost b/e acrylic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add ue prost a/e acrylic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add ue prost s/d acrylic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7406", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Addition to upper extremity prosthesis, user adjustable, mechanical, residual limb volume management system (with or without lamination kit)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Add upp ext mec limb vol lam", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Upper extremity prosthesis, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Upper extremity prosthes nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Repair of prosthetic device, repair or replace minor parts", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Prosthetic device repair rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Repair prosthetic device, labor component, per 15 minutes", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Repair prosthesis per 15 min", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Prosthetic donning sleeve, any material, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prosthetic donning sleeve", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Gasket or seal, for use with prosthetic socket insert, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pros soc insert gasket/seal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Male vacuum erection system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Male vacuum erection system", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L7902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Tension ring, for vacuum erection device, any type, replacement only, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tension ring, vac erect dev", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mastectomy bra", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Breast prosthesis bra & form", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Brst prsth bra & bilat form", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breast prosthesis, mastectomy sleeve", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mastectomy sleeve", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "External breast prosthesis garment, with mastectomy form, post mastectomy", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ext breastprosthesis garment", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breast prosthesis, mastectomy form", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mastectomy form", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breast prosthesis, silicone or equal, without integral adhesive", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Breast prosthes w/o adhesive", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Breast prosthesis, silicone or equal, with integral adhesive", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Breast prosthesis w adhesive", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Nipple prosthesis, prefabricated, reusable, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Reusable nipple prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Nipple prosthesis, custom fabricated, reusable, any material, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Nipple prosthesis custom, ea", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Custom breast prosthesis, post mastectomy, molded to patient model", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Custom breast prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Breast prosthesis, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Breast prosthesis nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Nasal prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Nasal prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Midfacial prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Midfacial prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Orbital prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Orbital prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Upper facial prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Upper facial prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Hemi-facial prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hemi-facial prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Auricular prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Auricular prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Partial facial prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Partial facial prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Nasal septal prosthesis, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Nasal septal prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Unspecified maxillofacial prosthesis, by report, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Unspec maxillofacial prosth", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Repair maxillofacial prosth", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Truss, single with standard pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Truss single w/ standard pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Truss, double with standard pads", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Truss double w/ standard pad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Truss, addition to standard pad, water pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Truss addition to std pad wa", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Truss, addition to standard pad, scrotal pad", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Truss add to std pad scrotal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sheath, below knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sheath below knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sheath, above knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sheath above knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8415", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sheath, upper limb, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Sheath upper limb", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8417", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1997", "coverageCode": "C = Carrier judgment", "longDescription": "Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pros sheath/sock w gel cushn", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sock, multiple ply, below knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prosthetic sock multi ply bk", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sock, multiple ply, above knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prosthetic sock multi ply ak", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sock, multiple ply, upper limb, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pros sock multi ply upper lm", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8440", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic shrinker, below knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shrinker below knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic shrinker, above knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shrinker above knee", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1988", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic shrinker, upper limb, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shrinker upper limb", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sock, single ply, fitting, below knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pros sock single ply bk", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sock, single ply, fitting, above knee, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pros sock single ply ak", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1999", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic sock, single ply, fitting, upper limb, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pros sock single ply upper l", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "C = Carrier judgment", "longDescription": "Unlisted procedure for miscellaneous prosthetic services", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Unlisted misc prosthetic ser", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Artificial larynx, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Artificial larynx", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tracheostomy speaking valve", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tracheostomy speaking valve", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Artificial larynx replacement battery / accessory, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Artificial larynx, accessory", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheo-esophageal voice prosthesis, patient inserted, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Trach-esoph voice pros pt in", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Trach-esoph voice pros md in", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Voice amplifier", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Voice amplifier", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Indwelling trach insert", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Gel cap for trach voice pros", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Trach pros cleaning device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Tracheoesophageal puncture dilator, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl trach puncture dilator", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)", "shortDescription": "Gel cap app device for trach", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable breast prosthesis, silicone or equal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Implant breast silicone/eq", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1995", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Collagen imp urinary 2.5 ml", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dextranomer/hyaluronic acid", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8605", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Inj bulking agent anal canal", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8606", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Synthetic implnt urinary 1ml", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8607", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Inj vocal cord bulking agent", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8608", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Arg ii ext com/sup/acc misc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8609", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Artificial cornea", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Artificial cornea", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ocular implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ocular implant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q0074", "longDescription": "Aqueous shunt", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Aqueous shunt prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ossicula implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ossicular implant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8614", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cochlear device, includes all internal and external components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cochlear device", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Headset/headpiece for use with cochlear implant device, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Coch implant headset replace", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8616", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Microphone for use with cochlear implant device, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Coch implant microphone repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8617", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transmitting coil for use with cochlear implant device, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Coch implant trans coil repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8618", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Coch implant tran cable repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8619", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cochlear implant, external speech processor and controller, integrated system, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Coch imp ext proc/contr rplc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl zinc air battery", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Alkaline battery for use with cochlear implant device, any size, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Repl alkaline battery", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8623", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lith ion batt cid,non-earlvl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "C = Carrier judgment", "longDescription": "Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lith ion batt cid, ear level", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Charger coch impl/aoi battry", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cochlear implant, external speech processor, component, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cid ext speech process repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cochlear implant, external controller component, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cid ext controller repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transmitting coil and cable, integrated, for use with cochlear implant device, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cid transmit coil and cable", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Metacarpophalangeal joint implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Metacarpophalangeal implant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mcp joint repl 2 pc or more", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8641", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Metatarsal joint implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Metatarsal joint implant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8642", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "Q0073", "longDescription": "Hallux implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Hallux implant", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8658", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Interphalangeal joint spacer, silicone or equal, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Interphalangeal joint spacer", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8659", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Interphalangeal joint repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8670", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 1997", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Vascular graft material, synthetic, implant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Vascular graft, synthetic", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8678", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Electrical stimulator supplies (external) for use with implantable neurostimulator, per month", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ext sply implt neurostim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8679", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable neurostimulator, pulse generator, any type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Imp neurosti pls gn any type", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8680", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Implantable neurostimulator electrode, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implt neurostim elctr each", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8681", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pt prgrm for implt neurostim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8682", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Implantable neurostimulator radiofrequency receiver", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Implt neurostim radiofq rec", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8683", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Radiofq trsmtr for implt neu", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8684", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Radiof trsmtr implt scrl neu", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8685", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Implantable neurostimulator pulse generator, single array, rechargeable, includes extension", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implt nrostm pls gen sng rec", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8686", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implt nrostm pls gen sng non", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8687", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implt nrostm pls gen dua rec", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8688", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implt nrostm pls gen dua non", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8689", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "External recharging system for battery (internal) for use with implantable neurostimulator, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "External recharg sys intern", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8690", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Auditory osseointegrated device, includes all internal and external components", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Aud osseo dev, int/ext comp", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8691", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Aoi snd proc repl excl actua", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8692", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-osseointegrated snd proc", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8693", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Auditory osseointegrated device abutment, any length, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Aud osseo dev, abutment", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8694", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Auditory osseointegrated device, transducer/actuator, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Aoi transducer/actuator repl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8695", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "External recharging system for battery (external) for use with implantable neurostimulator, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "External recharg sys extern", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8696", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ext antenna phren nerve stim", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8698", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Miscellaneous component, supply or accessory for use with total artificial heart system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Misc used with tot art heart", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8699", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1998", "coverageCode": "C = Carrier judgment", "longDescription": "Prosthetic implant, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Prosthetic implant nos", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8701", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ewh s/d uprt micro sensor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Ewhf s/d uprt micro sensor", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8720", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "External lower extremity sensory prosthetic device, cutaneous stimulation of mechanoreceptors proximal to the ankle, per leg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Ext low ext sens prosthe mec", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "L8721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Receptor sole for use with l8720, replacement, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Receptor sole l8720 replace", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "L9900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "C = Carrier judgment", "longDescription": "Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs \"l\" code", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "O&p supply/accessory/service", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "M0001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Advancing cancer care mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Advancing cancer care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Optimal care for kidney health mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Opt care kidney hlth mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Optimal care for patients with episodic neurological conditions mips value pathways", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Opt care episod neuro mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Quality care for patients with neurological conditions mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Qual care neurologic cnd mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Value in primary care mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Value in primary care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0010", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eom meos payment", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0064", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Visit for drug monitoring", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0075", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Cellular therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cellular therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0076", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Prolotherapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prolotherapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Intragastric hypothermia using gastric freezing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intragastric hypothermia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "June 08, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Pne flu hepb cov home admin", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 08, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Tixagev and cilgav inj", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 08, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Tixagev and cilgav inj hm", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 11, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous injection, bebtelovimab, includes injection and post administration monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bebtelovimab injection", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 11, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bebtelovimab injection home", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 22, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 22, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Pemivibart infusion", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0233", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Intra inf, toci, first dose", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0234", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Intra inf, toci, second dos", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0235", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, first dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Intrav inf, mon anti, fir do", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0236", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, second dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Intrav inf, mon anti, sec do", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0237", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 24, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 24, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Intrav inf, toci, first dose", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0238", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 24, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 24, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Intrav inf, toci, second dos", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 17, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 09, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bamlanivimab-xxxx infusion", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 30, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Casiri and imdev repeat", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0241", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 30, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Casiri and imdev repeat hm", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 21, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Casirivi and imdevi inj", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 06, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Casirivi and imdevi inj hm", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 14, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 09, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bamlan and etesev infusion", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 14, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 06, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider based to the hospital during the covid 19 public health emergency", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bamlan and etesev infus home", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 26, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, sotrovimab, includes infusion and post administration monitoring", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Sotrovimab infusion", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0248", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 26, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Sotrovimab inf, home admin", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "June 24, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "June 24, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Adm tocilizu covid-19 1st", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "June 24, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "June 24, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Adm tocilizu covid-19 2nd", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "M0300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Iv chelation therapy (chemical endarterectomy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Iv chelationtherapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M0301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Fabric wrapping of abdominal aneurysm", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fabric wrapping of aneurysm", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "M1000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Pain screened as moderate to severe", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pain scr as mod to sevr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pln to adrs pain doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Plan of care for moderate to severe pain not documented on or before the date of the second visit with a clinician, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pln to adrs pain not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tb scr 12 mo pri fst bio dz", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no srn tb", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Tb screening not performed or results not interpreted, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tb scr no perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Disease activity not assessed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dz not ases, no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": ">=50% of total number of a patient's outpatient ra encounters assessed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": ">=50% total pt outpt ra enct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "<50% of total number of a patient's outpatient ra encounters assessed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "<50% total pt outpt ra encts", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge/discontinuation of the episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge/discontinuation of the episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge/discontinuation of the episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge/discontinuation of the episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge/discontinuation of the episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge/discontinuation of the episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc epi care doc medrec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Discharge/discontinuation of the episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dc eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Female patients unable to bear children", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx meop or sur steri", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient admitted to palliative care services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt admt to palitve serv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung cancer screening patients", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx hst cr pt sk lg cr scr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adl pt mj dep ds rs 12 phq<5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score was not assessed or is greater than or equal to 5", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adl pt mj dep ds no rs 12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had only urgent care visits during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt uc in pp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were in hospice at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hospice during perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adl pt mj dep ds rs 6 phq<5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adl pt mj dep ds no rs 6 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were in hospice at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hospice during perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were in hospice at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hospice during perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Imaging of the head (ct or mri) was obtained", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Img head (ct or mri) obtnd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc of pt prm hda dx and otr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Imaging of the head (ct or mri) was not obtained, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc sysm rsn img hd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt clin ind img hd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with no clinical indications for imaging of the head", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt clin ind img hd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adults currently taking pharmacotherapy for oud", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adt tkng pharmthry for oud", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Pharmacotherapy for oud initiated after june 30th of performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pharmthry for oud afr 6.30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adt 180 dys pharmthry oud", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adt pd out mat pr 180 dys tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adt no 180 dys pharmthry oud", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of lumbar spine region cancer at the time of the procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx lum sp reg cacr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of lumbar spine region fracture at the time of the procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx lum sp reg fract", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of lumbar spine region infection at the time of the procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx lum sp reg inf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of lumbar idiopathic or congenital scoliosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx lum idi or cong scol", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt cr ft inf lm or pt id sl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ftl st mea sco ot odi 3 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs no odi 9-15mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ftl st mea odi 3 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs oks 9-15mo >= 37 >= 71", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs oks 9-15mo < 37 < 71", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status was measured by the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs msrd oks pre and post", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fsm wth scr odi pre and post", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs wth scr no odi pre and p", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs msrd odi pre and post", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/cancer scoliosis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lg pn not meas w/ vas 1yr po", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre and post vas wthn 3 mos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had only urgent care visits during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt uc in pp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Aspirin or another antiplatelet therapy used", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aspirin used", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Presc antico med in pp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Aspirin or another antiplatelet therapy not used, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aspirin not used, no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was a permanent nursing home resident at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt prm nurs hm res in pp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1059", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was in hospice or receiving palliative care at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no prm nurs hm res in pp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient died prior to the end of the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died in pp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient pregnancy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt preg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1062", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient immunocompromised", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt imcomprmd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1063", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patients receiving high doses of immunosuppressive therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rec hg dos imsup thpy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1064", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Shingrix vaccine documented as administered or previously received", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shing vac doc adm or pv rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shing vac no adm clinc rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1066", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Shingrix vaccine not documented as administered, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Shing vac no doc no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1067", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services for patient provided any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hspc pt prv time meam per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1068", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Adults who are not ambulatory", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not ambulatory", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1069", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for future fall risk", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scr ft fall rsk", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not screened for future fall risk, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not scrn fut fall no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt had add'l sp pcr perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "The start of an episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Start eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1107", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docu dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt home prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1109", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt dc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc not p pt selfdc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "The start of an episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Start eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docu dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt home prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt dc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt selfdc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1116", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "The start of an episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Start eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docu dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1118", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt home prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1119", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt dc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt selfdc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "The start of an episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Start eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docu dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1123", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt home prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1124", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt dc 1-2 vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1125", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt selfdc 1-2 vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "The start of an episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Start eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1127", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docu dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt home prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt dc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt selfdc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docu dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt home prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1133", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt dc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1134", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt selfdc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "The start of an episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Start eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "The start of an episode of care documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Start eoc doc med rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Docu dx degen neuro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt 1-2 vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt self dc 1-2 vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make the treatment episode impossible such as the patient becomes hospitalized or scheduled for surgery for surgery or hospitalized", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc ni pt dc 1-2 vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Functional status was not measured by the oxford knee score (oks) or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) at one year (9 to 15 months) postoperatively", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fs no oks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1142", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Emergent cases", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Emerge cases", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1143", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ni rehab med chiro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oc no ind pt 1-2 vis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "February 28, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mfn drug add-on, per dose", "typeOfServiceCode": "1 = Medical care\n\nF = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "M1146", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ongoing care not ind", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1147", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Care not poss med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt self dschg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1149", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility, and an adequate proxy is not available", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No neck fs prom incap", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Current or prior left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lvef <=40% or mod/sev l vsf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a history of heart transplant or with a left ventricular assist device (lvad)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ hx trnsplt or lvad", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a history of heart transplant or with a left ventricular assist device (lvad)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ hx trnsplt or lvad", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1153", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient with diagnosis of osteoporosis on date of encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ dx osteo doe", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1154", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services provided to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospc serv dur meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt anphx due to pneum", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received active chemotherapy any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd actv chemo any time", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received bone marrow transplant any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd bone mar trnsplt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1158", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had history of immunocompromising conditions prior to or during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hx immcomp prior/dur pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1159", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services provided to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospc serv dur meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt anphx due to mengb bef 13", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt anphx due to dtp bef 13", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt enceph due to dtp bef 13", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1163", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt anphx due to hpv bef 13", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with dementia any time during the patient's history through the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ dementia any time", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who use hospice services any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt use hspc dur meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1166", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology report for tissue specimens produced from wide local excisions or re-excisions", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Path rpt tis spec wle/reexc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1167", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "In hospice or using hospice services during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hspc dur meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1168", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd flu vax 7/1-6/30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1169", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no flu vax", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/o flu vax 7/1-6/30", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd 1 td/tdap 9yrs prior", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no td/tdap", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1173", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no rec td/tdap 9yrs prior", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1174", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ 2 hzv 10/2017 - mp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no hzv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1176", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No 2 hzv 10/2017-meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recd pcv on/aft 19", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1178", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no pcv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1179", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pcv recd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients on immune checkpoint inhibitor therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt imm ckpt inhib therapy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Grade 2 or above diarrhea and/or grade 2 or above colitis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gr 2 or> dia or gr2 or> col", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not elg pre ex ibd/uc/crohn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1183", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc imm ckpt inhib hld", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1184", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn no cst/ist rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Imm ckpt inhib not hld no rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have an order for or are receiving hospice or palliative care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ rx for hspc/plltv care", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1187", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of end stage renal disease (esrd)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ esrd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1188", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of chronic kidney disease (ckd) stage 5", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ ckd stg 5", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1189", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc khe pef w/efgr/uacr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc khe not pef w/efgr/uacr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1191", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services provided to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hspc svc any time in meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1192", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an existing diagnosis of squamous cell carcinoma of the esophagus", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ dx sq cell ca of esoph", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1193", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rpts w/ imp/con mmr/msi", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1194", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no imp/con mmr/msi", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1195", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rpt wo imp/con mmr/msi", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1196", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ixv nrs vrs iqa >=4", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Isa reduced >=3 fr ixv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1198", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Isa not red 3pts /no assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patients receiving rrt", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rec'g rrt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ace-i/arb rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no ace-i/arb rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rsn no ace-i/arb rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rsn ace-i/arb rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ixv nrs vrs iqa >=4", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Isa reduced >=3", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Isa not red 3pts/no assess", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scrn sdoh", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no scrn sdoh", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": ">=2 same hi-rsk med w/o diag", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "At least two orders for high-risk medications from the same drug class, (table 4), not ordered", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": ">=2 same meds tbl4 not ord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent glycemic status assessment (hba1c or gmi) level > 9.0%", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gsa level>9.0%", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Missing gsa not perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No hx spiro prs spiro>=70%", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spiro results wth obs doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn for no doc spiro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1216", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No spiro doc no res doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1217", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sys rsn no doc spiro", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt copd symptoms", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1219", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Anaphylaxis due to the vaccine on or before the date of the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anphx due to vax", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dre wth interp rtnopthy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dre w/o rtnopthy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Glaucoma plan of care not documented, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Glaucoma pln of care not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1223", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Glaucoma plan of care documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Glaucoma plan of care doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Iop dec <20% from base", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Iop dec>=20% from base", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1226", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Iop measurement not documented, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Iop not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1227", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Evidence-based therapy was prescribed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eb therapy prescribed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1228", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt + hcv aby +vir w/ rx 3 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1229", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ +hcv +vir ref win 1 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hcv rctv aby no f/u tst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receives hcv antibody test with nonreactive result", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hcv tst no reactive res", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1232", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient receives hcv antibody test with reactive result", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hcv tst reactive result", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1233", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no hcv aby or result", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1234", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hcv rctv aby f/u neg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt hcv aby rna tst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1236", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Baseline mrs > 2", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Baseline mrs > 2", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1237", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rsn no scrn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1238", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc 2nd recom hzv 2-6 mo int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not respond to the question of patient felt heard and understood by this provider and team", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no resp heard", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no resp best int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1241", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no resp seen as person", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1242", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no resp imprt to me", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient provided a response other than \"completely true\" for the question of patient felt heard and understood by this provider and team", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt othr thn true heard", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient provided a response other than \"completely true\" for the question of patient felt this provider and team put my best interests first when making recommendations about my care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt othr thn true best int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient provided a response other than \"completely true\" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt othr thn true person", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient provided a response other than \"completely true\" for the question of patient felt this provider and team understood what is important to me in my life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt othr thn true imprt to me", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient responded \"completely true\" for the question of patient felt this provider and team put my best interests first when making recommendations about my care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt resp true best int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient responded \"completely true\" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt resp true seen as person", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient responded \"completely true\" for the question of patient felt this provider and team understood what is important to me in my life", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt resp true imprt to me", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient responded as \"completely true\" for the question of patient felt heard and understood by this provider and team", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt resp true heard", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts proxy cmplt hu surv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no cmplt hu survey", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1253", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts hu surv no amb plltv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1254", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were deceased when the hu survey reached them", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts deceased prior hu surv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts w/ othr rsn vst,+prg tst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1256", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Prior history of known cvd", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prior history of known cvd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cvd risk assess not perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1258", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Cvd risk assessment performed, have a documented calculated risk score", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cvd risk assess perf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient status documented within the first year of initiating dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt stat doc <= 1 yr dialysis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient status not documented within the first year of initiating dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not doc <= 1 yr dialysis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts on wtlist bef dialysis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had a transplant prior to initiation of dialysis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts transplt bef dialysis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1263", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients in hospice on their initiation of dialysis date or during the month of evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts hosp dialysis dt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1264", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients age 75 or older on their initiation of dialysis date", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts 75+ dialysis dt", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Cms medical evidence form 2728 for dialysis patients: initial form completed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cms 2728 completed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients admitted to a skilled nursing facility (snf)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts admit snf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1267", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients not observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no act kid transplt wtlst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1268", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ac stat kid trnsplt wtlst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1269", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Receiving esrd mcp dialysis services by the provider on the last day of the reporting month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rec'd esrd mcp lst day of mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no kid transplt wtlst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with dementia at any time prior to or during the month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts dem any time/dur mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts kid transplt wtlst", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1273", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts snf 1 yr dialysis", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts snf exl mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts hosp exl", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1276", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi documented outside normal parameters, no follow-up plan documented, no reason given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi out nrm param nof/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1277", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Colorectal cancer screening results documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Colorectal ca screen doc rev", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1278", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-htn or htn doc, f/u indc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1279", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pre-htn/htn, no f/u, not gvn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bilat mast/hx bi /unilat mas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Blood pressure reading not documented, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp scrn no perf at interval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1282", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for tobacco use and identified as a tobacco non-user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scrn tbco id as non user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1283", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for tobacco use and identified as a tobacco user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scrn tbco and id as user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1284", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ snp or ltc pos > 90d", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrn mam perf rslts not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1286", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmi doc onl fup not cmpltd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1287", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented below normal parameters and a follow-up plan is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi blw low param f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1288", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documented reason for not screening or recommending a follow-up for high blood pressure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc rsn no hbp scrn or f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1289", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pt tbco cess interv rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not eligible due to active diagnosis of hypertension", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not eli d/t act dig htn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1291", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frailty and med dem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1292", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt 66+ frail inpt adv ill", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1293", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented above normal parameters and a follow-up plan is documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi abv up param f/u", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1294", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Normal blood pressure reading documented, follow-up not required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bp scrn perf rec interval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1295", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis or past history of total colectomy or colorectal cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hx tot col or colon ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1296", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi is documented within normal parameters and no follow-up plan is required", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calc bmi norm parameters", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1297", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi not documented due to medical reason or patient refusal of height or weight measurement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmi not doc medrsn ptref", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1298", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt preg dur msrmt pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Influenza immunization administered or previously received", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flu immunize order/admin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flu imm no admin doc rea", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt recv tbco cess interv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scrn mam perf rslts doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1303", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Hospice services provided to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospc serv dur meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pneum vax admin 19+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pneum vax admin 19+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt anphx due to pneum", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1307", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation stating the patient has received or is currently receiving palliative or hospice care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pt pal or hospice", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1308", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Influenza immunization was not administered, reason not given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flu immunize no admin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1309", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Palliative care services provided to patient any time during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pall serv during meas", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt scr tob & cess int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1311", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Anaphylaxis due to the vaccine on or before the date of the encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Aphlx to vax bef enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient not screened for tobacco use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pt tbco scrn rng", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No tob scr/cess int", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1314", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Bmi not documented and no reason is given", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmi not calculated", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Crc no doc no rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Current tobacco non-user", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tobacco non-user", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1317", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are counseled on connection with a csp and explicitly opt out", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts counsl cpt opt out", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1318", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or documentation that there was no contact with a csp", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no csp doc contact", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1319", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts csp doc contact", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who screened positive for at least 1 of the 5 hrsns", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts scrn + hrsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no 7wk inj,no iop,iop>25", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1322", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts 7wk inj, scrn iop =<25", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1323", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts 7wk inj, scrn iop >25", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1324", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts intravitreal/pci", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn not seen", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of hypotony", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts dx hypotony", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no eval ini xm no 8 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis of acute vitreous hemorrhage", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts dx acute vitreous hem", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acute pvd encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts act pvd 2 wks 8 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pts rsn no f/u xm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1331", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts eval ini xm 8 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1332", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no eval ini xm no 2 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1333", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Acute vitreous hemorrhage", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute vitreous hemorrhage", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1334", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts act pvd 2 wks 2 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1335", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc pts rsn no f/u xm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1336", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts eval ini xm 2 wks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1337", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Acute pvd", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute pvd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1338", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt f/u 30-180 dys no + imprv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1339", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts f/u 30-180 dys + improv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Indx whodas 2.0 or sds", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no f/u 30-180 dys", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts died perf per", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1343", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt pam lvl 4 base or srt lin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1344", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No bsln/2nd pam score 4-12mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1345", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt bsln pam, 2nd scr 4-12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1346", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pam inc 6 pts 4-12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1347", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt pam incr 3 pt 4-12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1348", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pam incr 6 pt 4-12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1349", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a net increase in pam score of at least 3 points within a 4 to 12 month period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pam inc 3 pts 4-12 mo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ suic saf pln init rev", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt cmplt suicd saf pln 120dy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1352", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Suicd c-ssrs assessment, equ", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no cmplt suicd saf pln", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no suicd saf pln 120dy", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Suicide risk based on their clinician's evaluation or a clinician-rated tool", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Suicd based cln eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1356", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died dur meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/red suic idea 120 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1358", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pts no = 20 percent during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ascvd risk >=20pct", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1365", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Patient encounter during the performance period with hospice and palliative care specialty code 17", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hosp+pall care spec code 17", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1366", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Focusing on women's health mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Focus on women's health mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1367", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Quality care for the treatment of ear, nose, and throat disorders mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Qual care ent disorder mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1368", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prev trt inf d/o hiv/hep mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1369", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Quality care in mental health and substance use disorders mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Qualcare mental hlth/sud mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Rehabilitative support for musculoskeletal care mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rehab support msk care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1371", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent glycemic status assessment (hba1c or gmi) level < 7.0%", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mst rec gsa<7", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0%", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mst rec gsa >=7 and<8", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1373", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0%", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mst rec gsa >=8 and <=9", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1374", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ra dx enc 90 days dur per pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1375", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ra dx enc 90 days dur per pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1376", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ra dx enc 90 days dur per pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1377", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fu colscop 10 yr doc w/ disc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1378", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no 10 yr fu colscope", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1379", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "10 yr fu no rec rsn not giv", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1380", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under \"denominator note\" or the long-acting injectable antipsychotic medications listed under \"denominator note\"", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 rx in perf pd any com meds", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1381", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt sec strk wthin 5 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1382", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patient encounter during the performance period with place of service code 11", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Enc dur perf pd pos 11", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1383", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Acute pvd", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Acute pvd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1384", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died dur perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1385", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reasons for patients who were not seen for the second pam survey (e.g., less than four months between baseline pam assessment and follow-up", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rsn not seen 2nd pam", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1386", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Exc sx melmn or mlnm is", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1387", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died dur perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1388", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with documentation of an exam performed for recurrence of melanoma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt doc exm rec melmn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt no doc exm for rec", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1391", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "All patients who were diagnosed with recurrent melanoma during the current performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "All pt dx w/ rec mlnm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1392", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rsn no exm or lst to fu", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1393", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who were not diagnosed with recurrent melanoma during the current performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pr no dx rec mlnm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1394", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Stages i-iii breast cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stg i-iii br ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1395", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Init chemo w/def dur ec grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1396", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients on a therapeutic clinical trial", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ther clin trial", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1397", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with recurrence/disease progression", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ recur/prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1398", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with baseline and follow-up promis surveys documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bslne and fu promis doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who leave the practice during the follow-up period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt lve prac", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died during the follow-up period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died dur perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Stages i-iii breast cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stg i-iii br ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Init chemo w/def dur ec grp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1403", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with baseline and follow-up promis surveys documented in the medical record", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bslne and fu promis doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients on a therapeutic clinical trial", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt ther clin trial", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with recurrence/disease progression", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt w/ recur/prog", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1406", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who leave the practice during the follow-up period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt lve prac", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1407", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died during the follow-up period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died dur perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1408", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gmln brca bef dx ca", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1409", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Recd gmln brca1/brca2 couns", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No gmln brca1/brca2 couns", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Currently on first-line immune checkpoint inhibitors without chemotherapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "1st ln ici no chemo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1412", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Met nsclc w/ egfr alk oth ab", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1413", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pos pdl1 bef init ici tx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1414", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn no pdl1 bef 1st ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1415", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No pos pdl1 bef ici ther", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1416", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received hospice services any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt rec hosp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1417", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt up to date cov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1418", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med rsn not up to date cov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1419", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt not up to date cov", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Complete ophthalmologic care mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Complete ophthalmologic mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1421", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dermatological care mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dermatological care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1422", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Gastroenterology care mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gastroenterology care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1423", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Optimal care for patients with urologic conditions mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Opt care urologic cnd mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Pulmonology care mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pulmonology care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Surgical care mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surgical care mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1426", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1427", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Doc med rsn bone scn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1428", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bilateral absence of eyes", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1429", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Retinopathy in od, os, ou", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1430", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ret exm ou no retinopthy doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1431", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1432", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1433", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient on oral chemotherapy on or within 30 days before denominator eligible encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oral chemo wthn 30 days enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1434", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient on oral chemotherapy on or within 30 days after denominator eligible encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Orl chemo wthn 30 d post enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1435", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient on oral chemotherapy during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Oral chemo in perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1436", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1437", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1438", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Time last known well to hospital arrival less than or equal to 3.5 hours (<= 210 minutes)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lst knwn well <=210 min", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1439", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Significant ocular conditions that impact the visual outcome of surgery", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sig ocu cond imp surg out", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1440", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1441", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Init dx slp apn = 1st enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1442", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1443", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Encounters conducted via telehealth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth enc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1444", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Delivery at < 39 weeks of gestation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Del < 39 weeks gest", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1445", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Postpartum care visit before or at 12 weeks of giving birth", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pp care visit by 12 weeks", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1446", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who died any time prior to the end of the measure assessment period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died bef end meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1447", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx bd bef end meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1448", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx pd bef end meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1449", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx scz/pys bef end msr pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1450", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hos/pal care dur id/pf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1451", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx ppd dur id/pf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1452", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient ever had a diagnosis of dementia", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx dementia ever", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1453", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a pre-operative visual acuity better than 20/40", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Preop vis acu > 20/40", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1454", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "New cied", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "New cied", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1455", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Replaced or revised cied", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rep/rev cied", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1456", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had a heart transplant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt had htx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1457", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had a diagnosis of asthma with any contact during the current or prior performance period or had asthma present on an active problem list any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dx asth dur crnt/prv perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1458", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient died prior to the end of the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt died bef end meas pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1459", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient was in hospice or receiving palliative care services at any time during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt hosp/pal care dur perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1460", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dx copd, cf, or arf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1461", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient diagnosis for chronic hepatitis c", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx chron hepc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1462", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with clinical indications for imaging of the head", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt clin ind hd image", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1463", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of at least two attempts to follow up with patient within 180 days of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "2 f/u wthn 180 day rx atmp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1464", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "No documentation of at least two attempts to follow up with patient within 180 days of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No record of f/u by 180 days", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1465", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient follow up more than 180 days after treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "F/u > 180 days after rx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1466", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt disc/lam proc same day", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1467", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with an existing diagnosis of lynch syndrome", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx lynch syn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1468", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient received recommended doses of hepatitis b vaccination based on age", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep b vaccine received", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1469", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient has a history of hepatitis b illness or received a hepatitis b surface antigen, hepatitis b surface antibody, or total antibody to hepatitis b core antigen test with a positive result any time before or during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hx of hep b, or pos bld test", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1470", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep b vac not rec'd med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1471", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation that patient is a medicare fee-for-service beneficiary and without additional supplementary insurance coverage for whom hep b vaccination is not reimbursable under current medicare part b coverage rules", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ffs hep b not covered", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1472", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient did not receive recommended doses of hepatitis b vaccination based on age", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hep b vaccine not received", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1473", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt func cap not allow impr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1474", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with diagnosis of dementia", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx dementia", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1475", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with diagnosis of huntington's disease", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx huntington", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1476", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with diagnosis of cognitive impairment or alzheimer's disease", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt dx cog imp or ad", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1477", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Diagnosis of delirium", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dx delirium", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1478", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Psychoactive substance abuse", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Psychoactive sub abuse", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1479", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt func cap not allow impr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1480", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt func cap not allow impr", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1481", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients receiving hospice or palliative care or who died during the measurement period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt in hosp/pal care who died", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1482", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Positive/detectable hepatitis c virus quantitative or qualitative rna test result during the denominator identification period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pos quan hep c or qual rna", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1483", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neg quan hep c or qual rna", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1484", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not have a repeat hcv rna labs performed for medical reasons documented by clinician (e.g., patient with limited life expectancy, delay in treatment of hcv related to treatment of hiv, hbv, hepatocellular carcinoma, decompensated cirrhosis)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No rpt hcv rna perf med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1485", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neg viro resp hep c/qual rna", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1486", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients admitted to a skilled nursing facility (snf) during the period of evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt admitted to snf dur eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1487", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients in hospice in the year before or during the period of evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt adm to hospice dur eval", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1488", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients with a diagnosis for dementia in the year before or during the period of evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dx dementia in msr timeframe", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1489", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient status documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt status doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1490", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patient status not documented", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt status not doc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1491", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Receiving esrd mcp dialysis services by the provider during the performance period", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rec'd esrd mcp dur perf pd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1492", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients who did not report a fall", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No reported fall", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1493", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No fall doc med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1494", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients that reported a fall since the last visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fall rep since last visit", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1495", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fall w/ poc, no fall", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1496", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc of fall or poc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1497", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "No doc fall med rsn", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1498", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Diagnostic radiology mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diagnostic radiology mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1499", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Interventional radiology mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interventional radiology mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1500", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Neuropsychology mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Neuropsychology mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1501", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Pathology mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pathology mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1502", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Podiatry mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Podiatry mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "M1503", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Vascular surgery mips value pathway", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vascular surgery mvp", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "P2028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cephalin floculation, blood", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Cephalin floculation test", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P2029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Congo red, blood", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Congo red blood test", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P2031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1989", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Hair analysis (excluding arsenic)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hair analysis", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P2033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1990", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Thymol turbidity, blood", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Blood thymol turbidity", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P2038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1993", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mucoprotein, blood (seromucoid) (medical necessity procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Blood mucoprotein", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P3000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Screen pap by tech w md supv", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P3001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician", "multiplePricingIndicatorCode": "C = Physician interpretation of clinical lab service is priced under physician fee schedule using RVU's, while pricing of lab service is paid under clinical lab fee schedule", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Screening pap smear by phys", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P7001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "CPT", "longDescription": "Culture, bacterial, urine; quantitative, sensitivity study", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Culture bacterial urine", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P9010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1987", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood (whole), for transfusion, per unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Whole blood for transfusion", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Blood, split unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Blood split unit", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cryoprecipitate, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Cryoprecipitate each unit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, leukocytes reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rbc leukocytes reduced", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plasma 1 donor frz w/in 8 hr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets, each unit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelet rich plasma, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plaelet rich plasma unit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Red blood cells unit", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1987", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, washed, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Washed red blood cells unit", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Frozen plasma, pooled, sd", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Plasma, cryoprecipitate reduced, pathogen reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plasma cryo redu path each", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Cryoprecipitated fibrinogen complex, pathogen reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Cryo fib comp path redu each", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Red blood cells, leukocytes reduced, oxygen/ carbon dioxide reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rbc o2 co2 reduced", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, leukocytes reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets leukocytes reduced", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets, irradiated", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, leukocytes reduced, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets leukoreduced irrad", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, pheresis, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets, pheresis", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, pheresis, leukocytes reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelet pheres leukoreduced", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, pheresis, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelet pheresis irradiated", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, pheresis, leukocytes reduced, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plate pheres leukoredu irrad", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rbc irradiated", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, deglycerolized, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rbc deglycerolized", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, leukocytes reduced, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rbc leukoreduced irradiated", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Infusion, albumin (human), 5%, 50 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Albumin (human),5%, 50ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion, plasma protein fraction (human), 5%, 50 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plasma protein fract,5%,50ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Plasma, cryoprecipitate reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Cryoprecipitatereducedplasma", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Infusion, albumin (human), 5%, 250 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Albumin (human), 5%, 250 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Infusion, albumin (human), 25%, 20 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Albumin (human), 25%, 20 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Infusion, albumin (human), 25%, 50 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Albumin (human), 25%, 50ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Infusion, plasma protein fraction (human), 5%, 250 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plasmaprotein fract,5%,250ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "C = Carrier judgment", "longDescription": "Granulocytes, pheresis, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Granulocytes, pheresis unit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Whole blood or red blood cells, leukocytes reduced, cmv-negative, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Blood, l/r, cmv-neg", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, hla-matched leukocytes reduced, apheresis/pheresis, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets, hla-m, l/r, unit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, pheresis, leukocytes reduced, cmv-negative, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plt, pher, l/r cmv-neg, irr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Whole blood or red blood cells, leukocytes reduced, frozen, deglycerol, washed, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Blood, l/r, froz/degly/wash", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, leukocytes reduced, cmv-negative, apheresis/pheresis, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plt, aph/pher, l/r, cmv-neg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Whole blood, leukocytes reduced, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Blood, l/r, irradiated", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9057", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rbc, frz/deg/wsh, l/r, irrad", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9058", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Red blood cells, leukocytes reduced, cmv-negative, irradiated, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Rbc, l/r, cmv-neg, irrad", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9059", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fresh frozen plasma between 8-24 hours of collection, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plasma, frz between 8-24hour", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Fresh frozen plasma, donor retested, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Fr frz plasma donor retested", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Plasma, pooled multiple donor, pathogen reduced, frozen, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Pathogen reduced plasma pool", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9071", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Plasma (single donor), pathogen reduced, frozen, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Pathogen reduced plasma sing", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9072", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "I = Not payable by Medicare", "longDescription": "Platelets, pheresis, pathogen reduced or rapid bacterial tested, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Plate path red/rapid bac tes", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Platelets, pheresis, pathogen-reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets pheresis path redu", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "P9099", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Blood component or product not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Blood component/product noc", "typeOfServiceCode": "0 = Whole blood only eff 01/96, whole blood or packed red cells before 01/96", "year": "2026" }, { "code": "P9100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pathogen(s) test for platelets", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Pathogen test for platelets", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P9603", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1992", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "22 = Price established by carriers (e.g., gap - fills, carrier established panels)", "shortDescription": "One-way allow prorated miles", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P9604", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1992", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1987", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "22 = Price established by carriers (e.g., gap - fills, carrier established panels)", "shortDescription": "One-way allow prorated trip", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P9612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheterization for collection of specimen, single patient, all places of service", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Catheterize for urine spec", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "P9615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Catheterization for collection of specimen(s) (multiple patients)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Urine specimen collect mult", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q0035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1989", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Cardiokymography", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cardiokymography", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q0081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Infusion therapy, using other than chemotherapeutic drugs, per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Infusion ther other than che", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "C = Carrier judgment", "longDescription": "Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chemo by other than infusion", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0084", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Chemotherapy administration by infusion technique only, per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chemotherapy by infusion", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0085", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "C = Carrier judgment", "longDescription": "Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chemo by both infusion and o", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0091", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Obtaining screen pap smear", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0092", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1996", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Set-up portable x-ray equipment", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Set up port xray equipment", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q0111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Wet mounts, including preparations of vaginal, cervical or skin specimens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Wet mounts/ w preparations", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q0112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "All potassium hydroxide (koh) preparations", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Potassium hydroxide preps", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q0113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Pinworm examinations", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Pinworm examinations", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q0114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Fern test", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Fern test", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q0115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1994", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1994", "coverageCode": "C = Carrier judgment", "longDescription": "Post-coital direct, qualitative examinations of vaginal or cervical mucous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "21 = Price subject to national limitation amount", "shortDescription": "Post-coital mucous exam", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q0138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ferumoxytol, non-esrd", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ferumoxytol, esrd use", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1996", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Azithromycin dihydrate, oral, capsules/powder, 1 gram", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Azithromycin dihydrate, oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dronabinol (syndros), 0.1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dronabinol (syndros) 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Chlorpromazine hcl 5mg oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ondansetron oral", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0163", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Diphenhydramine hcl 50mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Prochlorperazine maleate 5mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0166", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Granisetron hcl 1 mg oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0167", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dronabinol 2.5mg oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0169", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Promethazine hydrochloride, 12.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Promethazine hcl 12.5mg oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0173", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Trimethobenzamide hydrochloride, 250 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Trimethobenzamide hcl 250mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0174", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Thiethylperazine maleate10mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Perphenazine 4mg oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hydroxyzine pamoate 25mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Dolasetron mesylate, 100 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dolasetron mesylate oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 1998", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Unspecified oral dosage form, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for a iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Unspecified oral anti-emetic", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q0220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "December 08, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Tixagev and cilgav, 300mg", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 24, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Tixagev and cilgav, 600mg", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0222", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 11, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bebtelovimab, 175 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bebtelovimab 175 mg", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0224", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "March 22, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "March 22, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to covid-19 vaccination, 4500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Inj, pemivibart, 4500 mg", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0235", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, not otherwise classified, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Inj, monoclon antibody, 1 mg", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0237", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 24, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 24, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Inj, tocilizumab-anoh, hospi", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0238", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Inj, tocilizumab-aazg, hospi", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0239", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 17, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 09, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bamlanivimab-xxxx, 700 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bamlanivimab-xxxx", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 30, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, casirivimab and imdevimab, 600 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Casirivi and imdevi 600 mg", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "November 21, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, casirivimab and imdevimab, 2400 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Casirivimab and imdevimab", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "June 03, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, casirivimab and imdevimab, 1200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Casirivi and imdevi 1200 mg", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 14, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 09, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bamlanivimab and etesevimab, 2100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Bamlanivimab and etesevima", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "December 13, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "May 26, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sotrovimab, 500 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Sotrovimab", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "June 24, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "June 24, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Tocilizumab for covid-19", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q0477", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pwr module pt cable lvad rpl", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0478", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Power adapter, combo vad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0479", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power module for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Power module combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Driver for use with pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Driver pneumatic vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0481", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Microprocessor control unit for use with electric ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Microprcsr cu elec vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Microprcsr cu combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0483", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Monitor/display module for use with electric ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Monitor elec vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0484", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Monitor elec or comb vad rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Monitor control cable for use with electric ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Monitor cable elec vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0486", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mon cable elec/pneum vad rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0487", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Leads any type vad, rep only", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0488", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power pack base for use with electric ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pwr pack base elec vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0489", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power pack base for use with electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pwr pck base combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Emergency power source for use with electric ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Emr pwr source elec vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0491", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Emergency power source for use with electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Emr pwr source combo vad rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0492", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Emergency power supply cable for use with electric ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Emr pwr cbl elec vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0493", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Emr pwr cbl combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0494", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Emr hd pmp elec/combo, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0495", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Charger elec/combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0496", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Battery elec/combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0497", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Bat clps elec/comb vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0498", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Holster for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Holster elec/combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Belt/vest elec/combo vad rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Filters for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Filters elec/combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Shwr cov elec/combo vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mobility cart for pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mobility cart pneum vad, rep", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Battery for pneumatic ventricular assist device, replacement only, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Battery pneum vad replacemnt", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Power adapter for pneumatic ventricular assist device, replacement only, vehicle type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Pwr adpt pneum vad, rep veh", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lith-ion batt elec/pneum vad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0507", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Miscellaneous supply or accessory for use with an external ventricular assist device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Misc sup/acc ext vad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Miscellaneous supply or accessory for use with an implanted ventricular assist device", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Mis sup/acc imp vad", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0509", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Mis sup/ac imp vad nopay med", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Dispens fee immunosupressive", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Sup fee antiem,antica,immuno", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Px sup fee anti-can sub pres", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy dispensing fee for inhalation drug(s); per 30 days", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Disp fee inhal drugs/30 days", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy dispensing fee for inhalation drug(s); per 90 days", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Disp fee inhal drugs/90 days", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sermorelin acetate, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Sermorelin acetate injection", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q0516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 30-days", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply fee hiv prep oral 30", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 60-days", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply fee hiv prep oral 60", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 02, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 90-days", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply fee hiv prep oral 90", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0519", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "September 15, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 30-days", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply fee hiv prep inj 30", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "September 15, 2024", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 60-days", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply fee hiv prep inj 60", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q0521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Supply fee hiv prep fda appr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q1004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "New technology intraocular lens category 4 as defined in federal register notice", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Ntiol category 4", "typeOfServiceCode": "F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "Q1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 1999", "coverageCode": "D = Special coverage instructions apply", "longDescription": "New technology intraocular lens category 5 as defined in federal register notice", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Ntiol category 5", "typeOfServiceCode": "F = Ambulatory surgical center (facility usage for surgical services)", "year": "2026" }, { "code": "Q2004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bladder calculi irrig sol", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, fosphenytoin, 50 mg phenytoin equivalent", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Fosphenytoin inj pe", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2017", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, teniposide, 50 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Teniposide, 50 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, radiesse, 0.1 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Radiesse injection", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q2028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, sculptra, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, sculptra, 0.5mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q2034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2012", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Influenza virus vaccine, split virus, for intramuscular use (agriflu)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Agriflu vaccine", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q2035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Afluria vacc, 3 yrs & >, im", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q2036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Flulaval vacc, 3 yrs & >, im", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q2037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Fluvirin vacc, 3 yrs & >, im", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q2038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Fluzone vacc, 3 yrs & >, im", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q2039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Influenza virus vaccine, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "54 = Vaccinations", "shortDescription": "Influenza virus vaccine, nos", "typeOfServiceCode": "V = Pneumococcal/flu vaccine (eff 01/96), Pneumococcal/flu/hepatitis B vaccine (eff 04/95 - 12/95), Pneumococcal only before 04/95", "year": "2026" }, { "code": "Q2040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tisagenlecleucel car-pos t", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q2041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Axicabtagene ciloleucel car+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q2042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Tisagenlecleucel car-pos t", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q2043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2011", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Sipuleucel-t auto cd54+", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q2049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Imported lipodox inj", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Doxorubicin inj 10mg", "typeOfServiceCode": "1 = Medical care\n\n9 = Other medical items or services", "year": "2026" }, { "code": "Q2052", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Services, supplies and accessories used in the home for the administration of intravenous immune globulin (ivig)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Home ivig, services/supplies", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q2053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Brexucabtagene car pos t", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Lisocabtagene mara car pos t", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 04, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Idecabtagene vicleucel, up to 510 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Idecabtagene vicleucel car", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Ciltacabtagene autoleucel, up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ciltacabtagene car-pos t", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2057", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Afamitresgene autoleucel, including leukapheresis and dose preparation procedures, per therapeutic dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Afamitresgene autoleucel", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q2058", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Obecabtagene autoleucel, 10 up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Obecbtge autol up to 400 mil", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q3001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2000", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Radioelements for brachytherapy, any type, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Brachytherapy radioelements", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q3014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Telehealth originating site facility fee", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Telehealth facility fee", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q3027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, interferon beta-1a, 1 mcg for intramuscular use", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj beta interferon im 1 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q3028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, interferon beta-1a, 1 mcg for subcutaneous use", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj beta interferon sq 1 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q3031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Collagen skin test", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Collagen skin test", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q4001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Casting supplies, body cast adult, with or without head, plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup body cast plaster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, body cast adult, with or without head, fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup body cast fiberglas", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, shoulder cast, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup shoulder cast plstr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, shoulder cast, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup shoulder cast fbrgl", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm cast, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup long arm adult plst", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm cast, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup long arm adult fbrg", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm cast, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup long arm ped plster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm cast, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup long arm ped fbrgls", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm cast, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm adult plstr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm cast, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm adult fbrgl", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm cast, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm ped plaster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm cast, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm ped fbrglas", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup gauntlet plaster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup gauntlet fiberglass", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup gauntlet ped plster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup gauntlet ped fbrgls", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm splint, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng arm splint plst", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm splint, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng arm splint fbrg", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm splint, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng arm splnt ped p", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long arm splint, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng arm splnt ped f", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm splint, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm splint plst", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm splint, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm splint fbrg", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm splint, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm splnt ped p", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short arm splint, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht arm splnt ped f", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, hip spica (one or both legs), adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup hip spica plaster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup hip spica fiberglas", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup hip spica ped plstr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup hip spica ped fbrgl", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cast, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup long leg plaster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cast, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup long leg fiberglass", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cast, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg ped plaster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cast, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg ped fbrgls", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cylinder cast, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg cylinder pl", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg cylinder fb", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lngleg cylndr ped p", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lngleg cylndr ped f", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg cast, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup shrt leg plaster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg cast, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup shrt leg fiberglass", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg cast, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup shrt leg ped plster", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg cast, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup shrt leg ped fbrgls", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg splint, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg splnt plstr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg splint, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg splnt fbrgl", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg splint, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg splnt ped p", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, long leg splint, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup lng leg splnt ped f", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg splint, adult (11 years +), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht leg splnt plstr", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg splint, adult (11 years +), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht leg splnt fbrgl", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg splint, pediatric (0-10 years), plaster", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht leg splnt ped p", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, short leg splint, pediatric (0-10 years), fiberglass", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Cast sup sht leg splnt ped f", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Finger splint, static", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "55 = Splints and Casts (effective 10/1/2014)", "shortDescription": "Finger splint, static", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Cast supplies, for unlisted types and materials of casts", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Cast supplies unlisted", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Splint supplies misc", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "Q4074", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Iloprost non-comp unit dose", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q4081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoetin alfa, 100 units (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Epoetin alfa, 100 units esrd", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q4082", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "C = Carrier judgment", "longDescription": "Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Drug/bio noc part b drug cap", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q4100", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Skin substitute, not otherwise specified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Skin substitute, nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4101", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Apligraf, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Apligraf", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4102", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Oasis wound matrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4103", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Oasis burn matrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4104", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Integra bmwd", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4105", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Integra drt or omnigraft", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4106", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Dermagraft, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Dermagraft", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4107", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Graftjacket", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4108", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Integra matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Integra matrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4110", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Primatrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Primatrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4111", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Gammagraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Gammagraft", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4112", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Cymetra, injectable, 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cymetra injectable", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4113", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Graftjacket xpress, injectable, 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Graftjacket xpress", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4114", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Integra flowable wound matrix, injectable, 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Integra flowable wound matri", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4115", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Alloskin, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alloskin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4116", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2009", "coverageCode": "C = Carrier judgment", "longDescription": "Alloderm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alloderm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4117", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Hyalomatrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Hyalomatrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4118", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Matristem micromatrix, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Matristem micromatrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4119", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Matristem wound matrix, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Matristem wound matrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Matristem burn matrix, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Matristem burn matrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4121", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "C = Carrier judgment", "longDescription": "Theraskin, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Theraskin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4122", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Dermacell, dermacell awm or dermacell awm porous, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermacell, awm, porous sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4123", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Alloskin rt, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alloskin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4124", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Oasis ultra tri-layer wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Oasis tri-layer wound matrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4125", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Arthroflex, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Arthroflex", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4126", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Memoderm, dermaspan, tranzgraft or integuply, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Memoderm/derma/tranz/integup", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4127", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Talymed, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Talymed", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4128", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Flex hd, or allopatch hd, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Flexhd/allopatchhd/sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Unite biomatrix, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Unite biomatrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4130", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "C = Carrier judgment", "longDescription": "Strattice tm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Strattice tm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Epifix or epicord, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Epifix or epicord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4132", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Grafix core and grafixpl core, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Grafix core, grafixpl core", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4133", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Grafix stravix prime pl sqcm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4134", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Hmatrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Hmatrix", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4135", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Mediskin, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Mediskin", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4136", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "C = Carrier judgment", "longDescription": "Ez-derm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ezderm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4137", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioexcel, amnioexcel plus or biodexcel, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioexcel biodexcel 1sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4138", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Biodfence dryflex, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biodfence dryflex, 1cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4139", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Amniomatrix or biodmatrix, injectable, 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Amnio or biodmatrix, inj 1cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4140", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Biodfence, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biodfence 1cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4141", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Alloskin ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alloskin ac, 1 cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4142", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Xcm biologic tissue matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xcm biologic tiss matrix 1cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4143", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Repriza, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Repriza, 1cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4145", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Epifix, injectable, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Epifix, inj, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4146", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Tensix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Tensix, 1cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4147", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Architect, architect px, or architect fx, extracellular matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Architect ecm px fx 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4148", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neox neox rt or clarix cord", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4149", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Excellagen, 0.1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Excellagen, 0.1 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4150", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Allowrap ds or dry, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Allowrap ds or dry 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4151", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioband or guardian, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioband, guardian 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4152", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Dermapure, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermapure 1 square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4153", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Dermavest and plurivest, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermavest, plurivest sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4154", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Biovance, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biovance 1 square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4155", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Neoxflo or clarixflo, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Neoxflo or clarixflo 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4156", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Neox 100 or clarix 100, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neox 100 or clarix 100", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4157", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Revitalon, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Revitalon 1 square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4158", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Kerecis omega3, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Kerecis omega3, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4159", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Affinity, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Affinity1 square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4160", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "C = Carrier judgment", "longDescription": "Nushield, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Nushield 1 square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4161", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Bio-connekt wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Bio-connekt per square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4162", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Woundex flow, bioskin flow, 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Wndex flw, bioskn flw, 0.5cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4163", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Woundex, bioskin, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Woundex, bioskin, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4164", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Helicoll, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Helicoll, per square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4165", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Keramatrix or kerasorb, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Keramatrix, kerasorb sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4166", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Cytal, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cytal, per square centimeter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4167", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Truskin, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Truskin, per sq centimeter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4168", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioband, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Amnioband, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4169", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent wound, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Artacent wound, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4170", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Cygnus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cygnus, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4171", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Interfyl, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Interfyl, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Puraply or puraply am, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Puraply or puraply am", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4173", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Palingen or palingen xplus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Palingen or palingen xplus", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4174", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Palingen or promatrx, 0.36 mg per 0.25 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Palingen or promatrx", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4175", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "C = Carrier judgment", "longDescription": "Miroderm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Miroderm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4176", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Neopatch or therion, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neopatch or therion, 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4177", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Floweramnioflo, 0.1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Floweramnioflo, 0.1 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4178", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Floweramniopatch, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Floweramniopatch, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4179", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Flowerderm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Flowerderm, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4180", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Revita, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Revita, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4181", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Amnio wound, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnio wound, per square cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4182", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Transcyte, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Transcyte, per sq centimeter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4183", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Surgigraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgigraft, 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4184", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Cellesta or cellesta duo, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cellesta or duo per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4185", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Cellesta flowable amnion (25 mg per cc); per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cellesta flowab amnion 0.5cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4186", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Epifix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Epifix 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4187", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Epicord, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Epicord 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4188", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioarmor, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioarmor 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4189", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent ac, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Artacent ac, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4190", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Artacent ac 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4191", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Restorigin, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Restorigin 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4192", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Restorigin, 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Restorigin, 1 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4193", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Coll-e-derm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Coll-e-derm 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4194", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Novachor, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Novachor 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4195", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Puraply, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Puraply 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4196", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Puraply am, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Puraply am 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4197", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Puraply xt 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4198", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Genesis amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Genesis amnio membrane 1sqcm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4199", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Cygnus matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cygnus matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4200", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Skin te, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Skin te 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4201", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Matrion, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Matrion 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4202", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Keroxx (2.5g/cc), 1cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Keroxx (2.5g/cc), 1cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4203", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Derma-gide, 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4204", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap 1 sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4205", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Membrane graft or wrap sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4206", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Fluid flow or fluid gf, 1 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Fluid flow or fluid gf 1 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4208", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Novafix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4209", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Surgraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgraft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Axolotl graft or axolotl dualgraft, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Axolotl graf dualgraf sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4211", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnion bio or axobio sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4212", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Allogen, per cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Allogen, per cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4213", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Ascent, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Ascent, 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4214", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Cellesta cord, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cellesta cord per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4215", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Axolotl ambient or axolotl cryo, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Axolotl ambient, cryo 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4216", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent cord, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Artacent cord per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4217", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Woundfix biowound plus xplus", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4218", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Surgicord, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgicord per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4219", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Surgigraft-dual, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgigraft dual per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4220", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Bellacell hd or surederm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Bellacell hd, surederm sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4221", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Amniowrap2, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniowrap2 per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4222", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Progenamatrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Progenamatrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4224", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Human health factor 10 amniotic patch (hhf10-p), per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Hhf10-p per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4225", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Amniobind or dermabind tl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnio or derma tl, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4226", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Myown skin, includes harvesting and preparation procedures, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Myown harv prep proc sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4227", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amniocore, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniocore per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4228", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Bionextpatch, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Bionextpatch, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4229", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Cogenex amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cogenex amnio memb per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4230", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Cogenex flowable amnion, per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Cogenex flow amnion 0.5 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4231", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Corplex p, per cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Corplex p, per cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4232", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Corplex, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Corplex, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4233", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Surfactor or nudyn, per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Surfactor /nudyn per 0.5 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4234", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Xcellerate, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xcellerate, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4235", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amniorepair or altiply, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniorepair or altiply sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4236", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Carepatch, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Carepatch per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4237", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Cryo-cord, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cryo-cord, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4238", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Derm-maxx, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Derm-maxx, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4239", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amnio-maxx or amnio-maxx lite, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnio-maxx or lite per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4240", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Corecyte, for topical use only, per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Corecyte topical only 0.5 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4241", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Polycyte, for topical use only, per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Polycyte, topical only 0.5cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4242", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amniocyte plus, per 0.5 cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Amniocyte plus, per 0.5 cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Procenta, per 200 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Procenta, per 200 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4245", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amniotext, per cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Amniotext, per cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4246", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Coretext or protext, per cc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Coretext or protext, per cc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4247", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amniotext patch, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniotext patch, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4248", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Dermacyte amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermacyte amn mem allo sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4249", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amniply, for topical use only, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniply, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4250", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioamp-mp, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioamp-mp per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4251", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Vim, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Vim, per square centimeter", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q4252", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Vendaje, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Vendaje, per square centimet", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q4253", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Zenith amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Zenith amniotic membrane psc", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q4254", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Novafix dl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Novafix dl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4255", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Reguard, for topical use only, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Reguard, topical use per sq", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4256", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Mlg-complete, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Mlg complet, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4257", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Relese, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Relese, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4258", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Enverse, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Enverse, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4259", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Celera dual layer or celera dual membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Celera per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4260", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Signature apatch, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Signature apatch, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4261", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Tag, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Tag, per square centimeter", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4262", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dual layer impax, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4263", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Surgraft tl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgraft tl, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4264", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Cocoon membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cocoon membrane, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4265", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Neostim tl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neostim tl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4266", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Neostim membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neostim per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4267", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Neostim dl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neostim dl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4268", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Surgraft ft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgraft ft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4269", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Surgraft xt, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgraft xt per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4270", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Complete sl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Complete sl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4271", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Complete ft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Complete ft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4272", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Esano a, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Esano a, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4273", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Esano aaa, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Esano aaa, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4274", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Esano ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Esano ac, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4275", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Esano aca, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Esano aca, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4276", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Orion, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Orion, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4277", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Woundplus membrane or e-graft, per square centimeter", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Woundplus e-grat, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4278", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Epieffect, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Epieffect, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4279", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Vendaje ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Vendaje ac, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4280", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Xcell amnio matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xcell amnio matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4281", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Barrera sl or barrera dl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Barrera slor dl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4282", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Cygnus dual, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cygnus dual per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4283", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Biovance tri-layer or biovance 3l, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biovance tri or 3l, sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4284", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind sl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermabind sl, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4285", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Nudyn dl or nudyn dl mesh, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Nudyn dl or dl mesh pr sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4286", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Nudyn sl or nudyn slw, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Nudyn sl or slw, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4287", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind dl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermabind dl, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4288", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind ch, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermabind ch, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4289", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Revoshield+ amnio, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4290", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Membrane wrap-hydro, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Membrane wrap hydr per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4291", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Lamellas xt, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Lamellas xt, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4292", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Lamellas, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Lamellas, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4293", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Acesso dl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Acesso dl, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4294", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amnio quad-core, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnio quad-core, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4295", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amnio tri-core amniotic, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnio tri-core, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4296", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Rebound matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rebound matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4297", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Emerge matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Emerge matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4298", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amniocore pro, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniocore pro, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4299", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amniocore pro+, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniocore pro+, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4300", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Acesso tl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Acesso tl, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4301", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Activate matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Activate matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4302", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Complete aca, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Complete aca, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4303", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Complete aa, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Complete aa, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4304", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Grafix plus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Grafix plus, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4305", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "American amnion ac tri-layer, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amer am ac tri-lay per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4306", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "American amnion ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Americ amnion ac per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4307", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "American amnion, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "American amnion, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4308", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Sanopellis, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Sanopellis, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4309", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Via matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Via matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4310", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Procenta, per 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Procenta, per 100 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4311", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Acesso, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Acesso, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4312", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Acesso ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Acesso ac, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4313", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind fm, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermabind fm, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4314", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Reeva ft, per square cenitmeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Reeva, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4315", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Regenelink amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Regenelink amniotic mem allo", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4316", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amchoplast, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amchoplast, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4317", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Vitograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Vitograft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4318", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "E-graft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "E-graft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4319", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Sanograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Sanograft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4320", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Pellograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Pellograft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4321", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Renograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Renograft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4322", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Caregraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Caregraft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4323", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Alloply, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alloply, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4324", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amniotx, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniotx, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4325", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Acapatch, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Acapatch, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4326", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Woundplus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Woundplus, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4327", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Duoamnion, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Duoamnion, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4328", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Most, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Most, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4329", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Singlay, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Singlay, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4330", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Total, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Total, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4331", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Axolotl graft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Axolotl graft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4332", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Axolotl dualgraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Axolotl dualgraft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4333", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Ardeograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ardeograft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4334", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioplast 1, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioplast 1, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4335", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioplast 2, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioplast 2, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4336", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent c, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Artecent c, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4337", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent trident, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Artecent trident, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4338", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent velos, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Artacent velos, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4339", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Artacent vericlen, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Artacent vericlen, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4340", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Simpligraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Simpligraft, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4341", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Simplimax, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Simplimax, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4342", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Theramend, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Theramend, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4343", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Dermacyte ac matrix amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermacyte ac matrx per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4344", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Tri-membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Tri membrane wrap, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4345", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Matrix hd allograft dermis, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Matrix hd allogrft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4346", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Shelter dm matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Shelter dm matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4347", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Rampart dl matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Rampart dl matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4348", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Sentry sl matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Sentry sl matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4349", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Mantle dl matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Mantle dl matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4350", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Palisade dm matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Palisade dm matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4351", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Enclose tl matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Enclose tl matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4352", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Overlay sl matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Overlay sl matrix, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4353", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Xceed tl matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xceed tl matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4354", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Palingen dual-layer membrane and dual-layer palingen x-membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Palingen dl-palingen dl-x", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4355", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Abiomend xplus membrane and abiomend xplus hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Abio xpl abio xpl hy p sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4356", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Abiomend membrane and abiomend hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Abio mem abio hyd per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4357", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap plus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap plus, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4358", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap dual, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap dual, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4359", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Choriply, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Choriply, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4360", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amchoplast fd, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amchoplast fd per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4361", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Epixpress, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Epixpress, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4362", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Cygnus disk, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cygnus disk, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4363", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amnio burgeon membrane and hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Am bur mem hydro per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4364", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amnio burgeon xplus membrane and xplus hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Am bur xp mem xpl hy p sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4365", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amnio burgeon dual-layer membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnio bur dl mem per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4366", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Dual layer amnio burgeon x-membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dl amnio bur x-mem per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4367", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amniocore sl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniocore sl, per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4368", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amchothick, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amchothick per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4369", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioplast 3, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioplast 3 per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4370", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Aeroguard, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Aeroguard per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4371", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Neoguard, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neoguard per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4372", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amchoplast excel, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amchoplast excl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4373", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Membrane wrap lite, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Membrane wrp lt per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4375", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Duograft ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Duograft ac per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4376", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Duograft aa, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Duograft aa per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4377", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Trigraft ft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Trigraft ft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4378", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Renew ft matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Renew ft matrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4379", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amniodefend ft matrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniodefend ft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4380", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Advograft one, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Advograft one per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4382", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Advograft dual, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Advograft dual per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4383", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Axolotl graft ultra, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Axolotl graft ult per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4384", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Axolotl dualgraft ultra, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Axolotl dual ult per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4385", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Apollo ft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Apollo ft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4386", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Acesso trifaca, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Acesso trifaca per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4387", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Neothelium ft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neothelium ft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4388", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Neothelium 4l, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neothelium 4l per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4389", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Neothelium 4l+, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Neothelium 4l+ per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4390", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Ascendion, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ascendion per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4391", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Amnioplast double, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amnioplast double per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4392", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Grafix duo, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Grafix duo per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4393", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Surgraft ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgraft ac per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4394", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Surgraft aca, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Surgraft aca per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4395", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Acelagraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Acelagraft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4396", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Natalin, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Natalin per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4397", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Summit aaa, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Summit aaa per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4398", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Summit ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Summit ac per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4399", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Summit fx, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Summit fx per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4400", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Polygon3 membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Polygon3 per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4401", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Absolv3 membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Absolv3 per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4402", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap 2.0, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap 2.0 per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4403", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap dual plus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap dual plus per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4404", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap hydro plus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap hydro plus per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4405", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap fenestra plus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap fenestra plus sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4406", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap fenestra, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap fenestra per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4407", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap tribus, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap tribus per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4408", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Xwrap hydro, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Xwrap hydro per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4409", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Amniomatrixf3x, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniomatrixf3x per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4410", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Amchomatrixdl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amchomatrixdl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4411", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Amniomatrixf4x, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Amniomatrixf4x per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4412", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Choriofix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Choriofix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4413", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Cygnus solo, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Cygnus solo per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4414", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Simplichor, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Simplichor per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4415", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Alexiguard sl-t, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alexiguard st-l per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4416", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Alexiguard tl-t, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alexiguard tl-t per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4417", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Alexiguard dl-t, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Alexiguard dl-t per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4418", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Biolab membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biolab wrap flow per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4419", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Biolab membrane wrap lite flow, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biolab wrap flw lt per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4420", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Nuform, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Nuform per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4421", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Biolab membrane wrap solo, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biolab wrap solo per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4422", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "A/c wrap, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Ac wrap per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4423", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Biolab tri-membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Biolab tri wrap fl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4424", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Revive ft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Revive ft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4425", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Revive tl, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Revive tl per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4426", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind tl + or dermabind tl x, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermbnd tl+, tlx per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4427", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind dl n or dermabind dl + or dermabind dl x, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermbnd dln dl+ dlx sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4428", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind sl n or dermabind sl + or dermabind sl x, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermbnd sln sl+ slx sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4429", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Dermabind ch n or dermabind ch x, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Dermbnd chn, chx per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4431", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Pma skin substitute product, not otherwise specified (list in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Pma skin substitute, nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4432", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "510(k) skin substitute product, not otherwise specified (list in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "510(k) skin subs, nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4433", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "361 hct/p skin substitute product, not otherwise specified (list in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "361 hct/p skin subs, nos", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4435", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Renati membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Renati membrane per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4436", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Renati ac membrane, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Renati ac membrane per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4437", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Revival ac, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Revival ac per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4438", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Pretect, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Pretect per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4439", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Instagraft, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Instagraft per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q4440", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Curamatrix, per square centimeter (add-on, list separately in addition to primary procedure)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "11 = Price established using national RVU's", "shortDescription": "Curamatrix per sq cm", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice or home health care provided in patient's home/residence", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice or home hlth in home", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice or home health care provided in assisted living facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice/home hlth in asst lv", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice in lt/non-skilled nf", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice care provided in skilled nursing facility (snf)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice in snf", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice care provided in inpatient hospital", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice, inpatient hospital", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice care provided in inpatient hospice facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice in hospice facility", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice care provided in long term care facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice in ltch", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice care provided in inpatient psychiatric facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice in inpatient psych", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice or home health care provided in place not otherwise specified (nos)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice/home hlth, place nos", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hospice home care provided in a hospice facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice home care in hospice", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5098", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ustekinumab-srlf, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5099", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ustekinumab-stba, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5100", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ustekinumab-kfce, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, zarxio", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, infliximab, biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., infliximab biosimilar", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, inflectra", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, infliximab-abda, biosimilar, (renflexis), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, renflexis", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj retacrit esrd on dialysi", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q5106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj retacrit non-esrd use", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q5107", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj mvasi 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, fulphila", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5109", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, ixifi, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2018", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Nivestym", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, udenyca 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ontruzant 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj herzuma 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ogivri 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2019", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, rituximab-abbs, biosimilar, (truxima), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj truxima 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5116", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., trazimera, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., kanjinti, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5118", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2019", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., zirabev, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5119", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ruxience, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj pegfilgrastim-bmez 0.5mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, infliximab-axxq, biosimilar, (avsola), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. avsola, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nyvepria", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5123", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, rituximab-arrx, biosimilar, (riabni), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. riabni, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5124", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. byooviz, 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5125", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, releuko 1 mcg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj alymsys 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5127", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, stimufend, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, cimerli, 0.1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, vegzelma, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, fylnetra, 0.5 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2023", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-aacf (idacio), biosimilar, 20 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, idacio, 20 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, abrilada, 10 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5133", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tofidence, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5134", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tyruko, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tyenne, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj. denosumab-bbdz, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-auub (wezlana), biosimilar, subcutaneous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, wezlana, sub cu, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2024", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, wezlana, iv, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eculizumab-aeeb (bkemv), biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, eculizumab-aeeb, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-fkjp, biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj adalimumab-fkjp, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-aaty, biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj adalimumab-aaty, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5142", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-ryvk biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj adalimumab-ryvk, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5143", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-adbm, biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj adalimumab-adbm, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-aacf (idacio), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, idacio, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, abrilada, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5146", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, hercessi, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5147", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aflibercept-ayyh, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, nyposi 1 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5149", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aflibercept-abzv (enzeevu), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aflibercept-abzv, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aflibercept-mrbb (ahzantive), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aflibercept-mrbb, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, eculizumab-aagh, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5152", "actionCode": "P = Payment change (MOG, pricing indicator codes, anesthesia base units, Ambulatory Surgical Centers)", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, eculizumab-aeeb, 2 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5153", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aflibercept-yszy (opuviz), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aflibercept-yszy, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5154", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, omalizumab-igec (omlyclo), biosimilar, 5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, omlyclo, 5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5155", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, aflibercept-jbvf (yesafili), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, aflibercept-jbvf, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5156", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, tocilizumab-anoh, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5157", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, denosumab-bmwo, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5158", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, denosumab-bnht, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5159", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, denosumab-dssb, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5160", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, jobevne, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q5161", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, denosumab-kyqq, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q5162", "actionCode": "A = Add procedure or modifier code", "actionEffectiveDate": "April 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2026", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj, denosumab-nxxp, 1 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Assessment by chaplain services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Chaplain assessment", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "Q9002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Counseling, individual, by chaplain services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Chaplain counsel individu", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "Q9003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Counseling, group, by chaplain services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Chaplain counsel group", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "Q9004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Department of veterans affairs whole health partner services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "99 = Value not established", "shortDescription": "Va whole health partner serv", "typeOfServiceCode": "3 = Consultation", "year": "2026" }, { "code": "Q9950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, sulfur hexafluoride lipid microspheres, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj sulf hexa lipid microsph", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9951", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Locm >= 400 mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9953", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Injection, iron-based magnetic resonance contrast agent, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj fe-based mr contrast,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9954", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Oral magnetic resonance contrast agent, per 100 ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Oral mr contrast, 100 ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9955", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, perflexane lipid microspheres, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj perflexane lip micros,ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9956", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, octafluoropropane microspheres, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj octafluoropropane mic,ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9957", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, perflutren lipid microspheres, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Inj perflutren lip micros,ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9958", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hocm <=149 mg/ml iodine, 1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9959", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hocm 150-199mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hocm 200-249mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9961", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hocm 250-299mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9962", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hocm 300-349mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9963", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hocm 350-399mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9964", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "D = Special coverage instructions apply", "longDescription": "High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Hocm>= 400mg/ml iodine, 1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9965", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Locm 100-199mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9966", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Locm 200-299mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9967", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Locm 300-399mg/ml iodine,1ml", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9968", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Visualization adjunct", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9969", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "53 = Statute", "shortDescription": "Non-heu tc-99m add-on/dose", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q9970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ferric carboxymaltose, 1mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ferric carboxymaltos 1mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9972", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0887", "longDescription": "Injection, epoetin beta, 1 microgram, (for esrd on dialysis)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Epoetin beta esrd use", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q9973", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0888", "longDescription": "Injection, epoetin beta, 1 microgram, (non-esrd use)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Epoetin beta non esrd", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q9974", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J2274", "longDescription": "Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Morphine epidural/intratheca", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9975", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J7205", "longDescription": "Injection, factor viii fc fusion protein (recombinant), per iu", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Factor viii fc fusion recomb", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9976", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2015", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "J1443", "longDescription": "Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ferric pyrophosphate cit", "typeOfServiceCode": "1 = Medical care\n\nL = ESRD supplies (eff 04/95) (renal supplier in the home before 04/95)", "year": "2026" }, { "code": "Q9977", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2015", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Compounded drug, not otherwise classified", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Compounded drug noc", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9978", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J8655", "longDescription": "Netupitant 300 mg and palonosetron 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Netupitant palonosetron oral", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9979", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2015", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J0202", "longDescription": "Injection, alemtuzumab, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Injection, alemtuzumab", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9980", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2016", "coverageCode": "C = Carrier judgment", "longDescription": "Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Genvisc, inj, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J8670", "longDescription": "Rolapitant, oral, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Rolapitant, oral, 1mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flutemetamol f18 diagnostic", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9983", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Florbetaben f18 diagnostic", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "Q9984", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "S = Non-covered by Medicare statute", "crossReferenceCode": "J7296", "longDescription": "Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Kyleena, 19.5 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q9985", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "J1729", "longDescription": "Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj hydroxyprogst capoat nos", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9986", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "J1726", "longDescription": "Injection, hydroxyprogesterone caproate, (makena), 10 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Makena, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9987", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "P9100", "longDescription": "Pathogen(s) test for platelets", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Pathogen test for platelets", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "Q9988", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "P9073", "longDescription": "Platelets, pheresis, pathogen-reduced, each unit", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "52 = Reasonable charge", "shortDescription": "Platelets, pathogen reduced", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "Q9989", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2017", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "J3358", "longDescription": "Ustekinumab, for intravenous injection, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ustekinumab, iv inject,1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9991", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Buprenorph xr 100 mg or less", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9992", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2018", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, buprenorphine extended-release (sublocade), greater than 100 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Buprenorphine xr over 100 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9993", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "D = Special coverage instructions apply", "crossReferenceCode": "J3304", "longDescription": "Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., triamcinolone ext rel", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9994", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "C = Carrier judgment", "longDescription": "In-line cartridge containing digestive enzyme(s) for enteral feeding, each", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "39 = Parenteral and Enteral Nutrition", "shortDescription": "Enzyme cartridge enteral nut", "typeOfServiceCode": "E = Enteral/parenteral nutrients/supplies (eff 04/95)", "year": "2026" }, { "code": "Q9995", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2018", "coverageCode": "C = Carrier judgment", "crossReferenceCode": "J7170", "longDescription": "Injection, emicizumab-kxwh, 0.5 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj., emicizumab-kxwh 0.5 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "Q9996", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ustekinumab- ttwe sub cu inj", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9997", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Ustekinumab-ttwe iv inj 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9998", "actionCode": "C = Change in long description of procedure or modifier code", "actionEffectiveDate": "July 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ustekinumab-aekn, 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "Q9999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "C = Carrier judgment", "longDescription": "Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "51 = Drugs", "shortDescription": "Inj ustekinumab-aauz 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "R0070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Transport portable x-ray", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "R0075", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Transport port x-ray multipl", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "R0076", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1998", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Transportation of portable ekg to facility or location, per patient", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Transport portable ekg", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "S0012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Butorphanol tartrate, nasal spray, 25 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Butorphanol tartrate, nasal", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "S0013", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "I = Not payable by Medicare", "longDescription": "Esketamine, nasal spray, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Esketamine, nasal spray", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "S0014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Tacrine hydrochloride, 10 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tacrine hydrochloride, 10 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, aminocaproic acid, 5 grams", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, aminocaproic acid", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, bupivicaine hydrochloride, 30 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, bupivicaine hydro", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, cefoperazone sodium, 1 gram", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, cefoperazone sod", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, cimetidine hydrochloride, 300 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, cimetidine hydroc", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, famotidine, 20 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, famotidine, 20 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, metronidazole, 500 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, metronidazole", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, nafcillin sodium, 2 grams", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, nafcillin sodium", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, ofloxacin, 400 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, ofloxacin, 400 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, sulfamethoxazole and trimethoprim, 10 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, sulfamethoxazole", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, ticarcillin disod", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0073", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, aztreonam, 500 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, aztreonam, 500 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0074", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "October 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, cefotetan disodium, 500 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, cefotetan disodiu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0077", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, clindamycin phosphate, 300 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, clindamycin phosp", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0078", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, fosphenytoin sodium, 750 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, fosphenytoin sodi", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0080", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, pentamidine isethionate, 300 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, pentamidine iseth", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0081", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, piperacillin sodium, 500 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection, piperacillin sodi", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0088", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Imatinib, 100 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Imatinib 100 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sildenafil citrate, 25 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sildenafil citrate, 25 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0091", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Granisetron 1mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0092", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hydromorphone 250 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0093", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, morphine sulfate, 500 mg (loading dose for infusion pump)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Morphine 500 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Zidovudine, oral, 100 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Zidovudine, oral, 100 mg", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "S0106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Bupropion hcl sustained release tablet, 150 mg, per bottle of 60 tablets", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bupropion hcl sr 60 tablets", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mercaptopurine, oral, 50 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mercaptopurine 50 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0109", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Methadone, oral, 5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Methadone oral 5mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Tretinoin, topical, 5 grams", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tretinoin topical 5 g", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0119", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ondansetron 4 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, menotropins, 75 iu", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj menotropins 75 iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, follitropin alfa, 75 iu", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj follitropin alfa 75 iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, follitropin beta, 75 iu", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj follitropin beta 75 iu", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0132", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, ganirelix acetate, 250 mcg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj ganirelix acetat 250 mcg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Clozapine, 25 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Clozapine, 25 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0137", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Didanosine (ddi), 25 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Didanosine, 25 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0138", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Finasteride, 5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Finasteride, 5 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0139", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Minoxidil, 10 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Minoxidil, 10 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Saquinavir, 200 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Saquinavir, 200 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0142", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Colistimethate sodium, inhalation solution administered through dme, concentrated form, per mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Colistimethate inh sol mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0144", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "J2704", "longDescription": "Injection, propofol, 10 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj, propofol, 10 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, pegylated interferon alfa-2a, 180 mcg per ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Peg interferon alfa-2a/180", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0148", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, pegylated interferon alfa-2b, 10 mcg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Peg interferon alfa-2b/10", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0155", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sterile dilutant for epoprostenol, 50 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Epoprostenol dilutant", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0156", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Exemestane, 25 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Exemestane, 25 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0157", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Becaplermin gel 0.01%, 0.5 gm", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Becaplermin gel 1%, 0.5 gm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dextroamphetamine sulfate, 5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dextroamphetamine", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0164", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, pantoprazole sodium, 40 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Injection pantroprazole", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0166", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, olanzapine, 2.5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Inj olanzapine 2.5mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0169", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2010", "coverageCode": "I = Not payable by Medicare", "longDescription": "Calcitrol, 0.25 microgram", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Calcitrol", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Anastrozole, oral, 1 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anastrozole 1 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Injection, bumetanide, 0.5 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bumetanide 0.5 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Chlorambucil, oral, 2 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chlorambucil 2 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0174", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dolasetron 50 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Flutamide, oral, 125 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flutamide 125 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0176", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hydroxyurea, oral, 500 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hydroxyurea 500 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0177", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Levamisole hydrochloride, oral, 50 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Levamisole 50 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0178", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lomustine, oral, 10 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lomustine 10 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0179", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Megestrol acetate, oral, 20 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Megestrol 20 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0182", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Procarbazine hydrochloride, oral, 50 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Procarbazine, oral", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0183", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prochlorperazine 5 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0187", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Tamoxifen citrate, oral, 10 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tamoxifen 10 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0189", "actionCode": "D = Discontinue procedure or modifier code", "actionEffectiveDate": "January 01, 2026", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Testosterone pellet, 75 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Testosterone pellet 75 mg", "typeOfServiceCode": "1 = Medical care\n\nP = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S0190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mifepristone, oral, 200 mg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mifepristone, oral, 200 mg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0191", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Misoprostol, oral, 200 mcg", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Misoprostol, oral, 200 mcg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0194", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dialysis/stress vitamin supplement, oral, 100 capsules", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vitamin suppl 100 caps", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0195", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from five years to nine years of age who have not previously received the vaccine", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pneumo vaccine 5-9 yrs", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0197", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prenatal vitamins, 30-day supply", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prenatal vitamins 30 day", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med abortion inc all ex drug", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Partial hospitalization services, less than 24 hours, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Partial hospitalization serv", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Paramedic intercept, non-hospital-based als service (non-voluntary), non-transport", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Paramedicintercep nonhospals", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Paramedic intercept, hospital-based als service (non-voluntary), non-transport", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Paramed intrcept nonvol", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "S0209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Wheelchair van, mileage, per mile", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wc van mileage per mi", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "S0215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation; mileage, per mile", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonemerg transp mileage", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "S0220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care (patient is present); approximately 30 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical conference by physic", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care (patient is present); approximately 60 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical conference, 60 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive geriatric assessment and treatment planning performed by assessment team", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comp geriatr assmt team", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospice referral visit (advising patient and family of care options) performed by nurse, social worker, or other designated staff", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice refer visit nonmd", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Counseling and discussion regarding advance directives or end of life care planning and decisions, with patient and/or surrogate (list separately in addition to code for appropriate evaluation and management service)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "End of life counseling", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "H&p for surgery", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic counseling, under physician supervision, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Genetic counsel 15 mins", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Physician management of patient home care, standard monthly case rate (per 30 days)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home std case rate 30 days", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Physician management of patient home care, hospice monthly case rate (per 30 days)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home hospice case 30 days", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Physician management of patient home care, episodic care monthly case rate (per 30 days)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home episodic case 30 days", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0273", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Physician visit at member's home, outside of a capitation arrangement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Md home visit outside cap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nurse practitioner visit at member's home, outside of a capitation arrangement", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nurse practr visit outs cap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0280", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical home program, comprehensive care coordination and planning, initial plan", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical home, initial plan", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2010", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2010", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical home program, comprehensive care coordination and planning, maintenance of plan", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical home, maintenance", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "I = Not payable by Medicare", "longDescription": "Colonoscopy consultation performed prior to a screening colonoscopy procedure", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cnslt before screen colonosc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Completed epsdt", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospitalist services (list separately in addition to code for appropriate evaluation and management service)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospitalist visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0311", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2016", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive management and care coordination for advanced illness, per calendar month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comp mgmt care coord adv ill", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Disease management program; initial assessment and initiation of the program", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disease management program", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0316", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Disease management program, follow-up/reassessment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Follow-up/reassessment", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0317", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Disease management program; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disease mgmt per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rn telephone calls to dmp", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lifestyle modification program for management of coronary artery disease, including all supportive services; first quarter / stage", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lifestyle mod 1st stage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lifestyle modification program for management of coronary artery disease, including all supportive services; second or third quarter / stage", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lifestyle mod 2 or 3 stage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lifestyle modification program for management of coronary artery disease, including all supportive services; fourth quarter / stage", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lifestyle mod 4th stage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Treatment planning and care coordination management for cancer, initial treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cancer treatmentplan initial", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0354", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Treatment planning and care coordination management for cancer, established patient with a change of regimen", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cancer treatment plan change", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0390", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rout foot care per visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0395", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Impression casting ft", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Global fee for extracorporeal shock wave lithotripsy treatment of kidney stone(s)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Global eswl kidney", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Disposable contact lens, per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dispos cont lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Single vision prescription lens (safety, athletic, or sunglass), per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Singl prscrp lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0506", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Bifocal vision prescription lens (safety, athletic, or sunglass), per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bifoc prscp lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0508", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Trifocal vision prescription lens (safety, athletic, or sunglass), per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trifoc prscrp lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-prescription lens (safety, athletic, or sunglass), per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-prscrp lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Daily wear specialty contact lens, per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Daily cont lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0514", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Color contact lens, per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Color cont lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0515", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Scleral lens, liquid bandage device, per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scleral lens liquid bandage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0516", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Safety eyeglass frames", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Safety frames", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sunglasses frames", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sunglass frames", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0580", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Polycarbonate lens (list this code in addition to the basic code for the lens)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Polycarb lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0581", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nonstandard lens (list this code in addition to the basic code for the lens)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonstnd lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Integral lens service, miscellaneous services reported separately", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Misc integral lens serv", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0592", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive contact lens evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comp cont lens eval", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S0595", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dispensing new spectacle lenses for patient supplied frame", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "New lenses in pts old frame", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0596", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Phakic intraocular lens for correction of refractive error", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Phakic iol refractive error", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Screening proctoscopy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Screening proctoscopy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Annual gynecological examination, new patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Annual gynecological examina", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0612", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Annual gynecological examination, established patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Annual gynecological examina", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0613", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Annual gynecological examination; clinical breast examination without pelvic evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ann breast exam", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0618", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Audiometry for hearing aid evaluation to determine the level and degree of hearing loss", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Audiometry for hearing aid", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Routine ophthalmological examination including refraction; new patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Routine ophthalmological exa", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0621", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Routine ophthalmological examination including refraction; established patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Routine ophthalmological exa", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0622", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Physical exam for college, new or established patient (list separately in addition to appropriate evaluation and management code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Phys exam for college", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Removal of sutures; by a physician other than the physician who originally closed the wound", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Removal of sutures", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Laser in situ keratomileusis (lasik)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Laser in situ keratomileusis", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S0810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Photorefractive keratectomy (prk)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Photorefractive keratectomy", "typeOfServiceCode": "2 = Surgery\n\n9 = Other medical items or services", "year": "2026" }, { "code": "S0812", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Phototherapeutic keratectomy (ptk)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Phototherap keratect", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "S1001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Deluxe item, patient aware (list in addition to code for basic item)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Deluxe item", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S1002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Customized item (list in addition to code for basic item)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom item", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S1015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Iv tubing extension set", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Iv tubing extension set", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S1016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-pvc (polyvinyl chloride) intravenous administration set, for use with drugs that are not stable in pvc e.g., paclitaxel", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-pvc intravenous administ", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S1030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gluc monitor purchase", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics\n\nR = Rental of DME", "year": "2026" }, { "code": "S1031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gluc monitor rental", "typeOfServiceCode": "A = Used durable medical equipment (DME)\n\nP = Lump sum purchase of DME, prosthetics, orthotics R = Rental of DME", "year": "2026" }, { "code": "S1034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Artificial pancreas device system (e.g., low glucose suspend (lgs) feature) including continuous glucose monitor, blood glucose device, insulin pump and computer algorithm that communicates with all of the devices", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Art pancreas system", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S1035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sensor; invasive (e.g., subcutaneous), disposable, for use with artificial pancreas device system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Art pancreas inv disp sensor", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S1036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transmitter; external, for use with artificial pancreas device system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Art pancreas ext transmitter", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S1037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Receiver (monitor); external, for use with artificial pancreas device system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Art pancreas ext receiver", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S1040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cranial remolding orthosis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S1090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mometasone furoate sinus implant, 370 micrograms", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mometasone sinus implant", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S1091", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2021", "coverageCode": "I = Not payable by Medicare", "longDescription": "Stent, non-coronary, temporary, with delivery system (propel)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stent non-coronary propel", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2053", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transplantation of small intestine and liver allografts", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transplantation of small int", "typeOfServiceCode": "2 = Surgery\n\n9 = Other medical items or services", "year": "2026" }, { "code": "S2054", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transplantation of multivisceral organs", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transplantation of multivisc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Harvesting of donor multivisceral organs, with preparation and maintenance of allografts; from cadaver donor", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Harvesting of donor multivis", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lobar lung transplantation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lobar lung transplantation", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Donor lobectomy (lung) for transplantation, living donor", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Donor lobectomy (lung)", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2065", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Simultaneous pancreas kidney transplantation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Simult panc kidn trans", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2066", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Breast reconstruction with gluteal artery perforator (gap) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Breast gap flap reconst", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2067", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Breast reconstruction of a single breast with \"stacked\" deep inferior epigastric perforator (diep) flap(s) and/or gluteal artery perforator (gap) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Breast \"stacked\" diep/gap", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2068", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior epigastric artery (siea) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Breast diep or siea flap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with endoscopic laser treatment of ureteral calculi (includes ureteral catheterization)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cysto laser tx ureteral calc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2079", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Laparoscopic esophagomyotomy (heller type)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lap esophagomyotomy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Laser-assisted uvulopalatoplasty (laup)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Laup", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adjustment gastric band", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2095", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transcatheter occlusion or embolization for tumor destruction, percutaneous, any method, using yttrium-90 microspheres", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transcath emboliz microspher", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Islet cell tissue transplant from pancreas; allogeneic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Islet cell tissue transplant", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Adrenal tissue transplant to brain", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adrenal tissue transplant", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2107", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Adoptive immunotherapy i.e. development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adoptive immunotherapy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Knee arthroscp harv", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Osteotomy, periacetabular, with internal fixation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Periacetabular osteotomy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Arthroereisis, subtalar", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Arthroereisis, subtalar", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2118", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2008", "coverageCode": "I = Not payable by Medicare", "longDescription": "Metal-on-metal total hip resurfacing, including acetabular and femoral components", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Total hip resurfacing", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Low density lipoprotein(ldl)", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cord blood harvesting for transplantation, allogeneic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cord blood harvesting", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2142", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cord blood-derived stem-cell transplantation, allogeneic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cord blood-derived stem-cell", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre-and post-transplant care in the global definition", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bmt harv/transpl 28d pkg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Solid organ(s), complete or segmental, single organ or combination of organs; deceased or living donor(s), procurement, transplantation, and related complications; including: drugs; supplies; hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services, and the number of days of pre- and post-transplant care in the global definition", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Solid organ transpl pkg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Echosclerotherapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Echosclerotherapy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using arterial graft(s), single coronary arterial graft", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Minimally invasive direct co", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using arterial graft(s), two coronary arterial grafts", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Minimally invasive direct co", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using venous graft only, single coronary venous graft", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Minimally invasive direct co", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using single arterial and venous graft(s), single venous graft", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Minimally invasive direct co", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using two arterial grafts and single venous graft", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Minimally invasive direct co", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2225", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Myringotomy, laser-assisted", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Myringotomy laser-assist", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implant semi-imp hear", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2235", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Implantation of auditory brain stem implant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implant auditory brain imp", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Induced abortion, 17 to 24 weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Induced abortion 17-24 weeks", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Induced abortion, 25 to 28 weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Induced abortion 25-28 wks", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Induced abortion, 29 to 31 weeks", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Induced abortion 29-31 wks", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2267", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Induced abortion, 32 weeks or greater", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Induced abortion 32 or more", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Arthroscopy, shoulder, surgi", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hip core decompression", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hip core decompression", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Chemodenervation of abductor muscle(s) of vocal cord", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chemodenervation of abductor", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Chemodenervation of adductor muscle(s) of vocal cord", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chemodenerv adduct vocal", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nasal endoscopy for post-operative debridement following functional endoscopic sinus surgery, nasal and/or sinus cavity(s), unilateral or bilateral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nasal endoscop po debrid", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2348", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbar", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Decompress disc rf lumbar", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2350", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, single interspace", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diskectomy, anterior, with d", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, each additional interspace (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diskectomy, anterior, with d", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2360", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; cervical", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vertebroplast cerv 1st", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Each additional cervical vertebral body (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vertebroplast cerv addl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2400", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Repair, congenital diaphragmatic hernia in the fetus using temporary tracheal occlusion, procedure performed in utero", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetal surg congen hernia", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Repair, urinary tract obstruction in the fetus, procedure performed in utero", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetal surg urin trac obstr", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2402", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Repair, congenital cystic adenomatoid malformation in the fetus, procedure performed in utero", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetal surg cong cyst malf", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2403", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Repair, extralobar pulmonary sequestration in the fetus, procedure performed in utero", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetal surg pulmon sequest", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2404", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Repair, myelomeningocele in the fetus, procedure performed in utero", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetal surg myelomeningo", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2405", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Repair of sacrococcygeal teratoma in the fetus, procedure performed in utero", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetal surg sacrococ teratoma", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2409", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Repair, congenital malformation of fetus, procedure performed in utero, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetal surg noc", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S2411", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Fetoscopic laser therapy for treatment of twin-to-twin transfusion syndrome", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fetoscop laser ther ttts", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S2900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Robotic surgical system", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diabetic indicator; retinal eye exam, dilated, bilateral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bilat dil retinal exam", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Performance measurement, evaluation of patient self assessment, depression", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eval self-assess depression", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Stat laboratory request (situations other than s3601)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stat lab", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3601", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Emergency stat laboratory charge for patient who is homebound or residing in a nursing facility", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stat lab home/nf", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3620", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (pku); and thyroxine, total)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Newborn metabolic screening", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Eosinophil count, blood, direct", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eosinophil blood count", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3645", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hiv-1 antibody testing of oral mucosal transudate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hiv-1 antibody testing of or", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3650", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Saliva test, hormone level; during menopause", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Saliva test, hormone level;", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3652", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Saliva test, hormone level; to assess preterm labor risk", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Saliva test, hormone level;", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3655", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Antisperm antibodies test (immunobead)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Antisperm antibodies test", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3708", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gastrointestinal fat absorption study", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gastrointestinal fat absorpt", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3721", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prostate cancer antigen 3 (pca3) testing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pca3 testing", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3722", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dose optimization by area under the curve (auc) analysis, for infusional 5-fluorouracil", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dose optimization auc - 5fu", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3800", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for amyotrophic lateral sclerosis (als)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Genetic testing als", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3840", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dna analysis for germline mutations of the ret proto-oncogene for susceptibility to multiple endocrine neoplasia type 2", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dna analysis ret-oncogene", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3841", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for retinoblastoma", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test retinoblastoma", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3842", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for von hippel-lindau disease", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test hippel-lindau", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3844", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dna analysis of the connexin 26 gene (gjb2) for susceptibility to congenital, profound deafness", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dna analysis deafness", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3845", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for alpha-thalassemia", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test alpha-thalassemia", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3846", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for hemoglobin e beta-thalassemia", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test beta-thalassemia", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3849", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for niemann-pick disease", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test niemann-pick", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3850", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for sickle cell anemia", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test sickle cell", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3852", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dna analysis for apoe epsilon 4 allele for susceptibility to alzheimer's disease", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dna analysis apoe alzheimer", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3853", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for myotonic muscular dystrophy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test myo musclr dyst", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3854", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gene expression profiling panel for use in the management of breast cancer treatment", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene profile panel breast", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3855", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing for detection of mutations in the presenilin - 1 gene", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gene test presenilin-1 gene", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3861", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2008", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic testing, sodium channel, voltage-gated, type v, alpha subunit (scn5a) and variants for suspected brugada syndrome", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Genetic test brugada", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3865", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2009", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive gene sequence analysis for hypertrophic cardiomyopathy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comp genet test hyp cardiomy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3866", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2009", "coverageCode": "I = Not payable by Medicare", "longDescription": "Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy (hcm) in an individual with a known hcm mutation in the family", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spec gene test hyp cardiomy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3870", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2009", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comparative genomic hybridization (cgh) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cgh test developmental delay", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3890", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Dna analysis, fecal, for colorectal cancer screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fecal dna analysis", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Surface electromyography (emg)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Surface emg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3902", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ballistocardiogram", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ballistocardiogram", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S3904", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Masters two step", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Masters two step", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Interim labor facility global (labor occurring but not resulting in delivery)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interim labor facility globa", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "In vitro fertilization; including but not limited to identification and incubation of mature oocytes, fertilization with sperm, incubation of embryo(s), and subsequent visualization for determination of development", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ivf package", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Complete cycle, gamete intrafallopian transfer (gift), case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Compl gift case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Complete cycle, zygote intrafallopian transfer (zift), case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Compl zift case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Complete in vitro fertilization cycle, not otherwise specified, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Complete ivf nos case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Frozen in vitro fertilization cycle, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Frozen ivf case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Incomplete cycle, treatment cancelled prior to stimulation, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ivf canc a stim case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Frozen embryo transfer procedure cancelled before transfer, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "F emb trns canc case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "In vitro fertilization procedure cancelled before aspiration, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ivf canc b4 aspir case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "In vitro fertilization procedure cancelled after aspiration, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ivf canc aftr aspr case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Assisted oocyte fertilization, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asst oocyte fert case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Donor egg cycle, incomplete, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Incompl donor egg case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2025", "coverageCode": "I = Not payable by Medicare", "longDescription": "Air polymer-type a intrauterine foam, per study dose", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Air polymer foam per study", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Donor services for in vitro fertilization (sperm or embryo), case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Donor serv ivf case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Procurement of donor sperm from sperm bank", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Procure donor sperm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Storage of previously frozen embryos", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Store prev froz embryos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Microsurgical epididymal sperm aspiration (mesa)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Microsurg epi sperm asp", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sperm procurement and cryopreservation services; initial visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sperm procure init visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sperm procurement and cryopreservation services; subsequent visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sperm procure subs visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Stimulated intrauterine insemination (iui), case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stimulated iui case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cryopreserved embryo transfer, case rate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cryo embryo transf case rate", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Monitoring and storage of cryopreserved embryos, per 30 days", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Monit store cryo embryo 30 d", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ovulation mgmt per cycle", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insertion of levonorgestrel-releasing intrauterine system", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insert levonorgestrel ius", "typeOfServiceCode": "2 = Surgery", "year": "2026" }, { "code": "S4988", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2025", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "I = Not payable by Medicare", "longDescription": "Penile contracture device, manual, greater than 3 lbs traction force", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Penile contractur devic manu", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4989", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Contracept iud", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nicotine patches, legend", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nicotine patch legend", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4991", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nicotine patches, non-legend", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nicotine patch nonlegend", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4993", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Contraceptive pills for birth control", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Contraceptive pills for bc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S4995", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Smoking cessation gum", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Smoking cessation gum", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prescription drug, generic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prescription drug, generic", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Prescription drug, brand name", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Prescription drug,brand name", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "5% dextrose and 0.45% normal saline, 1000 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "5% dextrose and 0.45% saline", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "5% dextrose in lactated ringer's, 1000 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "5% dextrose in lactated ring", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "5% dextrose with potassium chloride, 1000 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "5% dextrose with potassium", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1000 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "5%dextrose/0.45%saline1000ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1500 ml", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "D5w/0.45ns w kcl and mgs04", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, routine service of infusion device (e.g., pump maintenance)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit routine device maint", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, repair of infusion device (e.g., pump repair)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit device repair", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Day care services, adult; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult daycare services 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Day care services, adult; per half day", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult day care per half day", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5102", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Day care services, adult; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult day care per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Day care services, center-based; services not included in program fee, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Centerbased day care perdiem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home care training to home care client, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Homecare train pt 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5109", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home care training to home care client, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Homecare train pt session", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home care training, family; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Family homecare training 15m", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home care training, family; per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Family homecare train/sessio", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home care training, non-family; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonfamily homecare train/15m", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5116", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home care training, non-family; per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nonfamily hc train/session", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Chore services; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chore services per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Chore services; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Chore services per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5125", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Attendant care services; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Attendant care service /15m", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Attendant care services; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Attendant care service /diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Homemaker service, nos; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Homaker service nos per 15m", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Homemaker service, nos; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Homemaker service nos /diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5135", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Companion care, adult (e.g., iadl/adl); per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult companioncare per 15m", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5136", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Companion care, adult (e.g., iadl/adl); per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult companioncare per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Foster care, adult; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult foster care per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Foster care, adult; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult foster care per month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Foster care, therapeutic, child; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Child fostercare th per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5146", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Foster care, therapeutic, child; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ther fostercare child /month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Unskilled respite care, not hospice; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unskilled respite care /15m", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5151", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Unskilled respite care, not hospice; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Unskilled respitecare /diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Emergency response system; installation and testing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Emer response sys instal&tst", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5161", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Emergency response system; service fee, per month (excludes installation and testing)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Emer rspns sys serv permonth", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5162", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Emergency response system; purchase only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Emer rspns system purchase", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5165", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home modifications; per service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home modifications per serv", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home delivered meals, including preparation; per meal", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Homedelivered prepared meal", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5175", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Laundry service, external, professional; per order", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Laundry serv,ext,prof,/order", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home health respiratory therapy, initial evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hh respiratory thrpy in eval", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home health respiratory therapy, nos, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hh respiratory thrpy nos/day", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medication reminder service, non-face-to-face; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med reminder serv per month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Wellness assessment, performed by non-physician", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Wellness assessment by nonph", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Personal care item, nos, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Personal care item nos each", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5497", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, catheter care / maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit cath care noc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5498", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, catheter care / maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit simple cath care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit complex cath care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit interim cath care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5517", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit declotting kit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5518", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, all supplies necessary for catheter repair", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit cath repair kit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (picc) line insertion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit picc insert kit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit midline cath insert kit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, insertion of peripherally inserted central venous catheter (picc), nursing services only (no supplies or catheter included)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit picc insert no supp", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, insertion of midline venous catheter, nursing services only (no supplies or catheter included)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hip midline cath insert kit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5550", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin, rapid onset, 5 units", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin rapid 5 u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5551", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin, most rapid onset (lispro or aspart); 5 units", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin most rapid 5 u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5552", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin, intermediate acting (nph or lente); 5 units", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin intermed 5 u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5553", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin, long acting; 5 units", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin long acting 5 u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin delivery device, reusable pen; 1.5 ml size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin reuse pen 1.5 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5561", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin delivery device, reusable pen; 3 ml size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin reuse pen 3 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5565", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin cartridge for use in insulin delivery device other than pump; 150 units", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin cartridge 150 u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5566", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin cartridge for use in insulin delivery device other than pump; 300 units", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin cartridge 300 u", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5570", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin delivery device, disposable pen (including insulin); 1.5 ml size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin dispos pen 1.5 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S5571", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin delivery device, disposable pen (including insulin); 3 ml size", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin dispos pen 3 ml", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Scleral application of tantalum ring(s) for localization of lesions for proton beam therapy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tantalum ring application", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2014", "coverageCode": "I = Not payable by Medicare", "crossReferenceCode": "G0297", "longDescription": "Low-dose computed tomography for lung cancer screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Low dose ct lung screening", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Magnetic source imaging", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Magnetic source imaging", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Magnetic resonance cholangiopancreatography (mrcp)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mrcp", "typeOfServiceCode": "4 = Diagnostic radiology", "year": "2026" }, { "code": "S8040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Topographic brain mapping", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Topographic brain mapping", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Magnetic resonance imaging (mri), low-field", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mri low field", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ultrasound guidance for multifetal pregnancy reduction(s), technical component (only to be used when the physician doing the reduction procedure does not perform the ultrasound, guidance is included in the cpt code for multifetal pregnancy reduction - 59866)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Us guidance fetal reduct", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Scintimammography", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8085", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Fluorine-18 fluorodeoxyglucose (f-18 fdg) imaging using dual-head coincidence detection system (non-dedicated pet scan)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Fluorine-18 fluorodeoxygluco", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8092", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Electron beam computed tomography (also known as ultrafast ct, cine ct)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Electron beam computed tomog", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8096", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Portable peak flow meter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Portable peak flow meter", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8097", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Asthma kit (including but not limited to portable peak expiratory flow meter, instructional video, brochure, and/or spacer)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asthma kit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Holding chamber or spacer for use with an inhaler or nebulizer; without mask", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spacer without mask", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Holding chamber or spacer for use with an inhaler or nebulizer; with mask", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spacer with mask", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Peak expiratory flow rate (physician services)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Peak expiratory flow rate (p", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oxygen contents, gaseous, 1 unit equals 1 cubic foot", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O2 contents gas cubic ft", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Oxygen contents, liquid, 1 unit equals 1 pound", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "O2 contents liquid lb", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Interferential current stimulator, 2 channel", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interferential stim 2 chan", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Interferential current stimulator, 4 channel", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Interferential stim 4 chan", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8185", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Flutter device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Flutter device", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8186", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Swivel adapter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Swivel adaptor", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8189", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Tracheostomy supply, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Trach supply noc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mucus trap", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mucus trap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Mandibular orthopedic repositioning device, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mandib ortho repos device", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Haberman feeder for cleft lip/palate", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Haberman feeder", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Enuresis alarm, using auditory buzzer and/or vibration device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Enuresis alarm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Infection control supplies, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Infect control supplies nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8415", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supplies for home delivery of infant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supplies for home delivery", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8420", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (sleeve and glove combination), custom made", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom gradient sleev/glov", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8421", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (sleeve and glove combination), ready made", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ready gradient sleev/glov", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8422", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (sleeve), custom made, medium weight", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom grad sleeve med", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8423", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (sleeve), custom made, heavy weight", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom grad sleeve heavy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8424", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (sleeve), ready made", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ready gradient sleeve", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8425", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (glove), custom made, medium weight", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom grad glove med", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8426", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (glove), custom made, heavy weight", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Custom grad glove heavy", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8427", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (glove), ready made", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ready gradient glove", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8428", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure aid (gauntlet), ready made", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ready gradient gauntlet", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8429", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Gradient pressure exterior wrap", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Gradient pressure wrap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Padding for compression bandage, roll", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Padding for comprssn bdg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8431", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Compression bandage, roll", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Compression bandage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8450", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Splint, prefabricated, digit (specify digit by use of modifier)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Splint digit", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S8451", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Splint, prefabricated, wrist or ankle", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Splint wrist or ankle", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S8452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Splint, prefabricated, elbow", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Splint elbow", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "S8460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Camisole, post-mastectomy", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Camisole post-mast", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin syringes (100 syringes, any size)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "100 insulin syringes", "typeOfServiceCode": "S = Surgical dressings or other medical supplies (eff 04/95)", "year": "2026" }, { "code": "S8930", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2012", "coverageCode": "I = Not payable by Medicare", "longDescription": "Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Auricular electrostimulation", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8940", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Equestrian/hippotherapy, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hippotherapy per session", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8948", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Low-level laser trmt 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8950", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Complex lymphedema therapy, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Complex lymphedema therapy,", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Physical or manipulative therapy performed for maintenance rather than restoration", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt or manip for maint", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S8999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Resuscitation bag", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home uterine monitor with or without associated nursing services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home uterine monitor with or", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2024", "coverageCode": "I = Not payable by Medicare", "longDescription": "Intra-vaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intra-vag motion sens biofk", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ultrafiltration monitor", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ultrafiltration monitor", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2016", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Automated eeg monitoring", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Automated eeg monitoring", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Paranasal sinus ultrasound", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Paranasal sinus ultrasound", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Omnicardiogram/cardiointegram", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Omnicardiogram/cardiointegra", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Extracorporeal shockwave lithotripsy for gall stones (if performed with ercp, use 43265)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eswl for gallstones", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9055", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Procuren or other growth factor preparation to promote wound healing", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Procuren or other growth fac", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9056", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Coma stimulation per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Coma stimulation per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9061", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home administration of aerosolized drug therapy (e.g., pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical supplies and equipme", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9083", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Global fee urgent care centers", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Urgent care center global", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9088", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services provided in an urgent care center (list in addition to code for service)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Services provided in urgent", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Vertebral axial decompression, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vertebral axial decompressio", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9097", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home visit for wound care", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home visit wound care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9098", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home visit, phototherapy services (e.g., bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home phototherapy visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "I = Not payable by Medicare", "longDescription": "Telemonitoring of patient in their home, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telemonitoring/home per mnth", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9117", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Back school, per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Back school visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9122", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home health aide or certified nurse assistant, providing care in the home; per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home health aide or certifie", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9123", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "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)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nursing care in home rn", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9124", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nursing care, in the home; by licensed practical nurse, per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nursing care, in the home; b", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9125", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Respite care, in the home, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Respite care, in the home, p", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9126", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospice care, in the home, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice care, in the home, p", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9127", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Social work visit, in the home, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Social work visit, in the ho", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9128", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Speech therapy, in the home, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Speech therapy, in the home,", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9129", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Occupational therapy, in the home, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Occupational therapy, in the", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9131", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Physical therapy; in the home, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt in the home per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diabetic management program, follow-up visit to non-md provider", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diabetic management program,", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9141", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diabetic management program, follow-up visit to md provider", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diabetic management program,", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9145", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Insulin pump initiation, instruction in initial use of pump (pump not included)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Insulin pump initiation", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Evaluation by ocularist", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Evaluation by ocularist", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9152", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Speech therapy, re-evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Speech therapy, re-eval", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home mgmt preterm labor", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9209", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home management of preterm premature rupture of membranes (pprom), including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home mgmt pprom", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home mgmt gest hypertension", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hm postpar hyper per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately); per diem (do not use this code with any home infusion per diem code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hm preeclamp per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hm gest dm per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9325", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (do not use this code with s9326, s9327 or s9328)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit pain mgmt per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9326", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, continuous (twenty-four hours or more) pain management infusion; administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit cont pain per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9327", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, intermittent (less than twenty-four hours) pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit int pain per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9328", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit pain imp pump diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9329", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with s9330 or s9331)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit chemo per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9330", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, continuous (twenty-four hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit cont chem diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9331", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, intermittent (less than twenty-four hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit intermit chemo diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9335", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy, hemodialysis; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht hemodialysis diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9336", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, continuous anticoagulant infusion therapy (e.g., heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit cont anticoag diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9338", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit immunotherapy diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9339", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; peritoneal dialysis, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit periton dialysis diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9340", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit enteral per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9341", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit enteral grav diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9342", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit enteral pump diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9343", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit enteral bolus nurs", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9345", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, anti-hemophilic agent infusion therapy (e.g., factor viii); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit anti-hemophil diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9346", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, alpha-1-proteinase inhibitor (e.g., prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit alpha-1-proteinas diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9347", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit longterm infusion diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9348", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g., dobutamine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit sympathomim diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9349", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, tocolytic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit tocolysis diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9351", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, continuous or intermittent anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit cont antiemetic diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9353", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit cont insulin diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9355", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit chelation diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9357", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, enzyme replacement intravenous therapy; (e.g., imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit enzyme replace diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9359", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g., infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit anti-tnf per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9361", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit diuretic infus diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9363", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, anti-spasmotic therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit anti-spasmotic diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, total parenteral nutrition (tpn); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem (do not use with home infusion codes s9365-s9368 using daily volume scales)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit tpn total diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9365", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, total parenteral nutrition (tpn); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit tpn 1 liter diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9366", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, total parenteral nutrition (tpn); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit tpn 2 liter diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9367", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, total parenteral nutrition (tpn); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit tpn 3 liter diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9368", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, total parenteral nutrition (tpn); more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit tpn over 3l diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9370", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy, intermittent anti-emetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht inj antiemetic diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9372", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; intermittent anticoagulant injection therapy (e.g., heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code for flushing of infusion devices with heparin to maintain patency)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht inj anticoag diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9373", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use with hydration therapy codes s9374-s9377 using daily volume scales)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit hydra total diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9374", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit hydra 1 liter diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9375", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, hydration therapy; more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit hydra 2 liter diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9376", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, hydration therapy; more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit hydra 3 liter diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9377", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, hydration therapy; more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit hydra over 3l diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9379", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit noc per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9381", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Delivery or service to high risk areas requiring escort or extra protection, per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit high risk/escort", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9401", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Anticoagulation clinic, inclusive of all services except laboratory tests, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Anticoag clinic per session", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Pharmacy compounding and dispensing services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pharmacy comp/disp serv", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9432", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2021", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2021", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical foods for non-inborn errors of metabolism", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med food non inborn err meta", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9433", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2009", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2009", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical food nutritionally complete, administered orally, providing 100% of nutritional intake", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical food oral 100% nutr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9434", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Modified solid food supplements for inborn errors of metabolism", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Mod solid food suppl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9435", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical foods for inborn errors of metabolism", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medical foods for inborn err", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9436", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Childbirth preparation/lamaze classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lamaze class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9437", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Childbirth refresher classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Childbirth refresher class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9438", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cesarean birth classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cesarean birth class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9439", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Vbac (vaginal birth after cesarean) classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vbac class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9441", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Asthma education, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Asthma education", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9442", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Birthing classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Birthing class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9443", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lactation classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lactation class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9444", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Parenting classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Parenting class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9445", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Patient education, not otherwise classified, non-physician provider, individual, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt education noc individ", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9446", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Patient education, not otherwise classified, non-physician provider, group, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pt education noc group", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9447", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Infant safety (including cpr) classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Infant safety class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9449", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Weight management classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Weight mgmt class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9451", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Exercise classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Exercise class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9452", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nutrition classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nutrition class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9453", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Smoking cessation classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Smoking cessation class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9454", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Stress management classes, non-physician provider, per session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Stress mgmt class", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9455", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diabetic management program, group session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diabetic management program,", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9460", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diabetic management program, nurse visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diabetic management program,", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9465", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Diabetic management program, dietitian visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diabetic management program,", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9470", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nutritional counseling, dietitian visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nutritional counseling, diet", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9472", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Cardiac rehabilitation program, non-physician provider, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cardiac rehabilitation progr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9473", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Pulmonary rehabilitation program, non-physician provider, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pulmonary rehabilitation pro", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9474", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Enterostomal therapy by a registered nurse certified in enterostomal therapy, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Enterostomal therapy by a re", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9475", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ambulatory setting substance abuse treatment or detoxification services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ambulatory setting substance", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9476", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Vestibular rehabilitation program, non-physician provider, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vestibular rehab per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9480", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Intensive outpatient psychiatric services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Intensive outpatient psychia", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9482", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Family stabilization services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Family stabilization 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9484", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Crisis intervention mental health services, per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Crisis intervention per hour", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9485", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Crisis intervention mental health services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Crisis intervention mental h", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9490", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, corticosteroid infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit corticosteroid/diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9494", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules s9497-s9504)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit antibiotic total diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9497", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit antibiotic q3h diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit antibiotic q24h diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit antibiotic q12h diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit antibiotic q8h diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit antibiotic q6h diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9504", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit antibiotic q4h diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9529", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Routine venipuncture for collection of specimen(s), single home bound, nursing home, or skilled nursing facility patient", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Venipuncture home/snf", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "S9537", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; hematopoietic hormone injection therapy (e.g., erythropoietin, g-csf, gm-csf); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht hem horm inj diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9538", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home transfusion of blood product(s); administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (blood products, drugs, and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit blood products diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht inj noc per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9558", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home injectable therapy; growth hormone, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht inj growth horm diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9559", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home injectable therapy, interferon, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hit inj interferon diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9560", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht inj hormone diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9562", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home injectable therapy, palivizumab or other monoclonal antibody for rsv, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht inj palivizumab/ab diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9563", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2023", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home injectable therapy, immunotherapy, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht inj immuno diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9590", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy, irrigation therapy (e.g., sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht irrigation diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9810", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ht pharm per hour", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9900", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2012", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services by a journal-listed christian science practitioner for the purpose of healing, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Christian sci pract visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9901", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2015", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services by a journal-listed christian science nurse, per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Christian sci nurse visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9960", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ambulance service, conventional air service, nonemergency transport, one way (fixed wing)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Air ambulanc nonemerg fixed", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "S9961", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "I = Not payable by Medicare", "longDescription": "Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Air ambulan nonemerg rotary", "typeOfServiceCode": "D = Ambulance (eff 04/95)", "year": "2026" }, { "code": "S9970", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Health club membership, annual", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Health club membership yr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9975", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transplant related lodging, meals and transportation, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transplant related per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9976", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lodging, per diem, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lodging per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9977", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Meals, per diem, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Meals per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9981", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical records copying fee, administrative", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med record copy admin", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9982", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medical records copying fee, per page", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med record copy per page", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9986", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Not medically necessary service (patient is aware that service not medically necessary)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Not medically necessary svc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9988", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services provided as part of a phase i clinical trial", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Serv part of phase i trial", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9989", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services provided outside of the united states of america (list in addition to code(s) for service(s))", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Services outside us", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9990", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services provided as part of a phase ii clinical trial", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Services provided as part of", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9991", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services provided as part of a phase iii clinical trial", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Services provided as part of", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9992", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transportation costs to and from trial location and local transportation costs (e.g., fares for taxicab or bus) for clinical trial participant and one caregiver/companion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Transportation costs to and", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9994", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lodging costs (e.g., hotel charges) for clinical trial participant and one caregiver/companion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lodging costs (e.g. hotel ch", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9996", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Meals for clinical trial participant and one caregiver/companion", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Meals for clinical trial par", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "S9999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2000", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2000", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sales tax", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sales tax", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1000", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Private duty / independent nursing service(s) - licensed, up to 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Private duty/independent nsg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nursing assessment / evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nursing assessment/evaluatn", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Rn services, up to 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rn services up to 15 minutes", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Lpn/lvn services, up to 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lpn/lvn services up to 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services of a qualified nursing aide, up to 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Nsg aide service up to 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Respite care services, up to 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Respite care service 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1006", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or substance abuse services, family/couple counseling", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Family/couple counseling", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or substance abuse services, treatment plan development and/or modification", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Treatment plan development", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1009", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Child sitting services for children of the individual receiving alcohol and/or substance abuse services", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Child sitting services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Meals for individuals receiving alcohol and/or substance abuse services (when meals not included in the program)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Meals when receive services", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Alcohol and/or substance abuse services, skills development", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alcohol/substance abuse skil", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Sign language or oral interpretive services, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sign lang/oral interpreter", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2001", "coverageCode": "I = Not payable by Medicare", "longDescription": "Telehealth transmission, per minute, professional services bill separately", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Telehealth transmit, per min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Clinic visit/encounter, all-inclusive", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Clinic service", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "T1016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Case management, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Case management", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Targeted case management, each 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Targeted case management", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "School-based individualized education program (iep) services, bundled", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "School-based iep ser bundled", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Personal care ser per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Personal care ser per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Home health aide or certified nurse assistant, per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hh aide or cn aide per visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Contracted home health agency services, all services provided under contract, per day", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Contracted services per day", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Program intake assessment", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Team evaluation & management", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped compr care pkg, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2024", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped compr care pkg, per hour", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Family training and counseling for child development, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Family training & counseling", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Home environment assessment", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Comprehensive environmental lead investigation, not including laboratory analysis, per dwelling", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dwelling lead investigation", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nursing care, in the home, by registered nurse, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Rn home care per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Nursing care, in the home, by licensed practical nurse, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Lpn home care per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services performed by a doula birth worker, per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sv doula brth wrk per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Services performed by a doula birth worker, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Sv doula brth wrk per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medicaid certified community behavioral health clinic services, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comm bh clinic svc per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2017", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2017", "coverageCode": "I = Not payable by Medicare", "longDescription": "Medicaid certified community behavioral health clinic services, per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comm bh clinic svc per month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1502", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Medication admin visit", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2007", "coverageCode": "I = Not payable by Medicare", "longDescription": "Administration of medication, other than oral and/or injectable, by a health care agency/professional, per visit", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Med admin, not oral/inject", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1505", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2011", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2011", "coverageCode": "I = Not payable by Medicare", "longDescription": "Electronic medication compliance management device, includes all components and accessories, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Elec med comp dev, noc", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T1999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in \"remarks\"", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Noc retail items andsupplies", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation; patient attendant/escort", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "N-et; patient attend/escort", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "N-et; per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation; encounter/trip", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "N-et; encounter/trip", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transport; commercial carrier, multi-pass", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "N-et; commerc carrier pass", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2002", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation; stretcher van", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "N-et; stretcher van", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2007", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Transportation waiting time, air ambulance and non-emergency vehicle, one-half (1/2) hour increments", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Non-emer transport wait time", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Preadmission screening and resident review (pasrr) level i identification screening, per screen", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pasrr level i", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Preadmission screening and resident review (pasrr) level ii evaluation, per evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Pasrr level ii", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2012", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, educational; waiver, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil ed waiver, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2013", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, educational, waiver; per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil ed waiver per hour", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, prevocational, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil prevoc waiver, per d", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2015", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, prevocational, waiver; per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil prevoc waiver per hr", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2016", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, residential, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil res waiver per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2017", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, residential, waiver; 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil res waiver 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2018", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, supported employment, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil sup empl waiver/diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2019", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, supported employment, waiver; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Habil sup empl waiver 15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Day habilitation, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Day habil waiver per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2021", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Day habilitation, waiver; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Day habil waiver per 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2022", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Case management, per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Case management, per month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2023", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Targeted case management; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Targeted case mgmt per month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2024", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Service assessment/plan of care development, waiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Serv asmnt/care plan waiver", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Waiver services; not otherwise specified (nos)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Waiver service, nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2026", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Specialized childcare, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Special childcare waiver/d", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2027", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Specialized childcare, waiver; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Spec childcare waiver 15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2028", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Specialized supply, not otherwise specified, waiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Special supply, nos waiver", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2029", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Specialized medical equipment, not otherwise specified, waiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Special med equip, noswaiver", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Assisted living, waiver; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Assist living waiver/month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2031", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Assisted living; waiver, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Assist living waiver/diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2032", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Residential care, not otherwise specified (nos), waiver; per month", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Res care, nos waiver/month", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2033", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Residential care, not otherwise specified (nos), waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Res, nos waiver per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2034", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Crisis intervention, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Crisis interven waiver/diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2035", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Utility services to support medical equipment and assistive technology/devices, waiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Utility services waiver", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2036", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Therapeutic camping, overnight, waiver; each session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Camp overnite waiver/session", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2037", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Therapeutic camping, day, waiver; each session", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Camp day waiver/session", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2038", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Community transition, waiver; per service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Comm trans waiver/service", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2039", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Vehicle modifications, waiver; per service", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vehicle mod waiver/service", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Financial management, self-directed, waiver; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Financial mgt waiver/15min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2041", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supports brokerage, self-directed, waiver; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Support broker waiver/15 min", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2042", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospice routine home care; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice routine home care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2043", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospice continuous home care; per hour", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice continuous home care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2044", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospice inpatient respite care; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice respite care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2045", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospice general inpatient care; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice general care", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2046", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Hospice long term care, room and board only; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hospice long term care, r&b", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2047", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "I = Not payable by Medicare", "longDescription": "Habilitation, prevocational, waiver; per 15 minutes", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hab prevo waiver per 15", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2048", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2003", "coverageCode": "I = Not payable by Medicare", "longDescription": "Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Bh ltc res r&b, per diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2049", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "July 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "July 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Non-emergency transportation; stretcher van, mileage; per mile", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "N-et; stretcher van, mileage", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Financial management, self-directed, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Financial mgt waiver/diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2051", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "April 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supports brokerage, self-directed, waiver; per diem", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Support broker waiver/diem", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T2101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Human breast milk processing, storage and distribution only", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Breast milk proc/store/dist", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, brief/diaper, small, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size brief/diaper sm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4522", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, brief/diaper, medium, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size brief/diaper med", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, brief/diaper, large, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size brief/diaper lg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, brief/diaper, extra large, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size brief/diaper xl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, protective underwear/pull-on, small size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size pull-on sm", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size pull-on med", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4527", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, protective underwear/pull-on, large size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size pull-on lg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4528", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult size pull-on xl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4529", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped size brief/diaper sm/med", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Pediatric sized disposable incontinence product, brief/diaper, large size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped size brief/diaper lg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped size pull-on sm/med", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4532", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ped size pull-on lg", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4533", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Youth sized disposable incontinence product, brief/diaper, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Youth size brief/diaper", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4534", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Youth sized disposable incontinence product, protective underwear/pull-on, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Youth size pull-on", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4535", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Disposable liner/shield/guard/pad/undergarment, for incontinence, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disposable liner/shield/pad", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4536", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Incontinence product, protective underwear/pull-on, reusable, any size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reusable pull-on any size", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4537", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Incontinence product, protective underpad, reusable, bed size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reusable underpad bed size", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4538", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Diaper service, reusable diaper, each diaper", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Diaper serv reusable diaper", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4539", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Incontinence product, diaper/brief, reusable, any size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reuse diaper/brief any size", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4540", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Incontinence product, protective underpad, reusable, chair size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Reusable underpad chair size", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4541", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Incontinence product, disposable underpad, large, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Large disposable underpad", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4542", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "I = Not payable by Medicare", "longDescription": "Incontinence product, disposable underpad, small size, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Small disposable underpad", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4543", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2007", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, protective brief/diaper, above extra large, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adult disp brief/diap abv xl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4544", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2014", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Adlt disp und/pull on abv xl", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T4545", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Incontinence product, disposable, penile wrap, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Incon disposable penile wrap", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "T5001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Positioning seat for persons with special orthopedic needs", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Position seat spec orth need", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "T5999", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "I = Not payable by Medicare", "longDescription": "Supply, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Supply, nos", "typeOfServiceCode": "9 = Other medical items or services", "year": "2026" }, { "code": "U0001", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "February 04, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 04, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "22 = Price established by carriers (e.g., gap - fills, carrier established panels)", "shortDescription": "2019-ncov diagnostic p", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "U0002", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "February 04, 2020", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "February 04, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "22 = Price established by carriers (e.g., gap - fills, carrier established panels)", "shortDescription": "Covid-19 lab test non-cdc", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "U0003", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 12, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 14, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "22 = Price established by carriers (e.g., gap - fills, carrier established panels)", "shortDescription": "Cov-19 amp prb hgh thruput", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "U0004", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 12, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 14, 2020", "coverageCode": "C = Carrier judgment", "longDescription": "2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "22 = Price established by carriers (e.g., gap - fills, carrier established panels)", "shortDescription": "Cov-19 test non-cdc hgh thru", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "U0005", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "May 12, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2021", "coverageCode": "C = Carrier judgment", "longDescription": "Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "22 = Price established by carriers (e.g., gap - fills, carrier established panels)", "shortDescription": "Infec agen detec ampli probe", "typeOfServiceCode": "5 = Diagnostic laboratory", "year": "2026" }, { "code": "V2020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Frames, purchases", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Vision svcs frames purchases", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2025", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1992", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Deluxe frame", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eyeglasses delux frames", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, single vision, plano to plus or minus 4.00, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens spher single plano 4.00", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2101", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Single visn sphere 4.12-7.00", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2102", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Singl visn sphere 7.12-20.00", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2103", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylindr 4.00d/12-2.00d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2104", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylindr 4.00d/2.12-4d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2105", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylinder 4.00d/4.25-6d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2106", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylinder 4.00d/>6.00d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2107", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylinder 4.25d/12-2d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2108", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylinder 4.25d/2.12-4d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2109", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylinder 4.25d/4.25-6d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylinder 4.25d/over 6d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2111", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylindr 7.25d/.25-2.25", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2112", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylindr 7.25d/2.25-4d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2113", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylindr 7.25d/4.25-6d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2114", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Spherocylinder over 12.00d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2115", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Lenticular, (myodisc), per lens, single vision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens lenticular bifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2118", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Aniseikonic lens, single vision", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens aniseikonic single", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2121", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lenticular lens, per lens, single", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lenticular lens, single", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2199", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Not otherwise classified, single vision lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Lens single vision not oth c", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, bifocal, plano to plus or minus 4.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens spher bifoc plano 4.00d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2201", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphere bifocal 4.12-7.0", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2202", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphere bifocal 7.12-20.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2203", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcyl bifocal 4.00d/.1", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2204", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifocal 4.00d/2.1", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2205", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifocal 4.00d/4.2", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2206", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifocal 4.00d/ove", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2207", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifocal 4.25-7d/.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2208", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifocal 4.25-7/2.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2209", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifocal 4.25-7/4.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2210", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifocal 4.25-7/ov", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy bifo 7.25-12/.25-", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcyl bifo 7.25-12/2.2", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcyl bifo 7.25-12/4.2", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, bifocal, sphere over plus or minus 12.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcyl bifocal over 12.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Lenticular (myodisc), per lens, bifocal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens lenticular bifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2218", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Aniseikonic, per lens, bifocal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens aniseikonic bifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2219", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Bifocal seg width over 28 mm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens bifocal seg width over", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Bifocal add over 3.25d", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens bifocal add over 3.25d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lenticular lens, per lens, bifocal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lenticular lens, bifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Specialty bifocal (by report)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Lens bifocal speciality", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2300", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, trifocal, plano to plus or minus 4.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphere trifocal 4.00d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2301", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphere trifocal 4.12-7.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2302", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphere trifocal 7.12-20", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2303", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy trifocal 4.0/.12-", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2304", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 2.25-4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy trifocal 4.0/2.25", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2305", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy trifocal 4.0/4.25", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2306", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcyl trifocal 4.00/>6", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2307", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, .12 to 2.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcy trifocal 4.25-7/.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2308", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphc trifocal 4.25-7/2.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2309", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphc trifocal 4.25-7/4.", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2310", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphc trifocal 4.25-7/>6", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2311", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphc trifo 7.25-12/.25-", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2312", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphc trifo 7.25-12/2.25", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2313", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphc trifo 7.25-12/4.25", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2314", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Spherocylinder, trifocal, sphere over plus or minus 12.00d, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens sphcyl trifocal over 12", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2315", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Lenticular, (myodisc), per lens, trifocal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens lenticular trifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2318", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Aniseikonic lens, trifocal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens aniseikonic trifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2319", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Trifocal seg width over 28 mm", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens trifocal seg width > 28", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2320", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Trifocal add over 3.25d", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens trifocal add over 3.25d", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2321", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lenticular lens, per lens, trifocal", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lenticular lens, trifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2399", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Specialty trifocal (by report)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Lens trifocal speciality", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2410", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Variable asphericity lens, single vision, full field, glass or plastic, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens variab asphericity sing", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2430", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Variable asphericity lens, bifocal, full field, glass or plastic, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens variable asphericity bi", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2499", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "C = Carrier judgment", "longDescription": "Variable sphericity lens, other type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Variable asphericity lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2500", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, pmma, spherical, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Contact lens pmma spherical", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2501", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, pmma, toric or prism ballast, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct lens pmma-toric/prism", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2502", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, pmma, bifocal, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Contact lens pmma bifocal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2503", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, pmma, color vision deficiency, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct lens pmma color vision", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2510", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, gas permeable, spherical, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct gas permeable sphericl", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2511", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, gas permeable, toric, prism ballast, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct toric prism ballast", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2512", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, gas permeable, bifocal, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct lens gas permbl bifocl", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2513", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, gas permeable, extended wear, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Contact lens extended wear", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2520", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact lens, hydrophilic, spherical, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Contact lens hydrophilic", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2521", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact lens, hydrophilic, toric, or prism ballast, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct lens hydrophilic toric", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2522", "actionCode": "N = No maintenance for this code", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact lens, hydrophilic, bifocal, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct lens hydrophil bifocl", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2523", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact lens, hydrophilic, extended wear, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct lens hydrophil extend", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2524", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2020", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact lens, hydrophilic, spherical, photochromic additive, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Cntct lens hydrophil photoch", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2525", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2022", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "April 01, 2022", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Contact lens, hydrophilic, dual focus, per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cl, hydrophilic, dual focus", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2526", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2023", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "October 01, 2023", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Contact lens, hydrophilic, with blue-violet filter, per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Cntct lens blue violet", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2530", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, scleral, gas impermeable, per lens (for contact lens modification, see 92325)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Contact lens gas impermeable", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2531", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Contact lens, scleral, gas permeable, per lens (for contact lens modification, see 92325)", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Contact lens gas permeable", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2599", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Contact lens, other type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Contact lens/es other type", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2600", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Hand held low vision aids and other nonspectacle mounted aids", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Hand held low vision aids", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2610", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Single lens spectacle mounted low vision aids", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Single lens spectacle mount", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2615", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Telescop/othr compound lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2623", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Prosthetic eye, plastic, custom", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Plastic eye prosth custom", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "V2624", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Polishing/resurfacing of ocular prosthesis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Polishing artifical eye", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "V2625", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Enlargement of ocular prosthesis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Enlargemnt of eye prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "V2626", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Reduction of ocular prosthesis", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Reduction of eye prosthesis", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "V2627", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Scleral cover shell", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Scleral cover shell", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "V2628", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1993", "coverageCode": "C = Carrier judgment", "longDescription": "Fabrication and fitting of ocular conformer", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Fabrication & fitting", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "V2629", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Prosthetic eye, other type", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Prosthetic eye other type", "typeOfServiceCode": "P = Lump sum purchase of DME, prosthetics, orthotics", "year": "2026" }, { "code": "V2630", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Anterior chamber intraocular lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "56 = IOL's inserted in a physician's office (effective 10/1/2014)", "shortDescription": "Anter chamber intraocul lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2631", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Iris supported intraocular lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "56 = IOL's inserted in a physician's office (effective 10/1/2014)", "shortDescription": "Iris support intraoclr lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2632", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2014", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Posterior chamber intraocular lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "56 = IOL's inserted in a physician's office (effective 10/1/2014)", "shortDescription": "Post chmbr intraocular lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2700", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Balance lens, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Balance lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2702", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2005", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Deluxe lens feature", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Deluxe lens feature", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2710", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Slab off prism, glass or plastic, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Glass/plastic slab off prism", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2715", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Prism, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Prism lens/es", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2718", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Press-on lens, fresnell prism, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Fresnell prism press-on lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2730", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Special base curve, glass or plastic, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Special base curve", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2744", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Tint, photochromatic, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tint photochromatic lens/es", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2745", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2005", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Tint, any color/solid/grad", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2750", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Anti-reflective coating, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Anti-reflective coating", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2755", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "D = Special coverage instructions apply", "longDescription": "U-v lens, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Uv lens/es", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2756", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2007", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Eye glass case", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Eye glass case", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2760", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Scratch resistant coating, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Scratch resistant coating", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2761", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Mirror coating, any type, solid, gradient or equal, any lens material, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Mirror coating", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2762", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Polarization, any lens material, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Polarization, any lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2770", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Occluder lens, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Occluder lens/es", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2780", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Oversize lens, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Oversize lens/es", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2781", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1996", "coverageCode": "C = Carrier judgment", "longDescription": "Progressive lens, per lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Progressive lens per lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2782", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens, 1.54-1.65 p/1.60-1.79g", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2783", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens, >= 1.66 p/>=1.80 g", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2784", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Lens, polycarbonate or equal, any index, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Lens polycarb or equal", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2785", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "C = Carrier judgment", "longDescription": "Processing, preserving and transporting corneal tissue", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Corneal tissue processing", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2786", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Specialty occupational multifocal lens, per lens", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings)", "shortDescription": "Occupational multifocal lens", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2787", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2008", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2008", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Astigmatism correcting function of intraocular lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Astigmatism-correct function", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2788", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2006", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2006", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Presbyopia correcting function of intraocular lens", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Presbyopia-correct function", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2790", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "October 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2001", "coverageCode": "C = Carrier judgment", "longDescription": "Amniotic membrane for surgical reconstruction, per procedure", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "57 = Other carrier priced", "shortDescription": "Amniotic membrane", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2797", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2004", "coverageCode": "C = Carrier judgment", "longDescription": "Vision supply, accessory and/or service component of another hcpcs vision code", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Vis item/svc in other code", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V2799", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2015", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1985", "coverageCode": "C = Carrier judgment", "longDescription": "Vision item or service, miscellaneous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap - filled amounts)", "shortDescription": "Misc vision item or service", "typeOfServiceCode": "Q = Vision items or services", "year": "2026" }, { "code": "V5008", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "M = Non-covered by Medicare", "longDescription": "Hearing screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing screening", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5010", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assessment for hearing aid", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Assessment for hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5011", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Fitting/orientation/checking of hearing aid", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid fitting/checking", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5014", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Repair/modification of a hearing aid", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid repair/modifying", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5020", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1984", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Conformity evaluation", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Conformity evaluation", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5030", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, monaural, body worn, air conduction", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Body-worn hearing aid air", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5040", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1986", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, monaural, body worn, bone conduction", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Body-worn hearing aid bone", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5050", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2001", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, monaural, in the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid monaural in ear", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5060", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, monaural, behind the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Behind ear hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5070", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Glasses, air conduction", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Glasses air conduction", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5080", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Glasses, bone conduction", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Glasses bone conduction", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5090", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Dispensing fee, unspecified hearing aid", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid dispensing fee", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5095", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Semi-implantable middle ear hearing prosthesis", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Implant mid ear hearing pros", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5100", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, bilateral, body worn", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Body-worn bilat hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5110", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Dispensing fee, bilateral", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid dispensing fee", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5120", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Binaural, body", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Body-worn binaur hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5130", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Binaural, in the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "In ear binaural hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5140", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Binaural, behind the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Behind ear binaur hearing ai", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5150", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Binaural, glasses", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Glasses binaural hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5160", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Dispensing fee, binaural", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dispensing fee binaural", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5170", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, cros, in the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Within ear cros hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5171", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing device, monaural, in the ear (ite)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid monaural ite", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5172", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing device, monaural, in the canal (itc)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid monaural itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5180", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, cros, behind the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Behind ear cros hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5181", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing device, monaural, behind the ear (bte)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid monaural bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5190", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing, monaural, glasses", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid monaural glasses", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5200", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Dispensing fee, contralateral, monaural", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disp fee contralateral monau", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5210", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, bicros, in the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "In ear bicros hearing aid", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5211", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing system, binaural, ite/ite", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid binaural ite/ite", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5212", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing system, binaural, ite/itc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid binaural ite/itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5213", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing system, binaural, ite/bte", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid binaural ite/bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5214", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing system, binaural, itc/itc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid binaural itc/itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5215", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing system, binaural, itc/bte", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid binaural itc/bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5220", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, bicros, behind the ear", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Behind ear bicros hearing ai", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5221", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2019", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing system, binaural, bte/bte", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid binaural bte/bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5230", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, contralateral routing system, binaural, glasses", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid binaural glasses", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5240", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2019", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Dispensing fee, contralateral routing system, binaural", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Disp fee contralateral binau", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5241", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Dispensing fee, monaural hearing aid, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dispensing fee, monaural", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5242", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, analog, monaural, cic (completely in the ear canal)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, monaural, cic", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5243", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, analog, monaural, itc (in the canal)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, monaural, itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5244", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable analog, monaural, cic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, mon, cic", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5245", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable, analog, monaural, itc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, mon, itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5246", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable analog, monaural, ite (in the ear)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, mon, ite", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5247", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable analog, monaural, bte (behind the ear)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, mon, bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5248", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, analog, binaural, cic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, binaural, cic", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5249", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, analog, binaural, itc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, binaural, itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5250", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable analog, binaural, cic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, bin, cic", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5251", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable analog, binaural, itc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, bin, itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5252", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable, binaural, ite", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, bin, ite", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5253", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digitally programmable, binaural, bte", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, prog, bin, bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5254", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, monaural, cic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing id, digit, mon, cic", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5255", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, monaural, itc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, digit, mon, itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5256", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, monaural, ite", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, digit, mon, ite", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5257", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, monaural, bte", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, digit, mon, bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5258", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, binaural, cic", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, digit, bin, cic", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5259", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, binaural, itc", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, digit, bin, itc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5260", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, binaural, ite", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, digit, bin, ite", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5261", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, digital, binaural, bte", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, digit, bin, bte", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5262", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, disposable, any type, monaural", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, disp, monaural", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5263", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, disposable, any type, binaural", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid, disp, binaural", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5264", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Ear mold/insert, not disposable, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ear mold/insert", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5265", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Ear mold/insert, disposable, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ear mold/insert, disp", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5266", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Battery for use in hearing device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Battery for hearing device", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5267", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid or assistive listening device/supplies/accessories, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid sup/access/dev", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5268", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, telephone amplifier, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald telephone amplifier", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5269", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, alerting, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Alerting device, any type", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5270", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, television amplifier, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald, tv amplifier, any type", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5271", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, television caption decoder", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald, tv caption decoder", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5272", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, tdd", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Tdd", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5273", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, for use with cochlear implant", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald for cochlear implant", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5274", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald unspecified", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5275", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2002", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2002", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Ear impression, each", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ear impression", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5281", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm system, monaural, (1 receiver, transmitter, microphone), any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald fm/dm system, monaural", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5282", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm system, binaural, (2 receivers, transmitter, microphone), any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald fm/dm system binaural", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5283", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm neck, loop induction receiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald neck, loop ind receiver", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5284", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm, ear level receiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald fm/dm ear level receiver", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5285", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm, direct audio input receiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald fm/dm aud input receiver", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5286", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal blue tooth fm/dm receiver", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald blu tooth fm/dm receiver", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5287", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm receiver, not otherwise specified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald fm/dm receiver, nos", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5288", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm transmitter assistive listening device", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald fm/dm transmitter ald", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5289", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, personal fm/dm adapter/boot coupling device for receiver, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald fm/dm adapt/boot couplin", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5290", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2013", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2013", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Assistive listening device, transmitter microphone, any type", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Ald transmitter microphone", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5298", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2003", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 2003", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Hearing aid, not otherwise classified", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Hearing aid noc", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5299", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1995", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1982", "coverageCode": "D = Special coverage instructions apply", "longDescription": "Hearing service, miscellaneous", "multiplePricingIndicatorCode": "A = Not applicable as HCPCS priced under one methodology", "pricingIndicatorCode": "13 = Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)", "shortDescription": "Hearing service", "typeOfServiceCode": "K = Hearing items and services (eff 04/95)", "year": "2026" }, { "code": "V5336", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 1991", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid)", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Repair communication device", "typeOfServiceCode": "1 = Medical care", "year": "2026" }, { "code": "V5362", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Speech screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Speech screening", "typeOfServiceCode": "1 = Medical care\n\nW = Physical therapy", "year": "2026" }, { "code": "V5363", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Language screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Language screening", "typeOfServiceCode": "1 = Medical care\n\nW = Physical therapy", "year": "2026" }, { "code": "V5364", "actionCode": "N = No maintenance for this code", "actionEffectiveDate": "January 01, 2004", "anesthesiaBaseUnitQuantity": "0", "codeAddedDate": "January 01, 1990", "coverageCode": "S = Non-covered by Medicare statute", "longDescription": "Dysphagia screening", "multiplePricingIndicatorCode": "9 = Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established(pricing indicator is '99')", "pricingIndicatorCode": "00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.)", "shortDescription": "Dysphagia screening", "typeOfServiceCode": "1 = Medical care\n\nW = Physical therapy", "year": "2026" } ] }