# HCPCS Data Explorer: complete 2026 HCPCS Level II list > Every HCPCS Level II code and modifier from the 2026 CMS release, with its description. Full details for any code are at https://hcpcsdata.vercel.app/codes/{CODE} and for any modifier at https://hcpcsdata.vercel.app/modifiers/{MODIFIER}. ## Modifiers - A1: Dressing for one wound - A2: Dressing for two wounds - A3: Dressing for three wounds - A4: Dressing for four wounds - A5: Dressing for five wounds - A6: Dressing for six wounds - A7: Dressing for seven wounds - A8: Dressing for eight wounds - A9: Dressing for nine or more wounds - AA: Anesthesia services performed personally by anesthesiologist - AB: Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary - AD: Medical supervision by a physician: more than four concurrent anesthesia procedures - AE: Registered dietician - AF: Specialty physician - AG: Primary physician - AH: Clinical psychologist - AI: Principal physician of record - AJ: Clinical social worker - AK: Non participating physician - AM: Physician, team member service - AO: Alternate payment method declined by provider of service - AP: Determination of refractive state was not performed in the course of diagnostic ophthalmological examination - AQ: Physician providing a service in an unlisted health professional shortage area (hpsa) - AR: Physician provider services in a physician scarcity area - AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery - AT: Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) - AU: Item furnished in conjunction with a urological, ostomy, or tracheostomy supply - AV: Item furnished in conjunction with a prosthetic device, prosthetic or orthotic - AW: Item furnished in conjunction with a surgical dressing - AX: Item furnished in conjunction with dialysis services - AY: Item or service furnished to an esrd patient that is not for the treatment of esrd - AZ: Physician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment - BA: Item furnished in conjunction with parenteral enteral nutrition (pen) services - BL: Special acquisition of blood and blood products - BO: Orally administered nutrition, not by feeding tube - BP: The beneficiary has been informed of the purchase and rental options and has elected to purchase the item - BR: The beneficiary has been informed of the purchase and rental options and has elected to rent the item - BU: The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision - CA: Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission - CB: Service ordered by a renal dialysis facility (rdf) physician as part of the esrd beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable - CC: Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) - CD: Amcc test has been ordered by an esrd facility or mcp physician that is part of the composite rate and is not separately billable - CE: Amcc test has been ordered by an esrd facility or mcp physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity - CF: Amcc test has been ordered by an esrd facility or mcp physician that is not part of the composite rate and is separately billable - CG: Policy criteria applied - CH: 0 percent impaired, limited or restricted - CI: At least 1 percent but less than 20 percent impaired, limited or restricted - CJ: At least 20 percent but less than 40 percent impaired, limited or restricted - CK: At least 40 percent but less than 60 percent impaired, limited or restricted - CL: At least 60 percent but less than 80 percent impaired, limited or restricted - CM: At least 80 percent but less than 100 percent impaired, limited or restricted - CN: 100 percent impaired, limited or restricted - CO: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant - CP: Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a different claim Terminated December 31, 2017. - CQ: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant - CR: Catastrophe/disaster related - CS: Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency - CT: Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard - E1: Upper left, eyelid - E2: Lower left, eyelid - E3: Upper right, eyelid - E4: Lower right, eyelid - EA: Erythropoietic stimulating agent (esa) administered to treat anemia due to anti-cancer chemotherapy - EB: Erythropoietic stimulating agent (esa) administered to treat anemia due to anti-cancer radiotherapy - EC: Erythropoietic stimulating agent (esa) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy - ED: Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle - EE: Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle - EJ: Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab - EM: Emergency reserve supply (for esrd benefit only) - EP: Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program - ER: Items and services furnished by a provider-based, off-campus emergency department - ET: Emergency services - EX: Expatriate beneficiary - EY: No physician or other licensed health care provider order for this item or service - F1: Left hand, second digit - F2: Left hand, third digit - F3: Left hand, fourth digit - F4: Left hand, fifth digit - F5: Right hand, thumb - F6: Right hand, second digit - F7: Right hand, third digit - F8: Right hand, fourth digit - F9: Right hand, fifth digit - FA: Left hand, thumb - FB: Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples) - FC: Partial credit received for replaced device - FP: Service provided as part of family planning program - FQ: The service was furnished using audio-only communication technology - FR: The supervising practitioner was present through two-way, audio/video communication technology - FS: Split (or shared) evaluation and management visit - FT: Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated) - FX: X-ray taken using film - FY: X-ray taken using computed radiography technology/cassette-based imaging - G0: Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke - G1: Most recent urr reading of less than 60 - G2: Most recent urr reading of 60 to 64.9 - G3: Most recent urr reading of 65 to 69.9 - G4: Most recent urr reading of 70 to 74.9 - G5: Most recent urr reading of 75 or greater - G6: Esrd patient for whom less than six dialysis sessions have been provided in a month - G7: Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening - G8: Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure - G9: Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition - GA: Waiver of liability statement issued as required by payer policy, individual case - GB: Claim being re-submitted for payment because it is no longer covered under a global payment demonstration - GC: This service has been performed in part by a resident under the direction of a teaching physician - GD: Units of service exceeds medically unlikely edit value and represents reasonable and necessary services Terminated December 31, 2019. - GE: This service has been performed by a resident without the presence of a teaching physician under the primary care exception - GF: Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital - GG: Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day - GH: Diagnostic mammogram converted from screening mammogram on same day - GJ: "opt out" physician or practitioner emergency or urgent service - GK: Reasonable and necessary item/service associated with a ga or gz modifier - GL: Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) - GM: Multiple patients on one ambulance trip - GN: Services delivered under an outpatient speech language pathology plan of care - GO: Services delivered under an outpatient occupational therapy plan of care - GP: Services delivered under an outpatient physical therapy plan of care - GQ: Via asynchronous telecommunications system - GR: This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy - GS: Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level - GT: Via interactive audio and video telecommunication systems - GU: Waiver of liability statement issued as required by payer policy, routine notice - GV: Attending physician not employed or paid under arrangement by the patient's hospice provider - GW: Service not related to the hospice patient's terminal condition - GX: Notice of liability issued, voluntary under payer policy - GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit - GZ: Item or service expected to be denied as not reasonable and necessary - H9: Court-ordered - HA: Child/adolescent program - HB: Adult program, non geriatric - HC: Adult program, geriatric - HD: Pregnant/parenting women's program - HE: Mental health program - HF: Substance abuse program - HG: Opioid addiction treatment program - HH: Integrated mental health/substance abuse program - HI: Integrated mental health and intellectual disability/developmental disabilities program - HJ: Employee assistance program - HK: Specialized mental health programs for high-risk populations - HL: Intern - HM: Less than bachelor degree level - HN: Bachelors degree level - HO: Masters degree level - HP: Doctoral level - HQ: Group setting - HR: Family/couple with client present - HS: Family/couple without client present - HT: Multi-disciplinary team - HU: Funded by child welfare agency - HV: Funded state addictions agency - HW: Funded by state mental health agency - HX: Funded by county/local agency - HY: Funded by juvenile justice agency - HZ: Funded by criminal justice agency - J1: Competitive acquisition program no-pay submission for a prescription number - J2: Competitive acquisition program, restocking of emergency drugs after emergency administration - J3: Competitive acquisition program (cap), drug not available through cap as written, reimbursed under average sales price methodology - J4: Dmepos item subject to dmepos competitive bidding program that is furnished by a hospital upon discharge - J5: Off-the-shelf orthotic subject to dmepos competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service - JA: Administered intravenously - JB: Administered subcutaneously - JC: Skin substitute used as a graft - JD: Skin substitute not used as a graft - JE: Administered via dialysate - JF: Compounded drug Terminated June 30, 2015. - JG: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes Terminated December 31, 2024. - JK: One month supply or less of drug or biological - JL: Three month supply of drug or biological - JW: Drug amount discarded/not administered to any patient - JZ: Zero drug amount discarded/not administered to any patient - K0: Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. - K1: Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator. - K2: Lower extremity prosthesis functional level 2 - has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator. - K3: Lower extremity prosthesis functional level 3 - has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. - K4: Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete. - KA: Add on option/accessory for wheelchair - KB: Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim - KC: Replacement of special power wheelchair interface - KD: Drug or biological infused through dme - KE: Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment - KF: Item designated by fda as class iii device - KG: Dmepos item subject to dmepos competitive bidding program number 1 - KH: Dmepos item, initial claim, purchase or first month rental - KI: Dmepos item, second or third month rental - KJ: Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen - KK: Dmepos item subject to dmepos competitive bidding program number 2 - KL: Dmepos item delivered via mail - KM: Replacement of facial prosthesis including new impression/moulage - KN: Replacement of facial prosthesis using previous master model - KO: Single drug unit dose formulation - KP: First drug of a multiple drug unit dose formulation - KQ: Second or subsequent drug of a multiple drug unit dose formulation - KR: Rental item, billing for partial month - KS: Glucose monitor supply for diabetic beneficiary not treated with insulin - KT: Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item - KU: Dmepos item subject to dmepos competitive bidding program number 3 - KV: Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service - KW: Dmepos item subject to dmepos competitive bidding program number 4 - KX: Requirements specified in the medical policy have been met - KY: Dmepos item subject to dmepos competitive bidding program number 5 - KZ: New coverage not implemented by managed care - L1: Provider attestation that the hospital laboratory test(s) is not packaged under the hospital opps Terminated December 31, 2016. - LC: Left circumflex coronary artery - LD: Left anterior descending coronary artery - LL: Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price) - LM: Left main coronary artery - LR: Laboratory round trip - LS: Fda-monitored intraocular lens implant - LT: Left side (used to identify procedures performed on the left side of the body) - LU: Fractionated payment - M2: Medicare secondary payer (msp) - MA: Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition Terminated December 31, 2024. - MB: Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access Terminated December 31, 2024. - MC: Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues Terminated December 31, 2024. - MD: Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances Terminated December 31, 2024. - ME: The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional Terminated December 31, 2024. - MF: The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional Terminated December 31, 2024. - MG: The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional Terminated December 31, 2024. - MH: Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider Terminated December 31, 2024. - MS: Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty - N1: Group 1 oxygen coverage criteria met - N2: Group 2 oxygen coverage criteria met - N3: Group 3 oxygen coverage criteria met - NB: Nebulizer system, any type, fda-cleared for use with specific drug - NR: New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased) - NU: New equipment - P1: A normal healthy patient - P2: A patient with mild systemic disease - P3: A patient with severe systemic disease - P4: A patient with severe systemic disease that is a constant threat to life - P5: A moribund patient who is not expected to survive without the operation - P6: A declared brain-dead patient whose organs are being removed for donor purposes - PA: Surgical or other invasive procedure on wrong body part - PB: Surgical or other invasive procedure on wrong patient - PC: Wrong surgery or other invasive procedure on patient - PD: Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days - PI: Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing - PL: Progressive addition lenses - PM: Post mortem - PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital - PO: Excepted service provided at an off-campus, outpatient, provider-based department of a hospital - PS: Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy - PT: Colorectal cancer screening test; converted to diagnostic test or other procedure - Q0: Investigational clinical service provided in a clinical research study that is in an approved clinical research study - Q1: Routine clinical service provided in a clinical research study that is in an approved clinical research study - Q2: Demonstration procedure/service - Q3: Live kidney donor surgery and related services - Q4: Service for ordering/referring physician qualifies as a service exemption - Q5: Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area - Q6: Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area - Q7: One class a finding - Q8: Two class b findings - Q9: One class b and two class c findings - QA: Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute (lpm) - QB: Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed - QC: Single channel monitoring - QD: Recording and storage in solid state memory by a digital recorder - QE: Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm) - QF: Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed - QG: Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm) - QH: Oxygen conserving device is being used with an oxygen delivery system - QJ: Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) - QK: Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals - QL: Patient pronounced dead after ambulance called - QM: Ambulance service provided under arrangement by a provider of services - QN: Ambulance service furnished directly by a provider of services - QP: Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a cpt-recognized panel other than automated profile codes 80002-80019, g0058, g0059, and g0060. - QQ: Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional Terminated December 31, 2024. - QR: Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (lpm) - QS: Monitored anesthesia care service - QT: Recording and storage on tape by an analog tape recorder - QW: Clia waived test - QX: Crna service: with medical direction by a physician - QY: Medical direction of one certified registered nurse anesthetist (crna) by an anesthesiologist - QZ: Crna service: without medical direction by a physician - RA: Replacement of a dme, orthotic or prosthetic item - RB: Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair - RC: Right coronary artery - RD: Drug provided to beneficiary, but not administered "incident-to" - RE: Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems) - RI: Ramus intermedius coronary artery - RR: Rental (use the 'rr' modifier when dme is to be rented) - RT: Right side (used to identify procedures performed on the right side of the body) - SA: Nurse practitioner rendering service in collaboration with a physician - SB: Nurse midwife - SC: Medically necessary service or supply - SD: Services provided by registered nurse with specialized, highly technical home infusion training - SE: State and/or federally-funded programs/services - SF: Second opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance) - SG: Ambulatory surgical center (asc) facility service - SH: Second concurrently administered infusion therapy - SJ: Third or more concurrently administered infusion therapy - SK: Member of high risk population (use only with codes for immunization) - SL: State supplied vaccine - SM: Second surgical opinion - SN: Third surgical opinion - SQ: Item ordered by home health - SS: Home infusion services provided in the infusion suite of the iv therapy provider - ST: Related to trauma or injury - SU: Procedure performed in physician's office (to denote use of facility and equipment) - SV: Pharmaceuticals delivered to patient's home but not utilized - SW: Services provided by a certified diabetic educator - SY: Persons who are in close contact with member of high-risk population (use only with codes for immunization) - SZ: Habilitative services Terminated December 31, 2017. - T1: Left foot, second digit - T2: Left foot, third digit - T3: Left foot, fourth digit - T4: Left foot, fifth digit - T5: Right foot, great toe - T6: Right foot, second digit - T7: Right foot, third digit - T8: Right foot, fourth digit - T9: Right foot, fifth digit - TA: Left foot, great toe - TB: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes - TC: Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles - TD: Rn - TE: Lpn/lvn - TF: Intermediate level of care - TG: Complex/high tech level of care - TH: Obstetrical treatment/services, prenatal or postpartum - TJ: Program group, child and/or adolescent - TK: Extra patient or passenger, non-ambulance - TL: Early intervention/individualized family service plan (ifsp) - TM: Individualized education program (iep) - TN: Rural/outside providers' customary service area - TP: Medical transport, unloaded vehicle - TQ: Basic life support transport by a volunteer ambulance provider - TR: School-based individualized education program (iep) services provided outside the public school district responsible for the student - TS: Follow-up service - TT: Individualized service provided to more than one patient in same setting - TU: Special payment rate, overtime - TV: Special payment rates, holidays/weekends - TW: Back-up equipment - U1: Medicaid level of care 1, as defined by each state - U2: Medicaid level of care 2, as defined by each state - U3: Medicaid level of care 3, as defined by each state - U4: Medicaid level of care 4, as defined by each state - U5: Medicaid level of care 5, as defined by each state - U6: Medicaid level of care 6, as defined by each state - U7: Medicaid level of care 7, as defined by each state - U8: Medicaid level of care 8, as defined by each state - U9: Medicaid level of care 9, as defined by each state - UA: Medicaid level of care 10, as defined by each state - UB: Medicaid level of care 11, as defined by each state - UC: Medicaid level of care 12, as defined by each state - UD: Medicaid level of care 13, as defined by each state - UE: Used durable medical equipment - UF: Services provided in the morning - UG: Services provided in the afternoon - UH: Services provided in the evening - UJ: Services provided at night - UK: Services provided on behalf of the client to someone other than the client (collateral relationship) - UN: Two patients served - UP: Three patients served - UQ: Four patients served - UR: Five patients served - US: Six or more patients served - V1: Demonstration modifier 1 - V2: Demonstration modifier 2 - V3: Demonstration modifier 3 - V4: Demonstration modifier 4 - V5: Vascular catheter (alone or with any other vascular access) - V6: Arteriovenous graft (or other vascular access not including a vascular catheter) - V7: Arteriovenous fistula only (in use with two needles) - V8: Infection present Terminated March 31, 2012. - V9: No infection present Terminated March 31, 2012. - VM: Medicare diabetes prevention program (mdpp) virtual make-up session - VP: Aphakic patient - X1: Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care - X2: Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services - X3: Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital - X4: Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period - X5: Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician - XE: Separate encounter, a service that is distinct because it occurred during a separate encounter - XP: Separate practitioner, a service that is distinct because it was performed by a different practitioner - XS: Separate structure, a service that is distinct because it was performed on a separate organ/structure - XU: Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service - ZA: Novartis/sandoz Terminated March 31, 2018. - ZB: Pfizer/hospira Terminated March 31, 2018. - ZC: Merck/samsung bioepis Terminated March 31, 2018. ## Codes - A0021: Ambulance service, outside state per mile, transport (medicaid only) (Medicare: Not payable by Medicare) - A0080: Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest (Medicare: Not payable by Medicare) - A0090: Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest (Medicare: Not payable by Medicare) - A0100: Non-emergency transportation; taxi (Medicare: Not payable by Medicare) - A0110: Non-emergency transportation and bus, intra or inter state carrier (Medicare: Not payable by Medicare) - A0120: Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems (Medicare: Not payable by Medicare) - A0130: Non-emergency transportation: wheelchair van (Medicare: Not payable by Medicare) - A0140: Non-emergency transportation and air travel (private or commercial) intra or inter state (Medicare: Not payable by Medicare) - A0160: Non-emergency transportation: per mile - case worker or social worker (Medicare: Not payable by Medicare) - A0170: Transportation ancillary: parking fees, tolls, other (Medicare: Not payable by Medicare) - A0180: Non-emergency transportation: ancillary: lodging-recipient (Medicare: Not payable by Medicare) - A0190: Non-emergency transportation: ancillary: meals-recipient (Medicare: Not payable by Medicare) - A0200: Non-emergency transportation: ancillary: lodging escort (Medicare: Not payable by Medicare) - A0210: Non-emergency transportation: ancillary: meals-escort (Medicare: Not payable by Medicare) - A0225: Ambulance service, neonatal transport, base rate, emergency transport, one way (Medicare: Not payable by Medicare) - A0380: Bls mileage (per mile) (Medicare: Not payable by Medicare) - A0382: Bls routine disposable supplies (Medicare: Not payable by Medicare) - A0384: Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances) (Medicare: Not payable by Medicare) - A0390: Als mileage (per mile) (Medicare: Not payable by Medicare) - A0392: Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances) (Medicare: Not payable by Medicare) - A0394: Als specialized service disposable supplies; iv drug therapy (Medicare: Not payable by Medicare) - A0396: Als specialized service disposable supplies; esophageal intubation (Medicare: Not payable by Medicare) - A0398: Als routine disposable supplies (Medicare: Not payable by Medicare) - A0420: Ambulance waiting time (als or bls), one half (1/2) hour increments (Medicare: Not payable by Medicare) - A0422: Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation (Medicare: Not payable by Medicare) - A0424: Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review) (Medicare: Not payable by Medicare) - A0425: Ground mileage, per statute mile (Medicare: Carrier judgment) - A0426: Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) (Medicare: Carrier judgment) - A0427: Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) (Medicare: Carrier judgment) - A0428: Ambulance service, basic life support, non-emergency transport, (bls) (Medicare: Carrier judgment) - A0429: Ambulance service, basic life support, emergency transport (bls-emergency) (Medicare: Carrier judgment) - A0430: Ambulance service, conventional air services, transport, one way (fixed wing) (Medicare: Carrier judgment) - A0431: Ambulance service, conventional air services, transport, one way (rotary wing) (Medicare: Carrier judgment) - A0432: Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers (Medicare: Carrier judgment) - A0433: Advanced life support, level 2 (als 2) (Medicare: Carrier judgment) - A0434: Specialty care transport (sct) (Medicare: Carrier judgment) - A0435: Fixed wing air mileage, per statute mile (Medicare: Carrier judgment) - A0436: Rotary wing air mileage, per statute mile (Medicare: Carrier judgment) - A0888: Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) (Medicare: Non-covered by Medicare) - A0998: Ambulance response and treatment, no transport (Medicare: Not payable by Medicare) - A0999: Unlisted ambulance service (Medicare: Special coverage instructions apply) - A2001: Innovamatrix ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2002: Mirragen advanced wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2004: Xcellistem, 1 mg (Medicare: Carrier judgment) - A2005: Microlyte matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2006: Novosorb synpath dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2007: Restrata, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2008: Theragenesis, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2009: Symphony, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2010: Apis, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2011: Supra sdrm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2012: Suprathel, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2013: Innovamatrix fs, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2014: Omeza collagen matrix or omeza complete matrix, per 100 mg (Medicare: Carrier judgment) - A2015: Phoenix wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2016: Permeaderm b, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2017: Permeaderm glove, each (Medicare: Carrier judgment) - A2018: Permeaderm c, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2019: Kerecis omega3 marigen shield, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2020: Ac5 advanced wound system (ac5) (Medicare: Carrier judgment) - A2021: Neomatrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2022: Innovaburn or innovamatrix xl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2023: Innovamatrix pd, 1 mg (Medicare: Carrier judgment) - A2024: Resolve matrix or xenopatch, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2025: Miro3d, per cubic centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2026: Restrata minimatrix, 5 mg (Medicare: Carrier judgment) - A2027: Matriderm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2028: Micromatrix flex, per mg (Medicare: Carrier judgment) - A2029: Mirotract wound matrix sheet, per cubic centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2030: Miro3d fibers, per milligram (Medicare: Carrier judgment) - A2031: Mirodry wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2032: Myriad matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2033: Myriad morcells, 4 milligrams (Medicare: Carrier judgment) - A2034: Foundation drs solo, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2035: Corplex p or theracor p or allacor p, per milligram (Medicare: Carrier judgment) - A2036: Cohealyx collagen dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2037: G4derm plus/suprello, per milliliter (Medicare: Carrier judgment) - A2038: Marigen pacto, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2039: Innovamatrix fd, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - A2040: Microlyte painguard, per square centimeter (Medicare: Carrier judgment) - A2041: Foundation drs+ duo, per square centimeter (Medicare: Carrier judgment) - A2042: Foundation drs+ solo, per square centimeter (Medicare: Carrier judgment) - A2043: Biobrane, per square centimeter (Medicare: Carrier judgment) - A2044: Biobrane glove, each (Medicare: Carrier judgment) - A2045: Novashield or novogen wound matrix, per square centimeter (Medicare: Carrier judgment) - A4100: Non-sheet form skin substitute, fda cleared as a device, not otherwise specified (list in addition to primary procedure) (Medicare: Carrier judgment) - A4206: Syringe with needle, sterile, 1 cc or less, each (Medicare: Carrier judgment) - A4207: Syringe with needle, sterile 2 cc, each (Medicare: Carrier judgment) - A4208: Syringe with needle, sterile 3 cc, each (Medicare: Carrier judgment) - A4209: Syringe with needle, sterile 5 cc or greater, each (Medicare: Carrier judgment) - A4210: Needle-free injection device, each (Medicare: Non-covered by Medicare) - A4211: Supplies for self-administered injections (Medicare: Special coverage instructions apply) - A4212: Non-coring needle or stylet with or without catheter (Medicare: Carrier judgment) - A4213: Syringe, sterile, 20 cc or greater, each (Medicare: Carrier judgment) - A4215: Needle, sterile, any size, each (Medicare: Carrier judgment) - A4216: Sterile water, saline and/or dextrose, diluent/flush, 10 ml (Medicare: Special coverage instructions apply) - A4217: Sterile water/saline, 500 ml (Medicare: Special coverage instructions apply) - A4218: Sterile saline or water, metered dose dispenser, 10 ml (Medicare: Special coverage instructions apply) - A4220: Refill kit for implantable infusion pump (Medicare: Special coverage instructions apply) - A4221: Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) (Medicare: Carrier judgment) - A4222: Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) (Medicare: Carrier judgment) - A4223: Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) (Medicare: Carrier judgment) - A4224: Supplies for maintenance of insulin infusion catheter, per week (Medicare: Carrier judgment) - A4225: Supplies for external insulin infusion pump, syringe type cartridge, sterile, each (Medicare: Special coverage instructions apply) - A4226: Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week (Medicare: Not payable by Medicare) - A4230: Infusion set for external insulin pump, non needle cannula type (Medicare: Special coverage instructions apply) - A4231: Infusion set for external insulin pump, needle type (Medicare: Special coverage instructions apply) - A4232: Syringe with needle for external insulin pump, sterile, 3 cc (Medicare: Not payable by Medicare) - A4233: Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each (Medicare: Carrier judgment) - A4234: Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each (Medicare: Carrier judgment) - A4235: Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each (Medicare: Carrier judgment) - A4236: Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each (Medicare: Carrier judgment) - A4238: Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (Medicare: Carrier judgment) - A4239: Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (Medicare: Carrier judgment) - A4244: Alcohol or peroxide, per pint (Medicare: Carrier judgment) - A4245: Alcohol wipes, per box (Medicare: Carrier judgment) - A4246: Betadine or phisohex solution, per pint (Medicare: Carrier judgment) - A4247: Betadine or iodine swabs/wipes, per box (Medicare: Carrier judgment) - A4248: Chlorhexidine containing antiseptic, 1 ml (Medicare: Carrier judgment) - A4250: Urine test or reagent strips or tablets (100 tablets or strips) (Medicare: Non-covered by Medicare) - A4252: Blood ketone test or reagent strip, each (Medicare: Non-covered by Medicare statute) - A4253: Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (Medicare: Special coverage instructions apply) - A4255: Platforms for home blood glucose monitor, 50 per box (Medicare: Special coverage instructions apply) - A4256: Normal, low and high calibrator solution / chips (Medicare: Special coverage instructions apply) - A4257: Replacement lens shield cartridge for use with laser skin piercing device, each (Medicare: Carrier judgment) - A4258: Spring-powered device for lancet, each (Medicare: Special coverage instructions apply) - A4259: Lancets, per box of 100 (Medicare: Special coverage instructions apply) - A4261: Cervical cap for contraceptive use (Medicare: Non-covered by Medicare statute) - A4262: Temporary, absorbable lacrimal duct implant, each (Medicare: Special coverage instructions apply) - A4263: Permanent, long term, non-dissolvable lacrimal duct implant, each (Medicare: Special coverage instructions apply) - A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system (Medicare: Not payable by Medicare) - A4265: Paraffin, per pound (Medicare: Special coverage instructions apply) - A4266: Diaphragm for contraceptive use (Medicare: Not payable by Medicare) - A4267: Contraceptive supply, condom, male, each (Medicare: Not payable by Medicare) - A4268: Contraceptive supply, condom, female, each (Medicare: Not payable by Medicare) - A4269: Contraceptive supply, spermicide (e.g., foam, gel), each (Medicare: Not payable by Medicare) - A4270: Disposable endoscope sheath, each (Medicare: Carrier judgment) - A4271: Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests (Medicare: Special coverage instructions apply) - A4280: Adhesive skin support attachment for use with external breast prosthesis, each (Medicare: Carrier judgment) - A4281: Tubing for breast pump, replacement (Medicare: Carrier judgment) - A4282: Adapter for breast pump, replacement (Medicare: Carrier judgment) - A4283: Cap for breast pump bottle, replacement (Medicare: Carrier judgment) - A4284: Breast shield and splash protector for use with breast pump, replacement (Medicare: Carrier judgment) - A4285: Polycarbonate bottle for use with breast pump, replacement (Medicare: Carrier judgment) - A4286: Locking ring for breast pump, replacement (Medicare: Carrier judgment) - A4287: Disposable collection and storage bag for breast milk, any size, any type, each (Medicare: Carrier judgment) - A4288: Valve for breast pump, replacement (Medicare: Carrier judgment) - A4290: Sacral nerve stimulation test lead, each (Medicare: Carrier judgment) - A4295: Intermittent urinary catheter; straight tip, hydrophilic coating, each (Medicare: Special coverage instructions apply) - A4296: Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each (Medicare: Special coverage instructions apply) - A4297: Intermittent urinary catheter; hydrophilic coating, with insertion supplies (Medicare: Special coverage instructions apply) - A4300: Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access (Medicare: Special coverage instructions apply) - A4301: Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) (Medicare: Carrier judgment) - A4305: Disposable drug delivery system, flow rate of 50 ml or greater per hour (Medicare: Carrier judgment) - A4306: Disposable drug delivery system, flow rate of less than 50 ml per hour (Medicare: Carrier judgment) - A4310: Insertion tray without drainage bag and without catheter (accessories only) (Medicare: Special coverage instructions apply) - A4312: Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone (Medicare: Special coverage instructions apply) - A4313: Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation (Medicare: Special coverage instructions apply) - A4314: Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) (Medicare: Special coverage instructions apply) - A4315: Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone (Medicare: Special coverage instructions apply) - A4316: Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation (Medicare: Special coverage instructions apply) - A4318: Female external urinary collection cup, with or without ring attachment, per day (Medicare: Carrier judgment) - A4320: Irrigation tray with bulb or piston syringe, any purpose (Medicare: Special coverage instructions apply) - A4321: Therapeutic agent for urinary catheter irrigation (Medicare: Special coverage instructions apply) - A4322: Irrigation syringe, bulb or piston, each (Medicare: Special coverage instructions apply) - A4326: Male external catheter with integral collection chamber, any type, each (Medicare: Special coverage instructions apply) - A4327: Female external urinary collection device; meatal cup, each (Medicare: Special coverage instructions apply) - A4328: Female external urinary collection device; pouch, each (Medicare: Special coverage instructions apply) - A4330: Perianal fecal collection pouch with adhesive, each (Medicare: Special coverage instructions apply) - A4331: Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each (Medicare: Special coverage instructions apply) - A4332: Lubricant, individual sterile packet, each (Medicare: Special coverage instructions apply) - A4333: Urinary catheter anchoring device, adhesive skin attachment, each (Medicare: Special coverage instructions apply) - A4334: Urinary catheter anchoring device, leg strap, each (Medicare: Special coverage instructions apply) - A4335: Incontinence supply; miscellaneous (Medicare: Special coverage instructions apply) - A4336: Incontinence supply, urethral insert, any type, each (Medicare: Special coverage instructions apply) - A4337: Incontinence supply, rectal insert, any type, each (Medicare: Special coverage instructions apply) - A4338: Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each (Medicare: Special coverage instructions apply) - A4340: Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each (Medicare: Special coverage instructions apply) - A4341: Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each (Medicare: Carrier judgment) - A4342: Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each (Medicare: Carrier judgment) - A4344: Indwelling catheter, foley type, two-way, all silicone or polyurethane, each (Medicare: Special coverage instructions apply) - A4346: Indwelling catheter; foley type, three way for continuous irrigation, each (Medicare: Special coverage instructions apply) - A4349: Male external catheter, with or without adhesive, disposable, each (Medicare: Special coverage instructions apply) - A4351: Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each (Medicare: Special coverage instructions apply) - A4352: Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each (Medicare: Special coverage instructions apply) - A4353: Intermittent urinary catheter, with insertion supplies (Medicare: Special coverage instructions apply) - A4354: Insertion tray with drainage bag but without catheter (Medicare: Special coverage instructions apply) - A4355: Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each (Medicare: Special coverage instructions apply) - A4356: External urethral clamp or compression device (not to be used for catheter clamp), each (Medicare: Special coverage instructions apply) - A4357: Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each (Medicare: Special coverage instructions apply) - A4358: Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each (Medicare: Special coverage instructions apply) - A4360: Disposable external urethral clamp or compression device, with pad and/or pouch, each (Medicare: Special coverage instructions apply) - A4361: Ostomy faceplate, each (Medicare: Special coverage instructions apply) - A4362: Skin barrier; solid, 4 x 4 or equivalent; each (Medicare: Special coverage instructions apply) - A4363: Ostomy clamp, any type, replacement only, each (Medicare: Special coverage instructions apply) - A4364: Adhesive, liquid or equal, any type, per oz (Medicare: Special coverage instructions apply) - A4366: Ostomy vent, any type, each (Medicare: Carrier judgment) - A4367: Ostomy belt, each (Medicare: Special coverage instructions apply) - A4368: Ostomy filter, any type, each (Medicare: Carrier judgment) - A4369: Ostomy skin barrier, liquid (spray, brush, etc.), per oz (Medicare: Special coverage instructions apply) - A4371: Ostomy skin barrier, powder, per oz (Medicare: Special coverage instructions apply) - A4372: Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each (Medicare: Special coverage instructions apply) - A4373: Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each (Medicare: Special coverage instructions apply) - A4375: Ostomy pouch, drainable, with faceplate attached, plastic, each (Medicare: Special coverage instructions apply) - A4376: Ostomy pouch, drainable, with faceplate attached, rubber, each (Medicare: Special coverage instructions apply) - A4377: Ostomy pouch, drainable, for use on faceplate, plastic, each (Medicare: Special coverage instructions apply) - A4378: Ostomy pouch, drainable, for use on faceplate, rubber, each (Medicare: Special coverage instructions apply) - A4379: Ostomy pouch, urinary, with faceplate attached, plastic, each (Medicare: Special coverage instructions apply) - A4380: Ostomy pouch, urinary, with faceplate attached, rubber, each (Medicare: Special coverage instructions apply) - A4381: Ostomy pouch, urinary, for use on faceplate, plastic, each (Medicare: Special coverage instructions apply) - A4382: Ostomy pouch, urinary, for use on faceplate, heavy plastic, each (Medicare: Special coverage instructions apply) - A4383: Ostomy pouch, urinary, for use on faceplate, rubber, each (Medicare: Special coverage instructions apply) - A4384: Ostomy faceplate equivalent, silicone ring, each (Medicare: Special coverage instructions apply) - A4385: Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each (Medicare: Special coverage instructions apply) - A4387: Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each (Medicare: Special coverage instructions apply) - A4388: Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each (Medicare: Special coverage instructions apply) - A4389: Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each (Medicare: Special coverage instructions apply) - A4390: Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each (Medicare: Special coverage instructions apply) - A4391: Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each (Medicare: Special coverage instructions apply) - A4392: Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each (Medicare: Special coverage instructions apply) - A4393: Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each (Medicare: Special coverage instructions apply) - A4394: Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce (Medicare: Special coverage instructions apply) - A4395: Ostomy deodorant for use in ostomy pouch, solid, per tablet (Medicare: Special coverage instructions apply) - A4396: Ostomy belt with peristomal hernia support (Medicare: Special coverage instructions apply) - A4397: Irrigation supply; sleeve, each (Medicare: Special coverage instructions apply) - A4398: Ostomy irrigation supply; bag, each (Medicare: Special coverage instructions apply) - A4399: Ostomy irrigation supply; cone/catheter, with or without brush (Medicare: Special coverage instructions apply) - A4400: Ostomy irrigation set (Medicare: Special coverage instructions apply) - A4402: Lubricant, per ounce (Medicare: Special coverage instructions apply) - A4404: Ostomy ring, each (Medicare: Special coverage instructions apply) - A4405: Ostomy skin barrier, non-pectin based, paste, per ounce (Medicare: Special coverage instructions apply) - A4406: Ostomy skin barrier, pectin-based, paste, per ounce (Medicare: Special coverage instructions apply) - A4407: Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each (Medicare: Special coverage instructions apply) - A4408: Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each (Medicare: Special coverage instructions apply) - A4409: Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each (Medicare: Special coverage instructions apply) - A4410: Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each (Medicare: Special coverage instructions apply) - A4411: Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each (Medicare: Special coverage instructions apply) - A4412: Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each (Medicare: Special coverage instructions apply) - A4413: Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each (Medicare: Special coverage instructions apply) - A4414: Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each (Medicare: Special coverage instructions apply) - A4415: Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each (Medicare: Special coverage instructions apply) - A4416: Ostomy pouch, closed, with barrier attached, with filter (1 piece), each (Medicare: Carrier judgment) - A4417: Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each (Medicare: Carrier judgment) - A4418: Ostomy pouch, closed; without barrier attached, with filter (1 piece), each (Medicare: Carrier judgment) - A4419: Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each (Medicare: Carrier judgment) - A4420: Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each (Medicare: Carrier judgment) - A4421: Ostomy supply; miscellaneous (Medicare: Carrier judgment) - A4422: Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each (Medicare: Special coverage instructions apply) - A4423: Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each (Medicare: Carrier judgment) - A4424: Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each (Medicare: Carrier judgment) - A4425: Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each (Medicare: Carrier judgment) - A4426: Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each (Medicare: Carrier judgment) - A4427: Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each (Medicare: Carrier judgment) - A4428: Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each (Medicare: Carrier judgment) - A4429: Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each (Medicare: Carrier judgment) - A4430: Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each (Medicare: Carrier judgment) - A4431: Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each (Medicare: Carrier judgment) - A4432: Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each (Medicare: Carrier judgment) - A4433: Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each (Medicare: Carrier judgment) - A4434: Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each (Medicare: Carrier judgment) - A4435: Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each (Medicare: Carrier judgment) - A4436: Irrigation supply; sleeve, reusable, per month (Medicare: Special coverage instructions apply) - A4437: Irrigation supply; sleeve, disposable, per month (Medicare: Special coverage instructions apply) - A4438: Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each (Medicare: Carrier judgment) - A4450: Tape, non-waterproof, per 18 square inches (Medicare: Special coverage instructions apply) - A4452: Tape, waterproof, per 18 square inches (Medicare: Special coverage instructions apply) - A4453: Rectal catheter with or without balloon, for use with any type transanal irrigation system, each (Medicare: Carrier judgment) - A4455: Adhesive remover or solvent (for tape, cement or other adhesive), per ounce (Medicare: Special coverage instructions apply) - A4456: Adhesive remover, wipes, any type, each (Medicare: Special coverage instructions apply) - A4457: Enema tube, with or without adapter, any type, replacement only, each (Medicare: Non-covered by Medicare statute) - A4458: Enema bag with tubing, reusable (Medicare: Carrier judgment) - A4459: Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type (Medicare: Carrier judgment) - A4461: Surgical dressing holder, non-reusable, each (Medicare: Carrier judgment) - A4463: Surgical dressing holder, reusable, each (Medicare: Carrier judgment) - A4465: Non-elastic binder for extremity (Medicare: Carrier judgment) - A4466: Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each (Medicare: Non-covered by Medicare) - A4467: Belt, strap, sleeve, garment, or covering, any type (Medicare: Non-covered by Medicare) - A4468: Exsufflation belt, includes all supplies and accessories (Medicare: Non-covered by Medicare statute) - A4470: Gravlee jet washer (Medicare: Special coverage instructions apply) - A4479: Electronic transanal irrigation system, includes electronic pump, water reservoir, tubing, and accessories, without catheter, any type (Medicare: Carrier judgment) - A4480: Vabra aspirator (Medicare: Special coverage instructions apply) - A4481: Tracheostoma filter, any type, any size, each (Medicare: Special coverage instructions apply) - A4483: Moisture exchanger, disposable, for use with invasive mechanical ventilation (Medicare: Special coverage instructions apply) - A4490: Surgical stockings above knee length, each (Medicare: Non-covered by Medicare) - A4495: Surgical stockings thigh length, each (Medicare: Non-covered by Medicare) - A4500: Surgical stockings below knee length, each (Medicare: Non-covered by Medicare) - A4510: Surgical stockings full length, each (Medicare: Non-covered by Medicare) - A4520: Incontinence garment, any type, (e.g., brief, diaper), each (Medicare: Non-covered by Medicare) - A4540: Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm (Medicare: Non-covered by Medicare statute) - A4541: Monthly supplies for use of device coded at e0733 (Medicare: Carrier judgment) - A4542: Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist (Medicare: Carrier judgment) - A4543: Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month (Medicare: Carrier judgment) - A4544: Electrode for external lower extremity nerve stimulator for restless legs syndrome (Medicare: Carrier judgment) - A4545: Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one month (Medicare: Carrier judgment) - A4550: Surgical trays (Medicare: Special coverage instructions apply) - A4553: Non-disposable underpads, all sizes (Medicare: Non-covered by Medicare) - A4554: Disposable underpads, all sizes (Medicare: Non-covered by Medicare) - A4555: Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only (Medicare: Not payable by Medicare) - A4556: Electrodes, (e.g., apnea monitor), per pair (Medicare: Carrier judgment) - A4557: Lead wires, (e.g., apnea monitor), per pair (Medicare: Carrier judgment) - A4558: Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz (Medicare: Carrier judgment) - A4559: Coupling gel or paste, for use with ultrasound device, per oz (Medicare: Carrier judgment) - A4560: Neuromuscular electrical stimulator (nmes), disposable, replacement only (Medicare: Non-covered by Medicare statute) - A4561: Pessary, reusable, rubber, any type (Medicare: Carrier judgment) - A4562: Pessary, reusable, non rubber, any type (Medicare: Carrier judgment) - A4563: Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each (Medicare: Carrier judgment) - A4564: Pessary, disposable, any type (Medicare: Carrier judgment) - A4565: Slings (Medicare: Carrier judgment) - A4566: Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment (Medicare: Not payable by Medicare) - A4570: Splint (Medicare: Not payable by Medicare) - A4575: Topical hyperbaric oxygen chamber, disposable (Medicare: Carrier judgment) - A4580: Cast supplies (e.g., plaster) (Medicare: Not payable by Medicare) - A4590: Special casting material (e.g., fiberglass) (Medicare: Not payable by Medicare) - A4593: Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controller (Medicare: Carrier judgment) - A4594: Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each (Medicare: Carrier judgment) - A4595: Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) (Medicare: Special coverage instructions apply) - A4596: Cranial electrotherapy stimulation (ces) system supplies and accessories, per month (Medicare: Carrier judgment) - A4600: Sleeve for intermittent limb compression device, replacement only, each (Medicare: Carrier judgment) - A4601: Lithium ion battery, rechargeable, for non-prosthetic use, replacement (Medicare: Carrier judgment) - A4602: Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each (Medicare: Carrier judgment) - A4604: Tubing with integrated heating element for use with positive airway pressure device (Medicare: Carrier judgment) - A4605: Tracheal suction catheter, closed system, each (Medicare: Carrier judgment) - A4606: Oxygen probe for use with oximeter device, replacement (Medicare: Carrier judgment) - A4608: Transtracheal oxygen catheter, each (Medicare: Carrier judgment) - A4611: Battery, heavy duty; replacement for patient owned ventilator (Medicare: Non-covered by Medicare statute) - A4612: Battery cables; replacement for patient-owned ventilator (Medicare: Non-covered by Medicare statute) - A4613: Battery charger; replacement for patient-owned ventilator (Medicare: Non-covered by Medicare statute) - A4614: Peak expiratory flow rate meter, hand held (Medicare: Carrier judgment) - A4615: Cannula, nasal (Medicare: Special coverage instructions apply) - A4616: Tubing (oxygen), per foot (Medicare: Special coverage instructions apply) - A4617: Mouth piece (Medicare: Special coverage instructions apply) - A4618: Breathing circuits (Medicare: Special coverage instructions apply) - A4619: Face tent (Medicare: Special coverage instructions apply) - A4620: Variable concentration mask (Medicare: Special coverage instructions apply) - A4623: Tracheostomy, inner cannula (Medicare: Special coverage instructions apply) - A4624: Tracheal suction catheter, any type other than closed system, each (Medicare: Carrier judgment) - A4625: Tracheostomy care kit for new tracheostomy (Medicare: Special coverage instructions apply) - A4626: Tracheostomy cleaning brush, each (Medicare: Special coverage instructions apply) - A4627: Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler (Medicare: Non-covered by Medicare) - A4628: Oral and/or oropharyngeal suction catheter, each (Medicare: Carrier judgment) - A4629: Tracheostomy care kit for established tracheostomy (Medicare: Special coverage instructions apply) - A4630: Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient (Medicare: Special coverage instructions apply) - A4633: Replacement bulb/lamp for ultraviolet light therapy system, each (Medicare: Carrier judgment) - A4634: Replacement bulb for therapeutic light box, tabletop model (Medicare: Carrier judgment) - A4635: Underarm pad, crutch, replacement, each (Medicare: Special coverage instructions apply) - A4636: Replacement, handgrip, cane, crutch, or walker, each (Medicare: Special coverage instructions apply) - A4637: Replacement, tip, cane, crutch, walker, each. (Medicare: Special coverage instructions apply) - A4638: Replacement battery for patient-owned ear pulse generator, each (Medicare: Carrier judgment) - A4639: Replacement pad for infrared heating pad system, each (Medicare: Carrier judgment) - A4640: Replacement pad for use with medically necessary alternating pressure pad owned by patient (Medicare: Special coverage instructions apply) - A4641: Radiopharmaceutical, diagnostic, not otherwise classified (Medicare: Carrier judgment) - A4642: Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries (Medicare: Carrier judgment) - A4648: Tissue marker, implantable, any type, each (Medicare: Carrier judgment) - A4649: Surgical supply; miscellaneous (Medicare: Carrier judgment) - A4650: Implantable radiation dosimeter, each (Medicare: Carrier judgment) - A4651: Calibrated microcapillary tube, each (Medicare: Special coverage instructions apply) - A4652: Microcapillary tube sealant (Medicare: Special coverage instructions apply) - A4653: Peritoneal dialysis catheter anchoring device, belt, each (Medicare: Carrier judgment) - A4657: Syringe, with or without needle, each (Medicare: Special coverage instructions apply) - A4660: Sphygmomanometer/blood pressure apparatus with cuff and stethoscope (Medicare: Special coverage instructions apply) - A4663: Blood pressure cuff only (Medicare: Special coverage instructions apply) - A4670: Automatic blood pressure monitor (Medicare: Non-covered by Medicare) - A4671: Disposable cycler set used with cycler dialysis machine, each (Medicare: Special coverage instructions apply) - A4672: Drainage extension line, sterile, for dialysis, each (Medicare: Special coverage instructions apply) - A4673: Extension line with easy lock connectors, used with dialysis (Medicare: Special coverage instructions apply) - A4674: Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz (Medicare: Special coverage instructions apply) - A4680: Activated carbon filter for hemodialysis, each (Medicare: Special coverage instructions apply) - A4690: Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each (Medicare: Special coverage instructions apply) - A4706: Bicarbonate concentrate, solution, for hemodialysis, per gallon (Medicare: Special coverage instructions apply) - A4707: Bicarbonate concentrate, powder, for hemodialysis, per packet (Medicare: Special coverage instructions apply) - A4708: Acetate concentrate solution, for hemodialysis, per gallon (Medicare: Special coverage instructions apply) - A4709: Acid concentrate, solution, for hemodialysis, per gallon (Medicare: Special coverage instructions apply) - A4714: Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon (Medicare: Special coverage instructions apply) - A4719: "y set" tubing for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4720: Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4721: Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4722: Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4723: Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4724: Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4725: Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4726: Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis (Medicare: Special coverage instructions apply) - A4728: Dialysate solution, non-dextrose containing, 500 ml (Medicare: Carrier judgment) - A4730: Fistula cannulation set for hemodialysis, each (Medicare: Special coverage instructions apply) - A4736: Topical anesthetic, for dialysis, per gram (Medicare: Special coverage instructions apply) - A4737: Injectable anesthetic, for dialysis, per 10 ml (Medicare: Special coverage instructions apply) - A4740: Shunt accessory, for hemodialysis, any type, each (Medicare: Special coverage instructions apply) - A4750: Blood tubing, arterial or venous, for hemodialysis, each (Medicare: Special coverage instructions apply) - A4755: Blood tubing, arterial and venous combined, for hemodialysis, each (Medicare: Special coverage instructions apply) - A4760: Dialysate solution test kit, for peritoneal dialysis, any type, each (Medicare: Special coverage instructions apply) - A4765: Dialysate concentrate, powder, additive for peritoneal dialysis, per packet (Medicare: Special coverage instructions apply) - A4766: Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml (Medicare: Special coverage instructions apply) - A4770: Blood collection tube, vacuum, for dialysis, per 50 (Medicare: Special coverage instructions apply) - A4771: Serum clotting time tube, for dialysis, per 50 (Medicare: Special coverage instructions apply) - A4772: Blood glucose test strips, for dialysis, per 50 (Medicare: Special coverage instructions apply) - A4773: Occult blood test strips, for dialysis, per 50 (Medicare: Special coverage instructions apply) - A4774: Ammonia test strips, for dialysis, per 50 (Medicare: Special coverage instructions apply) - A4802: Protamine sulfate, for hemodialysis, per 50 mg (Medicare: Special coverage instructions apply) - A4860: Disposable catheter tips for peritoneal dialysis, per 10 (Medicare: Special coverage instructions apply) - A4870: Plumbing and/or electrical work for home hemodialysis equipment (Medicare: Special coverage instructions apply) - A4890: Contracts, repair and maintenance, for hemodialysis equipment (Medicare: Special coverage instructions apply) - A4911: Drain bag/bottle, for dialysis, each (Medicare: Special coverage instructions apply) - A4913: Miscellaneous dialysis supplies, not otherwise specified (Medicare: Special coverage instructions apply) - A4918: Venous pressure clamp, for hemodialysis, each (Medicare: Special coverage instructions apply) - A4927: Gloves, non-sterile, per 100 (Medicare: Special coverage instructions apply) - A4928: Surgical mask, per 20 (Medicare: Special coverage instructions apply) - A4929: Tourniquet for dialysis, each (Medicare: Special coverage instructions apply) - A4930: Gloves, sterile, per pair (Medicare: Special coverage instructions apply) - A4931: Oral thermometer, reusable, any type, each (Medicare: Carrier judgment) - A4932: Rectal thermometer, reusable, any type, each (Medicare: Carrier judgment) - A5051: Ostomy pouch, closed; with barrier attached (1 piece), each (Medicare: Special coverage instructions apply) - A5052: Ostomy pouch, closed; without barrier attached (1 piece), each (Medicare: Special coverage instructions apply) - A5053: Ostomy pouch, closed; for use on faceplate, each (Medicare: Special coverage instructions apply) - A5054: Ostomy pouch, closed; for use on barrier with flange (2 piece), each (Medicare: Special coverage instructions apply) - A5055: Stoma cap (Medicare: Special coverage instructions apply) - A5056: Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each (Medicare: Special coverage instructions apply) - A5057: Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each (Medicare: Special coverage instructions apply) - A5061: Ostomy pouch, drainable; with barrier attached, (1 piece), each (Medicare: Carrier judgment) - A5062: Ostomy pouch, drainable; without barrier attached (1 piece), each (Medicare: Special coverage instructions apply) - A5063: Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each (Medicare: Special coverage instructions apply) - A5071: Ostomy pouch, urinary; with barrier attached (1 piece), each (Medicare: Special coverage instructions apply) - A5072: Ostomy pouch, urinary; without barrier attached (1 piece), each (Medicare: Special coverage instructions apply) - A5073: Ostomy pouch, urinary; for use on barrier with flange (2 piece), each (Medicare: Special coverage instructions apply) - A5081: Stoma plug or seal, any type (Medicare: Special coverage instructions apply) - A5082: Continent device; catheter for continent stoma (Medicare: Special coverage instructions apply) - A5083: Continent device, stoma absorptive cover for continent stoma (Medicare: Carrier judgment) - A5093: Ostomy accessory; convex insert (Medicare: Special coverage instructions apply) - A5102: Bedside drainage bottle with or without tubing, rigid or expandable, each (Medicare: Special coverage instructions apply) - A5105: Urinary suspensory with leg bag, with or without tube, each (Medicare: Special coverage instructions apply) - A5112: Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each (Medicare: Special coverage instructions apply) - A5113: Leg strap; latex, replacement only, per set (Medicare: Special coverage instructions apply) - A5114: Leg strap; foam or fabric, replacement only, per set (Medicare: Special coverage instructions apply) - A5120: Skin barrier, wipes or swabs, each (Medicare: Special coverage instructions apply) - A5121: Skin barrier; solid, 6 x 6 or equivalent, each (Medicare: Special coverage instructions apply) - A5122: Skin barrier; solid, 8 x 8 or equivalent, each (Medicare: Special coverage instructions apply) - A5126: Adhesive or non-adhesive; disk or foam pad (Medicare: Special coverage instructions apply) - A5131: Appliance cleaner, incontinence and ostomy appliances, per 16 oz. (Medicare: Special coverage instructions apply) - A5200: Percutaneous catheter/tube anchoring device, adhesive skin attachment (Medicare: Special coverage instructions apply) - A5500: 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 (Medicare: Special coverage instructions apply) - A5501: 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 (Medicare: Special coverage instructions apply) - A5503: 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 (Medicare: Special coverage instructions apply) - A5504: For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe (Medicare: Special coverage instructions apply) - A5505: For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe (Medicare: Special coverage instructions apply) - A5506: For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe (Medicare: Special coverage instructions apply) - A5507: For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe (Medicare: Special coverage instructions apply) - A5508: For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe (Medicare: Special coverage instructions apply) - A5510: For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe (Medicare: Special coverage instructions apply) - A5512: 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 (Medicare: Special coverage instructions apply) - A5513: 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 (Medicare: Special coverage instructions apply) - A5514: 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 (Medicare: Special coverage instructions apply) - A6000: Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card (Medicare: Non-covered by Medicare) - A6010: Collagen based wound filler, dry form, sterile, per gram of collagen (Medicare: Special coverage instructions apply) - A6011: Collagen based wound filler, gel/paste, per gram of collagen (Medicare: Special coverage instructions apply) - A6021: Collagen dressing, sterile, size 16 sq. in. or less, each (Medicare: Special coverage instructions apply) - A6022: Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each (Medicare: Special coverage instructions apply) - A6023: Collagen dressing, sterile, size more than 48 sq. in., each (Medicare: Special coverage instructions apply) - A6024: Collagen dressing wound filler, sterile, per 6 inches (Medicare: Special coverage instructions apply) - A6025: Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each (Medicare: Carrier judgment) - A6154: Wound pouch, each (Medicare: Special coverage instructions apply) - A6196: Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing (Medicare: Special coverage instructions apply) - A6197: 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 (Medicare: Special coverage instructions apply) - A6198: Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing (Medicare: Special coverage instructions apply) - A6199: Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches (Medicare: Special coverage instructions apply) - A6203: Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6204: 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 (Medicare: Special coverage instructions apply) - A6205: Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6206: Contact layer, sterile, 16 sq. in. or less, each dressing (Medicare: Special coverage instructions apply) - A6207: Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing (Medicare: Special coverage instructions apply) - A6208: Contact layer, sterile, more than 48 sq. in., each dressing (Medicare: Special coverage instructions apply) - A6209: Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6210: 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 (Medicare: Special coverage instructions apply) - A6211: Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6212: Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6213: 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 (Medicare: Special coverage instructions apply) - A6214: Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6215: Foam dressing, wound filler, sterile, per gram (Medicare: Special coverage instructions apply) - A6216: Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6217: 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 (Medicare: Special coverage instructions apply) - A6218: Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6219: Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6220: 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 (Medicare: Special coverage instructions apply) - A6221: Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6222: Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6223: 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 (Medicare: Special coverage instructions apply) - A6224: Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6228: Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6229: 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 (Medicare: Special coverage instructions apply) - A6230: Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6231: Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing (Medicare: Special coverage instructions apply) - A6232: 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 (Medicare: Special coverage instructions apply) - A6233: Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing (Medicare: Special coverage instructions apply) - A6234: Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6235: 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 (Medicare: Special coverage instructions apply) - A6236: Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6237: Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6238: 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 (Medicare: Special coverage instructions apply) - A6239: Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6240: Hydrocolloid dressing, wound filler, paste, sterile, per ounce (Medicare: Special coverage instructions apply) - A6241: Hydrocolloid dressing, wound filler, dry form, sterile, per gram (Medicare: Special coverage instructions apply) - A6242: Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6243: 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 (Medicare: Special coverage instructions apply) - A6244: Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6245: Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6246: 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 (Medicare: Special coverage instructions apply) - A6247: Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6248: Hydrogel dressing, wound filler, gel, per fluid ounce (Medicare: Special coverage instructions apply) - A6250: Skin sealants, protectants, moisturizers, ointments, any type, any size (Medicare: Special coverage instructions apply) - A6251: Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6252: 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 (Medicare: Special coverage instructions apply) - A6253: Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6254: Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6255: 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 (Medicare: Special coverage instructions apply) - A6256: Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6257: Transparent film, sterile, 16 sq. in. or less, each dressing (Medicare: Special coverage instructions apply) - A6258: Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing (Medicare: Special coverage instructions apply) - A6259: Transparent film, sterile, more than 48 sq. in., each dressing (Medicare: Special coverage instructions apply) - A6260: Wound cleansers, any type, any size (Medicare: Special coverage instructions apply) - A6261: Wound filler, gel/paste, per fluid ounce, not otherwise specified (Medicare: Special coverage instructions apply) - A6262: Wound filler, dry form, per gram, not otherwise specified (Medicare: Special coverage instructions apply) - A6266: Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard (Medicare: Special coverage instructions apply) - A6402: Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6403: Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6404: Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing (Medicare: Special coverage instructions apply) - A6407: Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard (Medicare: Carrier judgment) - A6410: Eye pad, sterile, each (Medicare: Special coverage instructions apply) - A6411: Eye pad, non-sterile, each (Medicare: Special coverage instructions apply) - A6412: Eye patch, occlusive, each (Medicare: Carrier judgment) - A6413: Adhesive bandage, first-aid type, any size, each (Medicare: Non-covered by Medicare statute) - A6441: Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard (Medicare: Carrier judgment) - A6442: Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard (Medicare: Carrier judgment) - A6443: Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard (Medicare: Carrier judgment) - A6444: Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard (Medicare: Carrier judgment) - A6445: Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard (Medicare: Carrier judgment) - A6446: Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard (Medicare: Carrier judgment) - A6447: Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard (Medicare: Carrier judgment) - A6448: Light compression bandage, elastic, knitted/woven, width less than three inches, per yard (Medicare: Carrier judgment) - A6449: Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard (Medicare: Carrier judgment) - A6450: Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard (Medicare: Carrier judgment) - A6451: 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 (Medicare: Carrier judgment) - A6452: 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 (Medicare: Carrier judgment) - A6453: Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard (Medicare: Carrier judgment) - A6454: Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard (Medicare: Carrier judgment) - A6455: Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard (Medicare: Carrier judgment) - A6456: Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard (Medicare: Carrier judgment) - A6457: Tubular dressing with or without elastic, any width, per linear yard (Medicare: Carrier judgment) - A6460: Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing (Medicare: Carrier judgment) - A6461: 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 (Medicare: Carrier judgment) - A6501: Compression burn garment, bodysuit (head to foot), custom fabricated (Medicare: Special coverage instructions apply) - A6502: Compression burn garment, chin strap, custom fabricated (Medicare: Special coverage instructions apply) - A6503: Compression burn garment, facial hood, custom fabricated (Medicare: Special coverage instructions apply) - A6504: Compression burn garment, glove to wrist, custom fabricated (Medicare: Special coverage instructions apply) - A6505: Compression burn garment, glove to elbow, custom fabricated (Medicare: Special coverage instructions apply) - A6506: Compression burn garment, glove to axilla, custom fabricated (Medicare: Special coverage instructions apply) - A6507: Compression burn garment, foot to knee length, custom fabricated (Medicare: Special coverage instructions apply) - A6508: Compression burn garment, foot to thigh length, custom fabricated (Medicare: Special coverage instructions apply) - A6509: Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated (Medicare: Special coverage instructions apply) - A6510: Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated (Medicare: Special coverage instructions apply) - A6511: Compression burn garment, lower trunk including leg openings (panty), custom fabricated (Medicare: Special coverage instructions apply) - A6512: Compression burn garment, not otherwise classified (Medicare: Special coverage instructions apply) - A6513: Compression burn mask, face and/or neck, plastic or equal, custom fabricated (Medicare: Carrier judgment) - A6515: Gradient compression wrap with adjustable straps, full leg, each, custom (Medicare: Carrier judgment) - A6516: Gradient compression wrap with adjustable straps, foot, each, custom (Medicare: Carrier judgment) - A6517: Gradient compression wrap with adjustable straps, below knee, each, custom (Medicare: Carrier judgment) - A6518: Gradient compression wrap with adjustable straps, arm, each, custom (Medicare: Carrier judgment) - A6519: Gradient compression garment, not otherwise specified, for nighttime use, each (Medicare: Carrier judgment) - A6520: Gradient compression garment, glove, padded, for nighttime use, each (Medicare: Carrier judgment) - A6521: Gradient compression garment, glove, padded, for nighttime use, custom, each (Medicare: Carrier judgment) - A6522: Gradient compression garment, arm, padded, for nighttime use, each (Medicare: Carrier judgment) - A6523: Gradient compression garment, arm, padded, for nighttime use, custom, each (Medicare: Carrier judgment) - A6524: Gradient compression garment, lower leg and foot, padded, for nighttime use, each (Medicare: Carrier judgment) - A6525: Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each (Medicare: Carrier judgment) - A6526: Gradient compression garment, full leg and foot, padded, for nighttime use, each (Medicare: Carrier judgment) - A6527: Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each (Medicare: Carrier judgment) - A6528: Gradient compression garment, bra, for nighttime use, each (Medicare: Carrier judgment) - A6529: Gradient compression garment, bra, for nighttime use, custom, each (Medicare: Carrier judgment) - A6530: Gradient compression stocking, below knee, 18-30 mmhg, each (Medicare: Carrier judgment) - A6531: Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each (Medicare: Special coverage instructions apply) - A6532: Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each (Medicare: Special coverage instructions apply) - A6533: Gradient compression stocking, thigh length, 18-30 mmhg, each (Medicare: Carrier judgment) - A6534: Gradient compression stocking, thigh length, 30-40 mmhg, each (Medicare: Carrier judgment) - A6535: Gradient compression stocking, thigh length, 40 mmhg or greater, each (Medicare: Carrier judgment) - A6536: Gradient compression stocking, full length/chap style, 18-30 mmhg, each (Medicare: Carrier judgment) - A6537: Gradient compression stocking, full length/chap style, 30-40 mmhg, each (Medicare: Carrier judgment) - A6538: Gradient compression stocking, full length/chap style, 40 mmhg or greater, each (Medicare: Carrier judgment) - A6539: Gradient compression stocking, waist length, 18-30 mmhg, each (Medicare: Carrier judgment) - A6540: Gradient compression stocking, waist length, 30-40 mmhg, each (Medicare: Carrier judgment) - A6541: Gradient compression stocking, waist length, 40 mmhg or greater, each (Medicare: Carrier judgment) - A6544: Gradient compression stocking, garter belt (Medicare: Carrier judgment) - A6545: Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each (Medicare: Special coverage instructions apply) - A6548: Accessory to custom gradient compression garment, silicone band, any size (Medicare: Carrier judgment) - A6549: Gradient compression garment, not otherwise specified, for daytime use, each (Medicare: Carrier judgment) - A6550: Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories (Medicare: Carrier judgment) - A6552: Gradient compression stocking, below knee, 30-40 mmhg, each (Medicare: Carrier judgment) - A6553: Gradient compression stocking, below knee, 30-40 mmhg, custom, each (Medicare: Carrier judgment) - A6554: Gradient compression stocking, below knee, 40 mmhg or greater, each (Medicare: Carrier judgment) - A6555: Gradient compression stocking, below knee, 40 mmhg or greater, custom, each (Medicare: Carrier judgment) - A6556: Gradient compression stocking, thigh length, 18-30 mmhg, custom, each (Medicare: Carrier judgment) - A6557: Gradient compression stocking, thigh length, 30-40 mmhg, custom, each (Medicare: Carrier judgment) - A6558: Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each (Medicare: Carrier judgment) - A6559: Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each (Medicare: Carrier judgment) - A6560: Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each (Medicare: Carrier judgment) - A6561: Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each (Medicare: Carrier judgment) - A6562: Gradient compression stocking, waist length, 18-30 mmhg, custom, each (Medicare: Carrier judgment) - A6563: Gradient compression stocking, waist length, 30-40 mmhg, custom, each (Medicare: Carrier judgment) - A6564: Gradient compression stocking, waist length, 40 mmhg or greater, custom, each (Medicare: Carrier judgment) - A6565: Gradient compression gauntlet, custom, each (Medicare: Carrier judgment) - A6566: Gradient compression garment, neck/head, each (Medicare: Carrier judgment) - A6567: Gradient compression garment, neck/head, custom, each (Medicare: Carrier judgment) - A6568: Gradient compression garment, torso and shoulder, each (Medicare: Carrier judgment) - A6569: Gradient compression garment, torso/shoulder, custom, each (Medicare: Carrier judgment) - A6570: Gradient compression garment, genital region, each (Medicare: Carrier judgment) - A6571: Gradient compression garment, genital region, custom, each (Medicare: Carrier judgment) - A6572: Gradient compression garment, toe caps, each (Medicare: Carrier judgment) - A6573: Gradient compression garment, toe caps, custom, each (Medicare: Carrier judgment) - A6574: Gradient compression arm sleeve and glove combination, custom, each (Medicare: Carrier judgment) - A6575: Gradient compression arm sleeve and glove combination, each (Medicare: Carrier judgment) - A6576: Gradient compression arm sleeve, custom, medium weight, each (Medicare: Carrier judgment) - A6577: Gradient compression arm sleeve, custom, heavy weight, each (Medicare: Carrier judgment) - A6578: Gradient compression arm sleeve, each (Medicare: Carrier judgment) - A6579: Gradient compression glove, custom, medium weight, each (Medicare: Carrier judgment) - A6580: Gradient compression glove, custom, heavy weight, each (Medicare: Carrier judgment) - A6581: Gradient compression glove, each (Medicare: Carrier judgment) - A6582: Gradient compression gauntlet, each (Medicare: Carrier judgment) - A6583: Gradient compression wrap with adjustable straps, below knee, each (Medicare: Carrier judgment) - A6584: Gradient compression wrap with adjustable straps, not otherwise specified (Medicare: Carrier judgment) - A6585: Gradient compression wrap with adjustable straps, above knee, each (Medicare: Carrier judgment) - A6586: Gradient compression wrap with adjustable straps, full leg, each (Medicare: Carrier judgment) - A6587: Gradient compression wrap with adjustable straps, foot, each (Medicare: Carrier judgment) - A6588: Gradient compression wrap with adjustable straps, arm, each (Medicare: Carrier judgment) - A6589: Gradient pressure wrap with adjustable straps, bra, each (Medicare: Carrier judgment) - A6590: External urinary catheters; disposable, with wicking material, for use with suction pump, per month (Medicare: Carrier judgment) - A6591: External urinary catheter; non-disposable, for use with suction pump, per month (Medicare: Carrier judgment) - A6593: Accessory for gradient compression garment or wrap with adjustable straps, not-otherwise specified (Medicare: Carrier judgment) - A6594: Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each (Medicare: Carrier judgment) - A6595: Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each (Medicare: Carrier judgment) - A6596: Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each (Medicare: Carrier judgment) - A6597: Gradient compression bandage roll, elastic long stretch, linear yard, any width, each (Medicare: Carrier judgment) - A6598: Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each (Medicare: Carrier judgment) - A6599: Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each (Medicare: Carrier judgment) - A6600: Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each (Medicare: Carrier judgment) - A6601: Gradient compression bandaging supply, high density foam pad, any size or shape, each (Medicare: Carrier judgment) - A6602: Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each (Medicare: Carrier judgment) - A6603: Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each (Medicare: Carrier judgment) - A6604: Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each (Medicare: Carrier judgment) - A6605: Gradient compression bandaging supply, padded foam, per linear yard, any width, each (Medicare: Carrier judgment) - A6606: Gradient compression bandaging supply, padded textile, per linear yard, any width, each (Medicare: Carrier judgment) - A6607: Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each (Medicare: Carrier judgment) - A6608: Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each (Medicare: Carrier judgment) - A6609: Gradient compression bandaging supply, not otherwise specified (Medicare: Carrier judgment) - A6610: Gradient compression stocking, below knee, 18-30 mmhg, custom, each (Medicare: Carrier judgment) - A6611: Gradient compression wrap with adjustable straps, above knee, each, custom (Medicare: Carrier judgment) - A7000: Canister, disposable, used with suction pump, each (Medicare: Carrier judgment) - A7001: Canister, non-disposable, used with suction pump, each (Medicare: Carrier judgment) - A7002: Tubing, used with suction pump, each (Medicare: Carrier judgment) - A7003: Administration set, with small volume nonfiltered pneumatic nebulizer, disposable (Medicare: Carrier judgment) - A7004: Small volume nonfiltered pneumatic nebulizer, disposable (Medicare: Carrier judgment) - A7005: Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable (Medicare: Carrier judgment) - A7006: Administration set, with small volume filtered pneumatic nebulizer (Medicare: Carrier judgment) - A7007: Large volume nebulizer, disposable, unfilled, used with aerosol compressor (Medicare: Carrier judgment) - A7008: Large volume nebulizer, disposable, prefilled, used with aerosol compressor (Medicare: Carrier judgment) - A7009: Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer (Medicare: Carrier judgment) - A7010: Corrugated tubing, disposable, used with large volume nebulizer, 100 feet (Medicare: Carrier judgment) - A7011: Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet (Medicare: Carrier judgment) - A7012: Water collection device, used with large volume nebulizer (Medicare: Carrier judgment) - A7013: Filter, disposable, used with aerosol compressor or ultrasonic generator (Medicare: Carrier judgment) - A7014: Filter, nondisposable, used with aerosol compressor or ultrasonic generator (Medicare: Carrier judgment) - A7015: Aerosol mask, used with dme nebulizer (Medicare: Carrier judgment) - A7016: Dome and mouthpiece, used with small volume ultrasonic nebulizer (Medicare: Carrier judgment) - A7017: Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen (Medicare: Special coverage instructions apply) - A7018: Water, distilled, used with large volume nebulizer, 1000 ml (Medicare: Carrier judgment) - A7020: Interface for cough stimulating device, includes all components, replacement only (Medicare: Carrier judgment) - A7021: Supplies and accessories for lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (e.g., handset, nebulizer kit, biofilter) (Medicare: Carrier judgment) - A7023: Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical (Medicare: Non-covered by Medicare statute) - A7025: High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each (Medicare: Carrier judgment) - A7026: High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each (Medicare: Carrier judgment) - A7027: Combination oral/nasal mask, used with continuous positive airway pressure device, each (Medicare: Carrier judgment) - A7028: Oral cushion for combination oral/nasal mask, replacement only, each (Medicare: Carrier judgment) - A7029: Nasal pillows for combination oral/nasal mask, replacement only, pair (Medicare: Carrier judgment) - A7030: Full face mask used with positive airway pressure device, each (Medicare: Carrier judgment) - A7031: Face mask interface, replacement for full face mask, each (Medicare: Carrier judgment) - A7032: Cushion for use on nasal mask interface, replacement only, each (Medicare: Carrier judgment) - A7033: Pillow for use on nasal cannula type interface, replacement only, pair (Medicare: Carrier judgment) - A7034: Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (Medicare: Carrier judgment) - A7035: Headgear used with positive airway pressure device (Medicare: Carrier judgment) - A7036: Chinstrap used with positive airway pressure device (Medicare: Carrier judgment) - A7037: Tubing used with positive airway pressure device (Medicare: Carrier judgment) - A7038: Filter, disposable, used with positive airway pressure device (Medicare: Carrier judgment) - A7039: Filter, non disposable, used with positive airway pressure device (Medicare: Carrier judgment) - A7040: One way chest drain valve (Medicare: Carrier judgment) - A7041: Water seal drainage container and tubing for use with implanted chest tube (Medicare: Carrier judgment) - A7042: Implanted pleural catheter, each (Medicare: Carrier judgment) - A7043: Vacuum drainage bottle and tubing for use with implanted catheter (Medicare: Carrier judgment) - A7044: Oral interface used with positive airway pressure device, each (Medicare: Carrier judgment) - A7045: Exhalation port with or without swivel used with accessories for positive airway devices, replacement only (Medicare: Special coverage instructions apply) - A7046: Water chamber for humidifier, used with positive airway pressure device, replacement, each (Medicare: Special coverage instructions apply) - A7047: Oral interface used with respiratory suction pump, each (Medicare: Carrier judgment) - A7048: Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each (Medicare: Carrier judgment) - A7049: Expiratory positive airway pressure intranasal resistance valve (Medicare: Non-covered by Medicare statute) - A7501: Tracheostoma valve, including diaphragm, each (Medicare: Special coverage instructions apply) - A7502: Replacement diaphragm/faceplate for tracheostoma valve, each (Medicare: Special coverage instructions apply) - A7503: Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each (Medicare: Special coverage instructions apply) - A7504: Filter for use in a tracheostoma heat and moisture exchange system, each (Medicare: Special coverage instructions apply) - A7505: Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each (Medicare: Special coverage instructions apply) - A7506: Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each (Medicare: Special coverage instructions apply) - A7507: Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each (Medicare: Special coverage instructions apply) - A7508: Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each (Medicare: Special coverage instructions apply) - A7509: Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each (Medicare: Special coverage instructions apply) - A7520: Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each (Medicare: Carrier judgment) - A7521: Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each (Medicare: Carrier judgment) - A7522: Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each (Medicare: Carrier judgment) - A7523: Tracheostomy shower protector, each (Medicare: Carrier judgment) - A7524: Tracheostoma stent/stud/button, each (Medicare: Carrier judgment) - A7525: Tracheostomy mask, each (Medicare: Carrier judgment) - A7526: Tracheostomy tube collar/holder, each (Medicare: Carrier judgment) - A7527: Tracheostomy/laryngectomy tube plug/stop, each (Medicare: Carrier judgment) - A8000: Helmet, protective, soft, prefabricated, includes all components and accessories (Medicare: Carrier judgment) - A8001: Helmet, protective, hard, prefabricated, includes all components and accessories (Medicare: Carrier judgment) - A8002: Helmet, protective, soft, custom fabricated, includes all components and accessories (Medicare: Carrier judgment) - A8003: Helmet, protective, hard, custom fabricated, includes all components and accessories (Medicare: Carrier judgment) - A8004: Soft interface for helmet, replacement only (Medicare: Carrier judgment) - A8005: Powered, cable driven grip assist glove, hand, finger, includes microprocessor, pressure sensors, all components and accessories, custom fitted (Medicare: Not payable by Medicare) - A8006: Powered, cable driven grip assist glove, hand, finger, includes pressure sensors, glove replacement only (Medicare: Not payable by Medicare) - A9150: Non-prescription drugs (Medicare: Special coverage instructions apply) - A9152: Single vitamin/mineral/trace element, oral, per dose, not otherwise specified (Medicare: Not payable by Medicare) - A9153: Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified (Medicare: Not payable by Medicare) - A9154: Artificial saliva, 1 ml (Medicare: Non-covered by Medicare statute) - A9155: Artificial saliva, 30 ml (Medicare: Carrier judgment) - A9156: Oral mucoadhesive, any type (liquid, gel, paste, etc.), per 1 ml (Medicare: Special coverage instructions apply) - A9180: Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker (Medicare: Not payable by Medicare) - A9268: Programmer for transient, orally ingested capsule (Medicare: Non-covered by Medicare statute) - A9269: Programable, transient, orally ingested capsule, for use with external programmer, per month (Medicare: Non-covered by Medicare statute) - A9270: Non-covered item or service (Medicare: Non-covered by Medicare) - A9272: Wound suction, disposable, includes dressing, all accessories and components, any type, each (Medicare: Special coverage instructions apply) - A9273: Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type (Medicare: Non-covered by Medicare) - A9274: External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories (Medicare: Non-covered by Medicare statute) - A9275: Home glucose disposable monitor, includes test strips (Medicare: Non-covered by Medicare) - A9276: Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply (Medicare: Non-covered by Medicare statute) - A9277: Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system (Medicare: Non-covered by Medicare statute) - A9278: Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system (Medicare: Non-covered by Medicare statute) - A9279: Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified (Medicare: Non-covered by Medicare statute) - A9280: Alert or alarm device, not otherwise classified (Medicare: Non-covered by Medicare statute) - A9281: Reaching/grabbing device, any type, any length, each (Medicare: Non-covered by Medicare statute) - A9282: Wig, any type, each (Medicare: Non-covered by Medicare statute) - A9283: Foot pressure off loading/supportive device, any type, each (Medicare: Non-covered by Medicare statute) - A9284: Spirometer, non-electronic, includes all accessories (Medicare: Special coverage instructions apply) - A9285: Inversion/eversion correction device (Medicare: Carrier judgment) - A9286: Hygienic item or device, disposable or non-disposable, any type, each (Medicare: Non-covered by Medicare statute) - A9291: Prescription digital cognitive and/or behavioral therapy, fda cleared, per course of treatment (Medicare: Carrier judgment) - A9292: Prescription digital visual therapy, software-only, fda cleared, per course of treatment (Medicare: Carrier judgment) - A9293: Fertility cycle (contraception & conception) tracking software application, fda cleared, per month, includes accessories (e.g., thermometer) (Medicare: Carrier judgment) - A9294: Prescription digital cognitive and/or behavioral therapy, biofeedback, fda cleared, per course of treatment (Medicare: Carrier judgment) - A9300: Exercise equipment (Medicare: Non-covered by Medicare) - A9500: Technetium tc-99m sestamibi, diagnostic, per study dose (Medicare: Carrier judgment) - A9501: Technetium tc-99m teboroxime, diagnostic, per study dose (Medicare: Carrier judgment) - A9502: Technetium tc-99m tetrofosmin, diagnostic, per study dose (Medicare: Carrier judgment) - A9503: Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries (Medicare: Carrier judgment) - A9504: Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries (Medicare: Carrier judgment) - A9505: Thallium tl-201 thallous chloride, diagnostic, per millicurie (Medicare: Carrier judgment) - A9506: Graphite crucible for preparation of technetium tc 99m-labeled carbon aerosol, one crucible (Medicare: Carrier judgment) - A9507: Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries (Medicare: Carrier judgment) - A9508: Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie (Medicare: Carrier judgment) - A9509: Iodine i-123 sodium iodide, diagnostic, per millicurie (Medicare: Carrier judgment) - A9510: Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries (Medicare: Carrier judgment) - A9512: Technetium tc-99m pertechnetate, diagnostic, per millicurie (Medicare: Carrier judgment) - A9513: Lutetium lu 177, dotatate, therapeutic, 1 millicurie (Medicare: Special coverage instructions apply) - A9515: Choline c-11, diagnostic, per study dose up to 20 millicuries (Medicare: Carrier judgment) - A9516: Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries (Medicare: Carrier judgment) - A9517: Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie (Medicare: Carrier judgment) - A9520: Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries (Medicare: Carrier judgment) - A9521: Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries (Medicare: Carrier judgment) - A9524: Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries (Medicare: Carrier judgment) - A9526: Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries (Medicare: Carrier judgment) - A9527: Iodine i-125, sodium iodide solution, therapeutic, per millicurie (Medicare: Carrier judgment) - A9528: Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie (Medicare: Carrier judgment) - A9529: Iodine i-131 sodium iodide solution, diagnostic, per millicurie (Medicare: Carrier judgment) - A9530: Iodine i-131 sodium iodide solution, therapeutic, per millicurie (Medicare: Carrier judgment) - A9531: Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) (Medicare: Carrier judgment) - A9532: Iodine i-125 serum albumin, diagnostic, per 5 microcuries (Medicare: Carrier judgment) - A9536: Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries (Medicare: Carrier judgment) - A9537: Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries (Medicare: Carrier judgment) - A9538: Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries (Medicare: Carrier judgment) - A9539: Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries (Medicare: Carrier judgment) - A9540: Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries (Medicare: Carrier judgment) - A9541: Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries (Medicare: Carrier judgment) - A9542: Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries (Medicare: Carrier judgment) - A9543: Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries (Medicare: Carrier judgment) - A9544: Iodine i-131 tositumomab, diagnostic, per study dose (Medicare: Carrier judgment) - A9545: Iodine i-131 tositumomab, therapeutic, per treatment dose (Medicare: Carrier judgment) - A9546: Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie (Medicare: Carrier judgment) - A9547: Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie (Medicare: Carrier judgment) - A9548: Indium in-111 pentetate, diagnostic, per 0.5 millicurie (Medicare: Carrier judgment) - A9550: Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie (Medicare: Carrier judgment) - A9551: Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries (Medicare: Carrier judgment) - A9552: Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries (Medicare: Carrier judgment) - A9553: Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries (Medicare: Carrier judgment) - A9554: Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries (Medicare: Carrier judgment) - A9555: Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries (Medicare: Carrier judgment) - A9556: Gallium ga-67 citrate, diagnostic, per millicurie (Medicare: Carrier judgment) - A9557: Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries (Medicare: Carrier judgment) - A9558: Xenon xe-133 gas, diagnostic, per 10 millicuries (Medicare: Carrier judgment) - A9559: Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie (Medicare: Carrier judgment) - A9560: Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries (Medicare: Carrier judgment) - A9561: Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries (Medicare: Carrier judgment) - A9562: Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries (Medicare: Carrier judgment) - A9563: Sodium phosphate p-32, therapeutic, per millicurie (Medicare: Carrier judgment) - A9564: Chromic phosphate p-32 suspension, therapeutic, per millicurie (Medicare: Carrier judgment) - A9566: Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries (Medicare: Carrier judgment) - A9567: Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries (Medicare: Carrier judgment) - A9568: Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries (Medicare: Carrier judgment) - A9569: Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose (Medicare: Carrier judgment) - A9570: Indium in-111 labeled autologous white blood cells, diagnostic, per study dose (Medicare: Carrier judgment) - A9571: Indium in-111 labeled autologous platelets, diagnostic, per study dose (Medicare: Carrier judgment) - A9572: Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries (Medicare: Carrier judgment) - A9573: Injection, gadopiclenol, 1 ml (Medicare: Carrier judgment) - A9575: Injection, gadoterate meglumine, 0.1 ml (Medicare: Carrier judgment) - A9576: Injection, gadoteridol, (prohance multipack), per ml (Medicare: Carrier judgment) - A9577: Injection, gadobenate dimeglumine (multihance), per ml (Medicare: Carrier judgment) - A9578: Injection, gadobenate dimeglumine (multihance multipack), per ml (Medicare: Carrier judgment) - A9579: Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml (Medicare: Carrier judgment) - A9580: Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries (Medicare: Carrier judgment) - A9581: Injection, gadoxetate disodium, 1 ml (Medicare: Carrier judgment) - A9582: Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries (Medicare: Carrier judgment) - A9583: Injection, gadofosveset trisodium, 1 ml (Medicare: Carrier judgment) - A9584: Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries (Medicare: Carrier judgment) - A9585: Injection, gadobutrol, 0.1 ml (Medicare: Carrier judgment) - A9586: Florbetapir f18, diagnostic, per study dose, up to 10 millicuries (Medicare: Special coverage instructions apply) - A9587: Gallium ga-68, dotatate, diagnostic, 0.1 millicurie (Medicare: Carrier judgment) - A9588: Fluciclovine f-18, diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9589: Instillation, hexaminolevulinate hydrochloride, 100 mg (Medicare: Carrier judgment) - A9590: Iodine i-131, iobenguane, 1 millicurie (Medicare: Carrier judgment) - A9591: Fluoroestradiol f 18, diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9592: Copper cu-64, dotatate, diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9593: Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie (Medicare: Carrier judgment) - A9594: Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie (Medicare: Carrier judgment) - A9595: Piflufolastat f-18, diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9596: Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie (Medicare: Carrier judgment) - A9597: Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified (Medicare: Carrier judgment) - A9598: Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified (Medicare: Carrier judgment) - A9599: Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified (Medicare: Special coverage instructions apply) - A9600: Strontium sr-89 chloride, therapeutic, per millicurie (Medicare: Carrier judgment) - A9601: Flortaucipir f 18 injection, diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9602: Fluorodopa f-18, diagnostic, per millicurie (Medicare: Carrier judgment) - A9603: Injection, pafolacianine, 0.1 mg (Medicare: Carrier judgment) - A9604: Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries (Medicare: Carrier judgment) - A9606: Radium ra-223 dichloride, therapeutic, per microcurie (Medicare: Carrier judgment) - A9607: Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie (Medicare: Carrier judgment) - A9608: Flotufolastat f 18, diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9609: Fludeoxyglucose f18 up to 15 millicuries (Medicare: Carrier judgment) - A9610: Xenon xe-129 hyperpolarized gas, diagnostic, per study dose (Medicare: Carrier judgment) - A9611: Flurpiridaz f 18, diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9612: Injection, fluorescein, 1 mg (Medicare: Carrier judgment) - A9615: Injection, pegulicianine, 1 mg (Medicare: Carrier judgment) - A9616: Gallium ga-68 gozetotide (gozellix), diagnostic, 1 millicurie (Medicare: Carrier judgment) - A9697: Injection, carboxydextran-coated superparamagnetic iron oxide, per study dose (Medicare: Carrier judgment) - A9698: Non-radioactive contrast imaging material, not otherwise classified, per study (Medicare: Special coverage instructions apply) - A9699: Radiopharmaceutical, therapeutic, not otherwise classified (Medicare: Carrier judgment) - A9700: Supply of injectable contrast material for use in echocardiography, per study (Medicare: Special coverage instructions apply) - A9800: Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie (Medicare: Carrier judgment) - A9900: Miscellaneous dme supply, accessory, and/or service component of another hcpcs code (Medicare: Carrier judgment) - A9901: Dme delivery, set up, and/or dispensing service component of another hcpcs code (Medicare: Carrier judgment) - A9999: Miscellaneous dme supply or accessory, not otherwise specified (Medicare: Carrier judgment) - B4034: Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape (Medicare: Special coverage instructions apply) - B4035: Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape (Medicare: Special coverage instructions apply) - B4036: Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape (Medicare: Special coverage instructions apply) - B4081: Nasogastric tubing with stylet (Medicare: Special coverage instructions apply) - B4082: Nasogastric tubing without stylet (Medicare: Special coverage instructions apply) - B4083: Stomach tube - levine type (Medicare: Special coverage instructions apply) - B4087: Gastrostomy/jejunostomy tube, standard, any material, any type, each (Medicare: Carrier judgment) - B4088: Gastrostomy/jejunostomy tube, low-profile, any material, any type, each (Medicare: Carrier judgment) - B4100: Food thickener, administered orally, per ounce (Medicare: Non-covered by Medicare) - B4102: Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit (Medicare: Special coverage instructions apply) - B4103: Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit (Medicare: Special coverage instructions apply) - B4104: Additive for enteral formula (e.g., fiber) (Medicare: Special coverage instructions apply) - B4105: In-line cartridge containing digestive enzyme(s) for enteral feeding, each (Medicare: Carrier judgment) - B4148: Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape (Medicare: Special coverage instructions apply) - B4149: 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 (Medicare: Special coverage instructions apply) - B4150: 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 (Medicare: Special coverage instructions apply) - B4152: 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 (Medicare: Special coverage instructions apply) - B4153: 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 (Medicare: Special coverage instructions apply) - B4154: 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 (Medicare: Special coverage instructions apply) - B4155: 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 (Medicare: Special coverage instructions apply) - B4157: 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 (Medicare: Special coverage instructions apply) - B4158: 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 (Medicare: Special coverage instructions apply) - B4159: 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 (Medicare: Special coverage instructions apply) - B4160: 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 (Medicare: Special coverage instructions apply) - B4161: 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 (Medicare: Special coverage instructions apply) - B4162: 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 (Medicare: Special coverage instructions apply) - B4164: Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix (Medicare: Special coverage instructions apply) - B4168: Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix (Medicare: Special coverage instructions apply) - B4172: Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - home mix (Medicare: Special coverage instructions apply) - B4176: Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix (Medicare: Special coverage instructions apply) - B4178: Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix (Medicare: Special coverage instructions apply) - B4180: Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix (Medicare: Special coverage instructions apply) - B4185: Parenteral nutrition solution, not otherwise specified, 10 grams lipids (Medicare: Special coverage instructions apply) - B4187: Omegaven, 10 grams lipids (Medicare: Special coverage instructions apply) - B4189: 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 (Medicare: Special coverage instructions apply) - B4193: 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 (Medicare: Special coverage instructions apply) - B4197: 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 (Medicare: Special coverage instructions apply) - B4199: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix (Medicare: Special coverage instructions apply) - B4216: Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day (Medicare: Special coverage instructions apply) - B4220: Parenteral nutrition supply kit; premix, per day (Medicare: Special coverage instructions apply) - B4222: Parenteral nutrition supply kit; home mix, per day (Medicare: Special coverage instructions apply) - B4224: Parenteral nutrition administration kit, per day (Medicare: Special coverage instructions apply) - B5000: Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal-aminosyn-rf, nephramine, renamine-premix (Medicare: Special coverage instructions apply) - B5100: Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic, hepatamine-premix (Medicare: Special coverage instructions apply) - B5200: 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 (Medicare: Special coverage instructions apply) - B9000: Enteral nutrition infusion pump - without alarm (Medicare: Special coverage instructions apply) - B9002: Enteral nutrition infusion pump, any type (Medicare: Special coverage instructions apply) - B9004: Parenteral nutrition infusion pump, portable (Medicare: Special coverage instructions apply) - B9006: Parenteral nutrition infusion pump, stationary (Medicare: Special coverage instructions apply) - B9998: Noc for enteral supplies (Medicare: Special coverage instructions apply) - B9999: Noc for parenteral supplies (Medicare: Special coverage instructions apply) - C1052: Hemostatic agent, gastrointestinal, topical (Medicare: Special coverage instructions apply) - C1062: Intravertebral body fracture augmentation with implant (e.g., metal, polymer) (Medicare: Special coverage instructions apply) - C1300: Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval (Medicare: Special coverage instructions apply) - C1600: Catheter, transluminal intravascular lesion preparation device, bladed, sheathed (insertable) (Medicare: Special coverage instructions apply) - C1601: Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable) (Medicare: Special coverage instructions apply) - C1602: Orthopedic/device/drug matrix/absorbable bone void filler, antimicrobial-eluting (implantable) (Medicare: Special coverage instructions apply) - C1603: Retrieval device, insertable, laser (used to retrieve intravascular inferior vena cava filter) (Medicare: Special coverage instructions apply) - C1604: Graft, transmural transvenous arterial bypass (implantable), with all delivery system components (Medicare: Special coverage instructions apply) - C1605: Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation (Medicare: Special coverage instructions apply) - C1606: Adapter, single-use (i.e. disposable), for attaching ultrasound system to upper gastrointestinal endoscope (Medicare: Special coverage instructions apply) - C1607: Neurostimulator, integrated (implantable), rechargeable with all implantable and external components including charging system (Medicare: Special coverage instructions apply) - C1608: Prosthesis, total, dual mobility, first carpometacarpal joint (implantable) (Medicare: Special coverage instructions apply) - C1713: Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) (Medicare: Special coverage instructions apply) - C1714: Catheter, transluminal atherectomy, directional (Medicare: Special coverage instructions apply) - C1715: Brachytherapy needle (Medicare: Special coverage instructions apply) - C1716: Brachytherapy source, non-stranded, gold-198, per source (Medicare: Special coverage instructions apply) - C1717: Brachytherapy source, non-stranded, high dose rate iridium-192, per source (Medicare: Special coverage instructions apply) - C1719: Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source (Medicare: Special coverage instructions apply) - C1721: Cardioverter-defibrillator, dual chamber (implantable) (Medicare: Special coverage instructions apply) - C1722: Cardioverter-defibrillator, single chamber (implantable) (Medicare: Special coverage instructions apply) - C1724: Catheter, transluminal atherectomy, rotational (Medicare: Special coverage instructions apply) - C1725: Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) (Medicare: Special coverage instructions apply) - C1726: Catheter, balloon dilatation, non-vascular (Medicare: Special coverage instructions apply) - C1727: Catheter, balloon tissue dissector, non-vascular (insertable) (Medicare: Special coverage instructions apply) - C1728: Catheter, brachytherapy seed administration (Medicare: Special coverage instructions apply) - C1729: Catheter, drainage (Medicare: Special coverage instructions apply) - C1730: Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes) (Medicare: Special coverage instructions apply) - C1731: Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes) (Medicare: Special coverage instructions apply) - C1732: Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping (Medicare: Special coverage instructions apply) - C1733: Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip (Medicare: Special coverage instructions apply) - C1734: Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable) (Medicare: Special coverage instructions apply) - C1735: Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system components (Medicare: Special coverage instructions apply) - C1736: Catheter(s), intravascular for renal denervation, ultrasound, including all single use system components (Medicare: Special coverage instructions apply) - C1737: Joint fusion and fixation device(s), sacroiliac and pelvis, including all system components (implantable) (Medicare: Special coverage instructions apply) - C1738: Powered, single-use (i.e. disposable) endoscopic ultrasound-guided biopsy device (Medicare: Special coverage instructions apply) - C1739: Tissue marker, uniquely detectable and identifiable with probe/sensor, any method (implantable), with delivery system (Medicare: Special coverage instructions apply) - C1740: Leadless electrode, transmitter, battery (all implantable), for sequential left ventricular pacing (Medicare: Special coverage instructions apply) - C1741: Anchor/screw for bone fixation, absorbable, metallic (implantable) (Medicare: Special coverage instructions apply) - C1742: Pressure monitoring system, compartmental intramuscular (implantable), continuous, including all components (e.g., introducer, sensor), excludes mobile (wireless) software application (Medicare: Special coverage instructions apply) - C1743: Scaffold, endovascular non-coronary, resorbable drug eluting, with delivery system (implantable) (Medicare: Special coverage instructions apply) - C1747: Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable) (Medicare: Special coverage instructions apply) - C1748: Endoscope, single-use (i.e. disposable), upper gi, imaging/illumination device (insertable) (Medicare: Special coverage instructions apply) - C1749: Endoscope, retrograde imaging/illumination colonoscope device (implantable) (Medicare: Special coverage instructions apply) - C1750: Catheter, hemodialysis/peritoneal, long-term (Medicare: Special coverage instructions apply) - C1751: Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) (Medicare: Special coverage instructions apply) - C1752: Catheter, hemodialysis/peritoneal, short-term (Medicare: Special coverage instructions apply) - C1753: Catheter, intravascular ultrasound (Medicare: Special coverage instructions apply) - C1754: Catheter, intradiscal (Medicare: Special coverage instructions apply) - C1755: Catheter, intraspinal (Medicare: Special coverage instructions apply) - C1756: Catheter, pacing, transesophageal (Medicare: Special coverage instructions apply) - C1757: Catheter, thrombectomy/embolectomy (Medicare: Special coverage instructions apply) - C1758: Catheter, ureteral (Medicare: Special coverage instructions apply) - C1759: Catheter, intracardiac echocardiography (Medicare: Special coverage instructions apply) - C1760: Closure device, vascular (implantable/insertable) (Medicare: Special coverage instructions apply) - C1761: Catheter, transluminal intravascular lithotripsy, coronary (Medicare: Special coverage instructions apply) - C1762: Connective tissue, human (includes fascia lata) (Medicare: Special coverage instructions apply) - C1763: Connective tissue, non-human (includes synthetic) (Medicare: Special coverage instructions apply) - C1764: Event recorder, cardiac (implantable) (Medicare: Special coverage instructions apply) - C1765: Adhesion barrier (Medicare: Special coverage instructions apply) - C1766: Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away (Medicare: Special coverage instructions apply) - C1767: Generator, neurostimulator (implantable), non-rechargeable (Medicare: Special coverage instructions apply) - C1768: Graft, vascular (Medicare: Special coverage instructions apply) - C1769: Guide wire (Medicare: Special coverage instructions apply) - C1770: Imaging coil, magnetic resonance (insertable) (Medicare: Special coverage instructions apply) - C1771: Repair device, urinary, incontinence, with sling graft (Medicare: Special coverage instructions apply) - C1772: Infusion pump, programmable (implantable) (Medicare: Special coverage instructions apply) - C1773: Retrieval device, insertable (used to retrieve fractured medical devices) (Medicare: Special coverage instructions apply) - C1776: Joint device (implantable) (Medicare: Special coverage instructions apply) - C1777: Lead, cardioverter-defibrillator, endocardial single coil (implantable) (Medicare: Special coverage instructions apply) - C1778: Lead, neurostimulator (implantable) (Medicare: Special coverage instructions apply) - C1779: Lead, pacemaker, transvenous vdd single pass (Medicare: Special coverage instructions apply) - C1780: Lens, intraocular (new technology) (Medicare: Special coverage instructions apply) - C1781: Mesh (implantable) (Medicare: Special coverage instructions apply) - C1782: Morcellator (Medicare: Special coverage instructions apply) - C1783: Ocular implant, aqueous drainage assist device (Medicare: Special coverage instructions apply) - C1784: Ocular device, intraoperative, detached retina (Medicare: Special coverage instructions apply) - C1785: Pacemaker, dual chamber, rate-responsive (implantable) (Medicare: Special coverage instructions apply) - C1786: Pacemaker, single chamber, rate-responsive (implantable) (Medicare: Special coverage instructions apply) - C1787: Patient programmer, neurostimulator (Medicare: Special coverage instructions apply) - C1788: Port, indwelling (implantable) (Medicare: Special coverage instructions apply) - C1789: Prosthesis, breast (implantable) (Medicare: Special coverage instructions apply) - C1813: Prosthesis, penile, inflatable (Medicare: Special coverage instructions apply) - C1814: Retinal tamponade device, silicone oil (Medicare: Special coverage instructions apply) - C1815: Prosthesis, urinary sphincter (implantable) (Medicare: Special coverage instructions apply) - C1816: Receiver and/or transmitter, neurostimulator (implantable) (Medicare: Special coverage instructions apply) - C1817: Septal defect implant system, intracardiac (Medicare: Special coverage instructions apply) - C1818: Integrated keratoprosthesis (Medicare: Special coverage instructions apply) - C1819: Surgical tissue localization and excision device (implantable) (Medicare: Special coverage instructions apply) - C1820: Generator, neurostimulator (implantable), with rechargeable battery and charging system (Medicare: Special coverage instructions apply) - C1821: Interspinous process distraction device (implantable) (Medicare: Special coverage instructions apply) - C1822: Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system (Medicare: Special coverage instructions apply) - C1823: Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads (Medicare: Special coverage instructions apply) - C1824: Generator, cardiac contractility modulation (implantable) (Medicare: Special coverage instructions apply) - C1825: Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s) (Medicare: Special coverage instructions apply) - C1826: Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system (Medicare: Special coverage instructions apply) - C1827: Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller (Medicare: Special coverage instructions apply) - C1830: Powered bone marrow biopsy needle (Medicare: Special coverage instructions apply) - C1831: Interbody cage, anterior, lateral or posterior, personalized (implantable) (Medicare: Special coverage instructions apply) - C1832: Autograft suspension, including cell processing and application, and all system components (Medicare: Special coverage instructions apply) - C1833: Monitor, cardiac, including intracardiac lead and all system components (implantable) (Medicare: Special coverage instructions apply) - C1834: Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application (Medicare: Special coverage instructions apply) - C1839: Iris prosthesis (Medicare: Special coverage instructions apply) - C1840: Lens, intraocular (telescopic) (Medicare: Special coverage instructions apply) - C1841: Retinal prosthesis, includes all internal and external components (Medicare: Special coverage instructions apply) - C1842: Retinal prosthesis, includes all internal and external components; add-on to c1841 (Medicare: Special coverage instructions apply) - C1849: Skin substitute, synthetic, resorbable, per square centimeter (Medicare: Special coverage instructions apply) - C1874: Stent, coated/covered, with delivery system (Medicare: Special coverage instructions apply) - C1875: Stent, coated/covered, without delivery system (Medicare: Special coverage instructions apply) - C1876: Stent, non-coated/non-covered, with delivery system (Medicare: Special coverage instructions apply) - C1877: Stent, non-coated/non-covered, without delivery system (Medicare: Special coverage instructions apply) - C1878: Material for vocal cord medialization, synthetic (implantable) (Medicare: Special coverage instructions apply) - C1880: Vena cava filter (Medicare: Special coverage instructions apply) - C1881: Dialysis access system (implantable) (Medicare: Special coverage instructions apply) - C1882: Cardioverter-defibrillator, other than single or dual chamber (implantable) (Medicare: Special coverage instructions apply) - C1883: Adapter/extension, pacing lead or neurostimulator lead (implantable) (Medicare: Special coverage instructions apply) - C1884: Embolization protective system (Medicare: Special coverage instructions apply) - C1885: Catheter, transluminal angioplasty, laser (Medicare: Special coverage instructions apply) - C1886: Catheter, extravascular tissue ablation, any modality (insertable) (Medicare: Special coverage instructions apply) - C1887: Catheter, guiding (may include infusion/perfusion capability) (Medicare: Special coverage instructions apply) - C1888: Catheter, ablation, non-cardiac, endovascular (implantable) (Medicare: Special coverage instructions apply) - C1889: Implantable/insertable device, not otherwise classified (Medicare: Special coverage instructions apply) - C1890: No implantable/insertable device used with device-intensive procedures (Medicare: Special coverage instructions apply) - C1891: Infusion pump, non-programmable, permanent (implantable) (Medicare: Special coverage instructions apply) - C1892: Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away (Medicare: Special coverage instructions apply) - C1893: Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away (Medicare: Special coverage instructions apply) - C1894: Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser (Medicare: Special coverage instructions apply) - C1895: Lead, cardioverter-defibrillator, endocardial dual coil (implantable) (Medicare: Special coverage instructions apply) - C1896: Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable) (Medicare: Special coverage instructions apply) - C1897: Lead, neurostimulator test kit (implantable) (Medicare: Special coverage instructions apply) - C1898: Lead, pacemaker, other than transvenous vdd single pass (Medicare: Special coverage instructions apply) - C1899: Lead, pacemaker/cardioverter-defibrillator combination (implantable) (Medicare: Special coverage instructions apply) - C1900: Lead, left ventricular coronary venous system (Medicare: Special coverage instructions apply) - C1982: Catheter, pressure-generating, (e.g., one-way valve, intermittently occlusive) (Medicare: Special coverage instructions apply) - C2596: Probe, image-guided, robotic, waterjet ablation (Medicare: Special coverage instructions apply) - C2613: Lung biopsy plug with delivery system (Medicare: Special coverage instructions apply) - C2614: Probe, percutaneous lumbar discectomy (Medicare: Special coverage instructions apply) - C2615: Sealant, pulmonary, liquid (Medicare: Special coverage instructions apply) - C2616: Brachytherapy source, non-stranded, yttrium-90, per source (Medicare: Special coverage instructions apply) - C2617: Stent, non-coronary, temporary, without delivery system (Medicare: Special coverage instructions apply) - C2618: Probe/needle, cryoablation (Medicare: Special coverage instructions apply) - C2619: Pacemaker, dual chamber, non rate-responsive (implantable) (Medicare: Special coverage instructions apply) - C2620: Pacemaker, single chamber, non rate-responsive (implantable) (Medicare: Special coverage instructions apply) - C2621: Pacemaker, other than single or dual chamber (implantable) (Medicare: Special coverage instructions apply) - C2622: Prosthesis, penile, non-inflatable (Medicare: Special coverage instructions apply) - C2623: Catheter, transluminal angioplasty, drug-coated, non-laser (Medicare: Special coverage instructions apply) - C2624: Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components (Medicare: Special coverage instructions apply) - C2625: Stent, non-coronary, temporary, with delivery system (Medicare: Special coverage instructions apply) - C2626: Infusion pump, non-programmable, temporary (implantable) (Medicare: Special coverage instructions apply) - C2627: Catheter, suprapubic/cystoscopic (Medicare: Special coverage instructions apply) - C2628: Catheter, occlusion (Medicare: Special coverage instructions apply) - C2629: Introducer/sheath, other than guiding, other than intracardiac electrophysiological, laser (Medicare: Special coverage instructions apply) - C2630: Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, cool-tip (Medicare: Special coverage instructions apply) - C2631: Repair device, urinary, incontinence, without sling graft (Medicare: Special coverage instructions apply) - C2634: Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source (Medicare: Special coverage instructions apply) - C2635: Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source (Medicare: Special coverage instructions apply) - C2636: Brachytherapy linear source, non-stranded, palladium-103, per 1 mm (Medicare: Special coverage instructions apply) - C2637: Brachytherapy source, non-stranded, ytterbium-169, per source (Medicare: Special coverage instructions apply) - C2638: Brachytherapy source, stranded, iodine-125, per source (Medicare: Special coverage instructions apply) - C2639: Brachytherapy source, non-stranded, iodine-125, per source (Medicare: Special coverage instructions apply) - C2640: Brachytherapy source, stranded, palladium-103, per source (Medicare: Special coverage instructions apply) - C2641: Brachytherapy source, non-stranded, palladium-103, per source (Medicare: Special coverage instructions apply) - C2642: Brachytherapy source, stranded, cesium-131, per source (Medicare: Special coverage instructions apply) - C2643: Brachytherapy source, non-stranded, cesium-131, per source (Medicare: Special coverage instructions apply) - C2644: Brachytherapy source, cesium-131 chloride solution, per millicurie (Medicare: Special coverage instructions apply) - C2645: Brachytherapy planar source, palladium-103, per square millimeter (Medicare: Special coverage instructions apply) - C2698: Brachytherapy source, stranded, not otherwise specified, per source (Medicare: Special coverage instructions apply) - C2699: Brachytherapy source, non-stranded, not otherwise specified, per source (Medicare: Special coverage instructions apply) - C5271: 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 (Medicare: Special coverage instructions apply) - C5272: 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) (Medicare: Special coverage instructions apply) - C5273: 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 (Medicare: Special coverage instructions apply) - C5274: 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) (Medicare: Special coverage instructions apply) - C5275: 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 (Medicare: Special coverage instructions apply) - C5276: 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) (Medicare: Special coverage instructions apply) - C5277: 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 (Medicare: Special coverage instructions apply) - C5278: 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) (Medicare: Special coverage instructions apply) - C7500: 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) (Medicare: Carrier judgment) - C7501: 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) (Medicare: Carrier judgment) - C7502: 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) (Medicare: Carrier judgment) - C7503: 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 (Medicare: Carrier judgment) - C7504: 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 (Medicare: Carrier judgment) - C7505: 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 (Medicare: Carrier judgment) - C7506: Arthrodesis, interphalangeal joints, with or without internal fixation (Medicare: Carrier judgment) - C7507: 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 (Medicare: Carrier judgment) - C7508: 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 (Medicare: Carrier judgment) - C7509: Bronchoscopy, rigid or flexible, diagnostic with cell washing(s) when performed, with computer-assisted image-guided navigation, including fluoroscopic guidance when performed (Medicare: Carrier judgment) - C7510: Bronchoscopy, rigid or flexible, with bronchial alveolar lavage(s), with computer-assisted image-guided navigation, including fluoroscopic guidance when performed (Medicare: Carrier judgment) - C7511: 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 (Medicare: Carrier judgment) - C7512: 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 (Medicare: Carrier judgment) - C7513: 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 (Medicare: Carrier judgment) - C7514: 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 (Medicare: Carrier judgment) - C7515: 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 (Medicare: Carrier judgment) - C7516: 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 (Medicare: Carrier judgment) - C7517: 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 (Medicare: Carrier judgment) - C7518: 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 (Medicare: Carrier judgment) - C7519: 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 (Medicare: Carrier judgment) - C7520: 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 (Medicare: Carrier judgment) - C7521: 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 (Medicare: Carrier judgment) - C7522: 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 (Medicare: Carrier judgment) - C7523: 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 (Medicare: Carrier judgment) - C7524: 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 (Medicare: Carrier judgment) - C7525: 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 (Medicare: Carrier judgment) - C7526: 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 (Medicare: Carrier judgment) - C7527: 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 (Medicare: Carrier judgment) - C7528: 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 (Medicare: Carrier judgment) - C7529: 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 (Medicare: Carrier judgment) - C7530: 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 (Medicare: Carrier judgment) - C7531: 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 (Medicare: Carrier judgment) - C7532: 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 (Medicare: Carrier judgment) - C7533: Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (Medicare: Carrier judgment) - C7534: 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 (Medicare: Carrier judgment) - C7535: 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 (Medicare: Carrier judgment) - C7537: 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) (Medicare: Special coverage instructions apply) - C7538: 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) (Medicare: Special coverage instructions apply) - C7539: 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) (Medicare: Special coverage instructions apply) - C7540: 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) (Medicare: Carrier judgment) - C7541: 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) (Medicare: Special coverage instructions apply) - C7542: Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) (Medicare: Special coverage instructions apply) - C7543: Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) (Medicare: Special coverage instructions apply) - C7544: 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) (Medicare: Special coverage instructions apply) - C7545: 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 (Medicare: Carrier judgment) - C7546: 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 (Medicare: Carrier judgment) - C7547: 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 (Medicare: Carrier judgment) - C7548: 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 (Medicare: Carrier judgment) - C7549: 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 (Medicare: Carrier judgment) - C7550: Cystourethroscopy, with biopsy(ies) with adjunctive blue light cystoscopy with fluorescent imaging agent (Medicare: Carrier judgment) - C7551: Excision of major peripheral nerve neuroma, except sciatic, with implantation of nerve end into bone or muscle (Medicare: Carrier judgment) - C7552: 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 (Medicare: Carrier judgment) - C7553: 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 (Medicare: Carrier judgment) - C7554: Cystourethroscopy with adjunctive blue light cystoscopy with fluorescent imaging agent (Medicare: Carrier judgment) - C7555: Thyroidectomy, total or complete with parathyroid autotransplantation (Medicare: Carrier judgment) - C7556: 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 (Medicare: Special coverage instructions apply) - C7557: 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 (Medicare: Special coverage instructions apply) - C7558: 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 (Medicare: Special coverage instructions apply) - C7560: 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) (Medicare: Special coverage instructions apply) - C7562: 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 (Medicare: Special coverage instructions apply) - C7563: 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 (Medicare: Special coverage instructions apply) - C7564: 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 (Medicare: Special coverage instructions apply) - C7565: 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 (Medicare: Special coverage instructions apply) - C7566: Arthrodesis, interphalangeal joints, with or without internal fixation, with autografts (includes obtaining grafts) (Medicare: Special coverage instructions apply) - C7567: 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 (Medicare: Special coverage instructions apply) - C7568: 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 (Medicare: Special coverage instructions apply) - C7569: 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 (Medicare: Special coverage instructions apply) - C7570: 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) (Medicare: Special coverage instructions apply) - C7571: Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with percutaneous transluminal coronary lithotripsy (Medicare: Special coverage instructions apply) - C7900: 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 (Medicare: Carrier judgment) - C7901: 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 (Medicare: Carrier judgment) - C7902: 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) (Medicare: Carrier judgment) - C7903: 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 (Medicare: Special coverage instructions apply) - C8000: Support device, extravascular, for arteriovenous fistula (implantable) (Medicare: Special coverage instructions apply) - C8001: 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 (Medicare: Carrier judgment) - C8002: Preparation of skin cell suspension autograft, automated, including all enzymatic processing and device components (do not report with manual suspension preparation) (Medicare: Carrier judgment) - C8003: 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) (Medicare: Carrier judgment) - C8004: 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 (Medicare: Special coverage instructions apply) - C8005: 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) (Medicare: Special coverage instructions apply) - C8006: Insertion of pleural-peritoneal shunt with intercostal pump chamber, including imaging, injection(s) of contrast with radiological supervision and interpretation, when performed (Medicare: Special coverage instructions apply) - C8007: Open implantation of hypoglossal nerve neurostimulator array and pulse generator, not requiring insertion of a separate distal respiratory sensor electrode or electrode array (Medicare: Carrier judgment) - C8008: Revision or replacement of hypoglossal nerve neurostimulator array including connection to existing pulse generator (Medicare: Carrier judgment) - C8009: Removal of hypoglossal nerve neurostimulator array and pulse generator (Medicare: Carrier judgment) - C8010: Percutaneous placement of permanent common carotid embolic protection device, including all system components and imaging guidance; bilateral (Medicare: Special coverage instructions apply) - C8011: Open implantation of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver, including external power source and all system components (Medicare: Carrier judgment) - C8012: Revision or replacement of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver (Medicare: Carrier judgment) - C8013: Removal of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver (Medicare: Carrier judgment) - C8900: Magnetic resonance angiography with contrast, abdomen (Medicare: Special coverage instructions apply) - C8901: Magnetic resonance angiography without contrast, abdomen (Medicare: Special coverage instructions apply) - C8902: Magnetic resonance angiography without contrast followed by with contrast, abdomen (Medicare: Special coverage instructions apply) - C8903: Magnetic resonance imaging with contrast, breast; unilateral (Medicare: Special coverage instructions apply) - C8904: Magnetic resonance imaging without contrast, breast; unilateral (Medicare: Special coverage instructions apply) - C8905: Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral (Medicare: Special coverage instructions apply) - C8906: Magnetic resonance imaging with contrast, breast; bilateral (Medicare: Special coverage instructions apply) - C8907: Magnetic resonance imaging without contrast, breast; bilateral (Medicare: Special coverage instructions apply) - C8908: Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral (Medicare: Special coverage instructions apply) - C8909: Magnetic resonance angiography with contrast, chest (excluding myocardium) (Medicare: Special coverage instructions apply) - C8910: Magnetic resonance angiography without contrast, chest (excluding myocardium) (Medicare: Special coverage instructions apply) - C8911: Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium) (Medicare: Special coverage instructions apply) - C8912: Magnetic resonance angiography with contrast, lower extremity (Medicare: Special coverage instructions apply) - C8913: Magnetic resonance angiography without contrast, lower extremity (Medicare: Special coverage instructions apply) - C8914: Magnetic resonance angiography without contrast followed by with contrast, lower extremity (Medicare: Special coverage instructions apply) - C8918: Magnetic resonance angiography with contrast, pelvis (Medicare: Special coverage instructions apply) - C8919: Magnetic resonance angiography without contrast, pelvis (Medicare: Special coverage instructions apply) - C8920: Magnetic resonance angiography without contrast followed by with contrast, pelvis (Medicare: Special coverage instructions apply) - C8921: Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete (Medicare: Special coverage instructions apply) - C8922: Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study (Medicare: Special coverage instructions apply) - C8923: 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 (Medicare: Special coverage instructions apply) - C8924: 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 (Medicare: Special coverage instructions apply) - C8925: 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 (Medicare: Special coverage instructions apply) - C8926: Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report (Medicare: Special coverage instructions apply) - C8927: 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 (Medicare: Special coverage instructions apply) - C8928: 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 (Medicare: Special coverage instructions apply) - C8929: 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 (Medicare: Special coverage instructions apply) - C8930: 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 (Medicare: Special coverage instructions apply) - C8931: Magnetic resonance angiography with contrast, spinal canal and contents (Medicare: Special coverage instructions apply) - C8932: Magnetic resonance angiography without contrast, spinal canal and contents (Medicare: Special coverage instructions apply) - C8933: Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents (Medicare: Special coverage instructions apply) - C8934: Magnetic resonance angiography with contrast, upper extremity (Medicare: Special coverage instructions apply) - C8935: Magnetic resonance angiography without contrast, upper extremity (Medicare: Special coverage instructions apply) - C8936: Magnetic resonance angiography without contrast followed by with contrast, upper extremity (Medicare: Special coverage instructions apply) - C8937: 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) (Medicare: Special coverage instructions apply) - C8957: Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion (more than 8 hours), requiring use of portable or implantable pump (Medicare: Special coverage instructions apply) - C9014: Injection, cerliponase alfa, 1 mg (Medicare: Special coverage instructions apply) - C9015: Injection, c-1 esterase inhibitor (human), haegarda, 10 units (Medicare: Special coverage instructions apply) - C9016: Injection, triptorelin extended release, 3.75 mg (Medicare: Special coverage instructions apply) - C9021: Injection, obinutuzumab, 10 mg (Medicare: Special coverage instructions apply) - C9022: Injection, elosulfase alfa, 1mg (Medicare: Special coverage instructions apply) - C9023: Injection, testosterone undecanoate, 1 mg (Medicare: Special coverage instructions apply) - C9024: Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine (Medicare: Special coverage instructions apply) - C9025: Injection, ramucirumab, 5 mg (Medicare: Special coverage instructions apply) - C9026: Injection, vedolizumab, 1 mg (Medicare: Special coverage instructions apply) - C9027: Injection, pembrolizumab, 1 mg (Medicare: Special coverage instructions apply) - C9028: Injection, inotuzumab ozogamicin, 0.1 mg (Medicare: Special coverage instructions apply) - C9029: Injection, guselkumab, 1 mg (Medicare: Special coverage instructions apply) - C9030: Injection, copanlisib, 1 mg (Medicare: Special coverage instructions apply) - C9031: Lutetium lu 177, dotatate, therapeutic, 1 mci (Medicare: Special coverage instructions apply) - C9032: Injection, voretigene neparvovec-rzyl, 1 billion vector genome (Medicare: Special coverage instructions apply) - C9033: Injection, fosnetupitant 235 mg and palonosetron 0.25 mg (Medicare: Special coverage instructions apply) - C9034: Injection, dexamethasone 9%, intraocular, 1 mcg (Medicare: Special coverage instructions apply) - C9035: Injection, aripiprazole lauroxil (aristada initio), 1 mg (Medicare: Special coverage instructions apply) - C9036: Injection, patisiran, 0.1 mg (Medicare: Special coverage instructions apply) - C9037: Injection, risperidone (perseris), 0.5 mg (Medicare: Special coverage instructions apply) - C9038: Injection, mogamulizumab-kpkc, 1 mg (Medicare: Special coverage instructions apply) - C9039: Injection, plazomicin, 5 mg (Medicare: Special coverage instructions apply) - C9040: Injection, fremanezumab-vfrm, 1mg (Medicare: Special coverage instructions apply) - C9041: Injection, coagulation factor xa (recombinant), inactivated (andexxa), 10 mg (Medicare: Special coverage instructions apply) - C9042: Injection, bendamustine hcl (belrapzo), 1 mg (Medicare: Special coverage instructions apply) - C9043: Injection, levoleucovorin, 1 mg (Medicare: Special coverage instructions apply) - C9044: Injection, cemiplimab-rwlc, 1 mg (Medicare: Special coverage instructions apply) - C9045: Injection, moxetumomab pasudotox-tdfk, 0.01 mg (Medicare: Special coverage instructions apply) - C9046: Cocaine hydrochloride nasal solution (goprelto), 1 mg (Medicare: Special coverage instructions apply) - C9047: Injection, caplacizumab-yhdp, 1 mg (Medicare: Special coverage instructions apply) - C9048: Dexamethasone, lacrimal ophthalmic insert, 0.1 mg (Medicare: Special coverage instructions apply) - C9049: Injection, tagraxofusp-erzs, 10 mcg (Medicare: Special coverage instructions apply) - C9050: Injection, emapalumab-lzsg, 1 mg (Medicare: Special coverage instructions apply) - C9051: Injection, omadacycline, 1 mg (Medicare: Special coverage instructions apply) - C9052: Injection, ravulizumab-cwvz, 10 mg (Medicare: Special coverage instructions apply) - C9053: Injection, crizanlizumab-tmca, 1 mg (Medicare: Special coverage instructions apply) - C9054: Injection, lefamulin (xenleta), 1 mg (Medicare: Special coverage instructions apply) - C9055: Injection, brexanolone, 1mg (Medicare: Special coverage instructions apply) - C9056: Injection, givosiran, 0.5 mg (Medicare: Special coverage instructions apply) - C9057: Injection, cetirizine hydrochloride, 1 mg (Medicare: Special coverage instructions apply) - C9058: Injection, pegfilgrastim-bmez, biosimilar, (ziextenzo) 0.5 mg (Medicare: Special coverage instructions apply) - C9059: Injection, meloxicam, 1 mg (Medicare: Special coverage instructions apply) - C9060: Fluoroestradiol f18, diagnostic, 1 mci (Medicare: Special coverage instructions apply) - C9061: Injection, teprotumumab-trbw, 10 mg (Medicare: Special coverage instructions apply) - C9062: Injection, daratumumab 10 mg and hyaluronidase-fihj (Medicare: Special coverage instructions apply) - C9063: Injection, eptinezumab-jjmr, 1 mg (Medicare: Special coverage instructions apply) - C9064: Mitomycin pyelocalyceal instillation, 1 mg (Medicare: Special coverage instructions apply) - C9065: Injection, romidepsin, non-lyophilized (e.g. liquid), 1mg (Medicare: Special coverage instructions apply) - C9066: Injection, sacituzumab govitecan-hziy, 2.5 mg (Medicare: Special coverage instructions apply) - C9067: Gallium ga-68, dotatoc, diagnostic, 0.01 mci (Medicare: Special coverage instructions apply) - C9068: Copper cu-64, dotatate, diagnostic, 1 millicurie (Medicare: Special coverage instructions apply) - C9069: Injection, belantamab mafodontin-blmf, 0.5 mg (Medicare: Special coverage instructions apply) - C9070: Injection, tafasitamab-cxix, 2 mg (Medicare: Special coverage instructions apply) - C9071: Injection, viltolarsen, 10 mg (Medicare: Special coverage instructions apply) - C9072: Injection, immune globulin (asceniv), 500 mg (Medicare: Special coverage instructions apply) - C9073: Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Special coverage instructions apply) - C9074: Injection, lumasiran, 0.5 mg (Medicare: Special coverage instructions apply) - C9075: Injection, casimersen, 10 mg (Medicare: Special coverage instructions apply) - C9076: Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Special coverage instructions apply) - C9077: Injection, cabotegravir and rilpivirine, 2mg/3mg (Medicare: Special coverage instructions apply) - C9078: Injection, trilaciclib, 1 mg (Medicare: Special coverage instructions apply) - C9079: Injection, evinacumab-dgnb, 5 mg (Medicare: Special coverage instructions apply) - C9080: Injection, melphalan flufenamide hydrochloride, 1 mg (Medicare: Special coverage instructions apply) - C9081: Idecabtagene vicleucel, up to 460 million autologous anti-bcma car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Special coverage instructions apply) - C9082: Injection, dostarlimab-gxly, 100 mg (Medicare: Special coverage instructions apply) - C9083: Injection, amivantamab-vmjw, 10 mg (Medicare: Special coverage instructions apply) - C9084: Injection, loncastuximab tesirine-lpyl, 0.1 mg (Medicare: Special coverage instructions apply) - C9085: Injection, avalglucosidase alfa-ngpt, 4 mg (Medicare: Special coverage instructions apply) - C9086: Injection, anifrolumab-fnia, 1 mg (Medicare: Special coverage instructions apply) - C9087: Injection, cyclophosphamide, (auromedics), 10 mg (Medicare: Special coverage instructions apply) - C9088: Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg (Medicare: Special coverage instructions apply) - C9089: Bupivacaine, collagen-matrix implant, 1 mg (Medicare: Special coverage instructions apply) - C9090: Injection, plasminogen, human-tvmh, 1 mg (Medicare: Special coverage instructions apply) - C9091: Injection, sirolimus protein-bound particles, 1 mg (Medicare: Special coverage instructions apply) - C9092: Injection, triamcinolone acetonide, suprachoroidal (xipere), 1 mg (Medicare: Special coverage instructions apply) - C9093: Injection, ranibizumab, via sustained release intravitreal implant (susvimo), 0.1 mg (Medicare: Special coverage instructions apply) - C9094: Inj, sutimlimab-jome, 10 mg (Medicare: Carrier judgment) - C9095: Inj, tebentafusp-tebn, 1 mcg (Medicare: Carrier judgment) - C9096: Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram (Medicare: Carrier judgment) - C9097: Inj, faricimab-svoa, 0.1 mg (Medicare: Carrier judgment) - C9098: 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 (Medicare: Carrier judgment) - C9101: Injection, oliceridine, 0.1 mg (Medicare: Special coverage instructions apply) - C9113: Injection, pantoprazole sodium, per vial (Medicare: Special coverage instructions apply) - C9121: Injection, argatroban, per 5 mg (Medicare: Special coverage instructions apply) - C9122: Mometasone furoate sinus implant, 10 micrograms (sinuva) (Medicare: Special coverage instructions apply) - C9132: Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity (Medicare: Special coverage instructions apply) - C9133: Factor ix (antihemophilic factor, recombinant), rixubis, per i.u. (Medicare: Special coverage instructions apply) - C9134: Factor xiii (antihemophilic factor, recombinant), tretten, per 10 i.u. (Medicare: Special coverage instructions apply) - C9135: Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. (Medicare: Special coverage instructions apply) - C9136: Injection, factor viii, fc fusion protein, (recombinant), per i.u. (Medicare: Special coverage instructions apply) - C9137: Injection, factor viii (antihemophilic factor, recombinant) pegylated, 1 i.u. (Medicare: Special coverage instructions apply) - C9138: Injection, factor viii (antihemophilic factor, recombinant) (nuwiq), 1 i.u. (Medicare: Special coverage instructions apply) - C9139: Injection, factor ix, albumin fusion protein (recombinant), idelvion, 1 i.u. (Medicare: Special coverage instructions apply) - C9140: Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u. (Medicare: Special coverage instructions apply) - C9141: Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl (jivi), 1 i.u. (Medicare: Special coverage instructions apply) - C9142: Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg (Medicare: Special coverage instructions apply) - C9143: Cocaine hydrochloride nasal solution (numbrino), 1 mg (Medicare: Special coverage instructions apply) - C9144: Injection, bupivacaine (posimir), 1 mg (Medicare: Special coverage instructions apply) - C9145: Injection, aprepitant, (aponvie), 1 mg (Medicare: Special coverage instructions apply) - C9146: Injection, mirvetuximab soravtansine-gynx, 1 mg (Medicare: Special coverage instructions apply) - C9147: Injection, tremelimumab-actl, 1 mg (Medicare: Special coverage instructions apply) - C9148: Injection, teclistamab-cqyv, 0.5 mg (Medicare: Special coverage instructions apply) - C9149: Injection, teplizumab-mzwv, 5 mcg (Medicare: Special coverage instructions apply) - C9150: Xenon xe-129 hyperpolarized gas, diagnostic, per study dose (Medicare: Special coverage instructions apply) - C9151: Injection, pegcetacoplan, 1 mg (Medicare: Special coverage instructions apply) - C9152: Injection, aripiprazole, (abilify asimtufii), 1 mg (Medicare: Special coverage instructions apply) - C9153: Injection, amisulpride, 1 mg (Medicare: Special coverage instructions apply) - C9154: Injection, buprenorphine extended-release (brixadi), 1 mg (Medicare: Special coverage instructions apply) - C9155: Injection, epcoritamab-bysp, 0.16 mg (Medicare: Special coverage instructions apply) - C9156: Flotufolastat f 18, diagnostic, 1 millicurie (Medicare: Special coverage instructions apply) - C9157: Injection, tofersen, 1 mg (Medicare: Special coverage instructions apply) - C9158: Injection, risperidone, (uzedy), 1 mg (Medicare: Special coverage instructions apply) - C9159: Injection, prothrombin complex concentrate (human), balfaxar, per i.u. of factor ix activity (Medicare: Special coverage instructions apply) - C9160: Injection, daxibotulinumtoxina-lanm, 1 unit (Medicare: Special coverage instructions apply) - C9161: Injection, aflibercept hd, 1 mg (Medicare: Special coverage instructions apply) - C9162: Injection, avacincaptad pegol, 0.1 mg (Medicare: Special coverage instructions apply) - C9163: Injection, talquetamab-tgvs, 0.25 mg (Medicare: Special coverage instructions apply) - C9164: Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) (Medicare: Special coverage instructions apply) - C9165: Injection, elranatamab-bcmm, 1 mg (Medicare: Special coverage instructions apply) - C9166: Injection, secukinumab, intravenous, 1 mg (Medicare: Special coverage instructions apply) - C9167: Injection, adamts13, recombinant-krhn, 10 iu (Medicare: Special coverage instructions apply) - C9168: Injection, mirikizumab-mrkz, 1 mg (Medicare: Special coverage instructions apply) - C9169: Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram (Medicare: Special coverage instructions apply) - C9170: Injection, tarlatamab-dlle, 1 mg (Medicare: Special coverage instructions apply) - C9171: Injection, pegulicianine, 1 mg (Medicare: Special coverage instructions apply) - C9172: Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose (Medicare: Special coverage instructions apply) - C9173: Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram (Medicare: Special coverage instructions apply) - C9174: Injection, datopotamab deruxtecan-dlnk, 1 mg (Medicare: Special coverage instructions apply) - C9175: Injection, treosulfan, 50 mg (Medicare: Special coverage instructions apply) - C9176: Tc-99m from domestically produced non-heu mo-99, [minimum 50 percent], full cost recovery add-on, per study dose (Medicare: Special coverage instructions apply) - C9248: Injection, clevidipine butyrate, 1 mg (Medicare: Special coverage instructions apply) - C9250: Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml (Medicare: Special coverage instructions apply) - C9254: Injection, lacosamide, 1 mg (Medicare: Special coverage instructions apply) - C9257: Injection, bevacizumab, 0.25 mg (Medicare: Special coverage instructions apply) - C9275: Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose (Medicare: Special coverage instructions apply) - C9285: Lidocaine 70 mg/tetracaine 70 mg, per patch (Medicare: Special coverage instructions apply) - C9290: Injection, bupivacaine liposome, 1 mg (Medicare: Special coverage instructions apply) - C9293: Injection, glucarpidase, 10 units (Medicare: Special coverage instructions apply) - C9300: Injection, indigotindisulfonate sodium, 1 mg (Medicare: Special coverage instructions apply) - C9301: Obecabtagene autoleucel, up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Special coverage instructions apply) - C9302: Injection, zanidatamab-hrii, 2 mg (Medicare: Special coverage instructions apply) - C9303: Injection, zolbetuximab-clzb, 1 mg (Medicare: Special coverage instructions apply) - C9304: Injection, marstacimab-hncq, 0.5 mg (Medicare: Special coverage instructions apply) - C9305: Injection, nipocalimab-aahu, 3 mg (Medicare: Special coverage instructions apply) - C9306: Injection, telisotuzumab vedotin-tllv, 1 mg (Medicare: Special coverage instructions apply) - C9307: Injection, linvoseltamab-gcpt, 1 mg (Medicare: Special coverage instructions apply) - C9308: Injection, carboplatin (avyxa), 1 mg (Medicare: Special coverage instructions apply) - C9309: Injection, onasemnogene abeparvovec-brve, per treatment (Medicare: Special coverage instructions apply) - C9349: Puraply, and puraply antimicrobial, any type, per square centimeter (Medicare: Special coverage instructions apply) - C9352: Microporous collagen implantable tube (neuragen nerve guide), per centimeter length (Medicare: Special coverage instructions apply) - C9353: Microporous collagen implantable slit tube (neurawrap nerve protector), per centimeter length (Medicare: Special coverage instructions apply) - C9354: Acellular pericardial tissue matrix of non-human origin (veritas), per square centimeter (Medicare: Special coverage instructions apply) - C9355: Collagen nerve cuff (neuromatrix), per 0.5 centimeter length (Medicare: Special coverage instructions apply) - C9356: Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix (tenoglide tendon protector sheet), per square centimeter (Medicare: Special coverage instructions apply) - C9358: Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters (Medicare: Special coverage instructions apply) - C9359: Porous purified collagen matrix bone void filler (integra mozaik osteoconductive scaffold putty, integra os osteoconductive scaffold putty), per 0.5 cc (Medicare: Special coverage instructions apply) - C9360: Dermal substitute, native, non-denatured collagen, neonatal bovine origin (surgimend collagen matrix), per 0.5 square centimeters (Medicare: Special coverage instructions apply) - C9361: Collagen matrix nerve wrap (neuromend collagen nerve wrap), per 0.5 centimeter length (Medicare: Special coverage instructions apply) - C9362: Porous purified collagen matrix bone void filler (integra mozaik osteoconductive scaffold strip), per 0.5 cc (Medicare: Special coverage instructions apply) - C9363: Skin substitute, integra meshed bilayer wound matrix, per square centimeter (Medicare: Special coverage instructions apply) - C9364: Porcine implant, permacol, per square centimeter (Medicare: Special coverage instructions apply) - C9399: Unclassified drugs or biologicals (Medicare: Special coverage instructions apply) - C9407: Iodine i-131 iobenguane, diagnostic, 1 millicurie (Medicare: Special coverage instructions apply) - C9408: Iodine i-131 iobenguane, therapeutic, 1 millicurie (Medicare: Special coverage instructions apply) - C9441: Injection, ferric carboxymaltose, 1 mg (Medicare: Special coverage instructions apply) - C9442: Injection, belinostat, 10 mg (Medicare: Special coverage instructions apply) - C9443: Injection, dalbavancin, 10 mg (Medicare: Special coverage instructions apply) - C9444: Injection, oritavancin, 10 mg (Medicare: Special coverage instructions apply) - C9445: Injection, c-1 esterase inhibitor (recombinant), ruconest, 10 units (Medicare: Special coverage instructions apply) - C9446: Injection, tedizolid phosphate, 1 mg (Medicare: Special coverage instructions apply) - C9447: Injection, phenylephrine and ketorolac, 4 ml vial (Medicare: Special coverage instructions apply) - C9448: Netupitant 300 mg and palonosetron 0.5 mg, oral (Medicare: Special coverage instructions apply) - C9449: Injection, blinatumomab, 1 mcg (Medicare: Special coverage instructions apply) - C9450: Injection, fluocinolone acetonide intravitreal implant, 0.01 mg (Medicare: Special coverage instructions apply) - C9451: Injection, peramivir, 1 mg (Medicare: Special coverage instructions apply) - C9452: Injection, ceftolozane 50 mg and tazobactam 25 mg (Medicare: Special coverage instructions apply) - C9453: Injection, nivolumab, 1 mg (Medicare: Special coverage instructions apply) - C9454: Injection, pasireotide long acting, 1 mg (Medicare: Special coverage instructions apply) - C9455: Injection, siltuximab, 10 mg (Medicare: Special coverage instructions apply) - C9456: Injection, isavuconazonium sulfate, 1 mg (Medicare: Special coverage instructions apply) - C9457: Injection, sulfur hexafluoride lipid microsphere, per ml (Medicare: Special coverage instructions apply) - C9458: Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries (Medicare: Special coverage instructions apply) - C9459: Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries (Medicare: Special coverage instructions apply) - C9460: Injection, cangrelor, 1 mg (Medicare: Special coverage instructions apply) - C9461: Choline c 11, diagnostic, per study dose (Medicare: Special coverage instructions apply) - C9462: Injection, delafloxacin, 1 mg (Medicare: Special coverage instructions apply) - C9463: Injection, aprepitant, 1 mg (Medicare: Special coverage instructions apply) - C9464: Injection, rolapitant, 0.5 mg (Medicare: Special coverage instructions apply) - C9465: Hyaluronan or derivative, durolane, for intra-articular injection, per dose (Medicare: Special coverage instructions apply) - C9466: Injection, benralizumab, 1 mg (Medicare: Special coverage instructions apply) - C9467: Injection, rituximab and hyaluronidase, 10 mg (Medicare: Special coverage instructions apply) - C9468: Injection, factor ix (antihemophilic factor, recombinant), glycopegylated, rebinyn, 1 i.u. (Medicare: Special coverage instructions apply) - C9469: Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg (Medicare: Special coverage instructions apply) - C9470: Injection, aripiprazole lauroxil, 1 mg (Medicare: Special coverage instructions apply) - C9471: Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg (Medicare: Special coverage instructions apply) - C9472: Injection, talimogene laherparepvec, 1 million plaque forming units (pfu) (Medicare: Special coverage instructions apply) - C9473: Injection, mepolizumab, 1 mg (Medicare: Special coverage instructions apply) - C9474: Injection, irinotecan liposome, 1 mg (Medicare: Special coverage instructions apply) - C9475: Injection, necitumumab, 1 mg (Medicare: Special coverage instructions apply) - C9476: Injection, daratumumab, 10 mg (Medicare: Special coverage instructions apply) - C9477: Injection, elotuzumab, 1 mg (Medicare: Special coverage instructions apply) - C9478: Injection, sebelipase alfa, 1 mg (Medicare: Special coverage instructions apply) - C9479: Instillation, ciprofloxacin otic suspension, 6 mg (Medicare: Special coverage instructions apply) - C9480: Injection, trabectedin, 0.1 mg (Medicare: Special coverage instructions apply) - C9481: Injection, reslizumab, 1 mg (Medicare: Special coverage instructions apply) - C9482: Injection, sotalol hydrochloride, 1 mg (Medicare: Special coverage instructions apply) - C9483: Injection, atezolizumab, 10 mg (Medicare: Special coverage instructions apply) - C9484: Injection, eteplirsen, 10 mg (Medicare: Special coverage instructions apply) - C9485: Injection, olaratumab, 10 mg (Medicare: Special coverage instructions apply) - C9486: Injection, granisetron extended release, 0.1 mg (Medicare: Special coverage instructions apply) - C9487: Ustekinumab, for intravenous injection, 1 mg (Medicare: Special coverage instructions apply) - C9488: Injection, conivaptan hydrochloride, 1 mg (Medicare: Special coverage instructions apply) - C9489: Injection, nusinersen, 0.1 mg (Medicare: Special coverage instructions apply) - C9490: Injection, bezlotoxumab, 10 mg (Medicare: Special coverage instructions apply) - C9491: Injection, avelumab, 10 mg (Medicare: Special coverage instructions apply) - C9492: Injection, durvalumab, 10 mg (Medicare: Special coverage instructions apply) - C9493: Injection, edaravone, 1 mg (Medicare: Special coverage instructions apply) - C9494: Injection, ocrelizumab, 1 mg (Medicare: Special coverage instructions apply) - C9497: Loxapine, inhalation powder, 10 mg (Medicare: Special coverage instructions apply) - C9507: Plasma, high titer covid-19 convalescent, each unit (Medicare: Special coverage instructions apply) - C9600: Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch (Medicare: Special coverage instructions apply) - C9601: 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) (Medicare: Special coverage instructions apply) - C9602: Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch (Medicare: Special coverage instructions apply) - C9603: 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) (Medicare: Special coverage instructions apply) - C9604: 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 (Medicare: Special coverage instructions apply) - C9605: 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) (Medicare: Special coverage instructions apply) - C9606: 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 (Medicare: Special coverage instructions apply) - C9607: 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 (Medicare: Special coverage instructions apply) - C9608: 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) (Medicare: Special coverage instructions apply) - C9610: Catheter, transluminal drug delivery with or without angioplasty, coronary, non-laser (insertable) (Medicare: Special coverage instructions apply) - C9724: Endoscopic full-thickness plication of the stomach using endoscopic plication system (eps); includes endoscopy (Medicare: Special coverage instructions apply) - C9725: Placement of endorectal intracavitary applicator for high intensity brachytherapy (Medicare: Special coverage instructions apply) - C9726: Placement and removal (if performed) of applicator into breast for intraoperative radiation therapy, add-on to primary breast procedure (Medicare: Special coverage instructions apply) - C9727: Insertion of implants into the soft palate; minimum of three implants (Medicare: Special coverage instructions apply) - C9728: 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 (Medicare: Special coverage instructions apply) - C9733: Non-ophthalmic fluorescent vascular angiography (Medicare: Special coverage instructions apply) - C9734: Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance (Medicare: Special coverage instructions apply) - C9735: Anoscopy; with directed submucosal injection(s), any substance (Medicare: Special coverage instructions apply) - C9737: Laparoscopy, surgical, esophageal sphincter augmentation with device (e.g., magnetic band) (Medicare: Special coverage instructions apply) - C9738: Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure) (Medicare: Special coverage instructions apply) - C9739: Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants (Medicare: Special coverage instructions apply) - C9740: Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants (Medicare: Special coverage instructions apply) - C9741: Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report (Medicare: Special coverage instructions apply) - C9742: Laryngoscopy, flexible fiberoptic, with injection into vocal cord(s), therapeutic, including diagnostic laryngoscopy, if performed (Medicare: Special coverage instructions apply) - C9743: Injection/implantation of bulking or spacer material (any type) with or without image guidance (not to be used if a more specific code applies) (Medicare: Special coverage instructions apply) - C9744: Ultrasound, abdominal, with contrast (Medicare: Special coverage instructions apply) - C9745: Nasal endoscopy, surgical; balloon dilation of eustachian tube (Medicare: Special coverage instructions apply) - C9746: Transperineal implantation of permanent adjustable balloon continence device, with cystourethroscopy, when performed and/or fluoroscopy, when performed (Medicare: Special coverage instructions apply) - C9747: Ablation of prostate, transrectal, high intensity focused ultrasound (hifu), including imaging guidance (Medicare: Special coverage instructions apply) - C9748: Transurethral destruction of prostate tissue; by radiofrequency water vapor (steam) thermal therapy (Medicare: Special coverage instructions apply) - C9749: Repair of nasal vestibular lateral wall stenosis with implant(s) (Medicare: Special coverage instructions apply) - C9750: 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) (Medicare: Special coverage instructions apply) - C9751: 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) (Medicare: Special coverage instructions apply) - C9752: Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (Medicare: Special coverage instructions apply) - C9753: 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) (Medicare: Special coverage instructions apply) - C9754: 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) (Medicare: Special coverage instructions apply) - C9755: 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 (Medicare: Special coverage instructions apply) - C9756: 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) (Medicare: Special coverage instructions apply) - C9757: 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 (Medicare: Special coverage instructions apply) - C9758: 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 (Medicare: Special coverage instructions apply) - C9759: Transcatheter intraoperative blood vessel microinfusion(s) (e.g., intraluminal, vascular wall and/or perivascular) therapy, any vessel, including radiological supervision and interpretation, when performed (Medicare: Special coverage instructions apply) - C9760: 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 (Medicare: Special coverage instructions apply) - C9761: 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) (Medicare: Special coverage instructions apply) - C9762: Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with strain imaging (Medicare: Special coverage instructions apply) - C9763: Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imaging (Medicare: Special coverage instructions apply) - C9764: Revascularization, endovascular, open or percutaneous, lower extremity artery(ies), except tibial/peroneal; with intravascular lithotripsy, includes angioplasty within the same vessel(s), when performed (Medicare: Special coverage instructions apply) - C9765: 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 (Medicare: Special coverage instructions apply) - C9766: 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 (Medicare: Special coverage instructions apply) - C9767: 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 (Medicare: Special coverage instructions apply) - C9768: Endoscopic ultrasound-guided direct measurement of hepatic portosystemic pressure gradient by any method (list separately in addition to code for primary procedure) (Medicare: Special coverage instructions apply) - C9769: Cystourethroscopy, with insertion of temporary prostatic implant/stent with fixation/anchor and incisional struts (Medicare: Special coverage instructions apply) - C9770: Vitrectomy, mechanical, pars plana approach, with subretinal injection of pharmacologic/biologic agent (Medicare: Special coverage instructions apply) - C9771: Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral (Medicare: Special coverage instructions apply) - C9772: Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies), with intravascular lithotripsy, includes angioplasty within the same vessel (s), when performed (Medicare: Special coverage instructions apply) - C9773: 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 (Medicare: Special coverage instructions apply) - C9774: Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel (s), when performed (Medicare: Special coverage instructions apply) - C9775: 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 (Medicare: Special coverage instructions apply) - C9776: 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) (Medicare: Special coverage instructions apply) - C9777: Esophageal mucosal integrity testing by electrical impedance, transoral, includes esophagoscopy or esophagogastroduodenoscopy (Medicare: Special coverage instructions apply) - C9778: Colpopexy, vaginal; minimally invasive extra-peritoneal approach (sacrospinous) (Medicare: Special coverage instructions apply) - C9779: Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed (Medicare: Special coverage instructions apply) - C9780: Insertion of central venous catheter through central venous occlusion via inferior and superior approaches (e.g., inside-out technique), including imaging guidance (Medicare: Special coverage instructions apply) - C9781: 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 (Medicare: Special coverage instructions apply) - C9782: 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 (Medicare: Special coverage instructions apply) - C9783: 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 (Medicare: Special coverage instructions apply) - C9784: Gastric restrictive procedure, endoscopic sleeve gastroplasty, with esophagogastroduodenoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components (Medicare: Special coverage instructions apply) - C9785: Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components (Medicare: Special coverage instructions apply) - C9786: Echocardiography image post processing for computer aided detection of heart failure with preserved ejection fraction, including interpretation and report (Medicare: Special coverage instructions apply) - C9787: Gastric electrophysiology mapping with simultaneous patient symptom profiling (Medicare: Special coverage instructions apply) - C9788: Opto-acoustic imaging, breast (including axilla when performed), unilateral, with image documentation, analysis and report, obtained with ultrasound examination (Medicare: Special coverage instructions apply) - C9789: Instillation of anti-neoplastic pharmacologic/biologic agent into renal pelvis, any method, including all imaging guidance, including volumetric measurement if performed (Medicare: Special coverage instructions apply) - C9790: Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including image guidance (Medicare: Special coverage instructions apply) - C9791: Magnetic resonance imaging with inhaled hyperpolarized xenon-129 contrast agent, chest, including preparation and administration of agent (Medicare: Special coverage instructions apply) - C9792: 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) (Medicare: Special coverage instructions apply) - C9793: 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 (Medicare: Special coverage instructions apply) - C9795: 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 (Medicare: Special coverage instructions apply) - C9796: Repair of enterocutaneous fistula small intestine or colon (excluding anorectal fistula) with plug (e.g., porcine small intestine submucosa [sis]) (Medicare: Special coverage instructions apply) - C9797: 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 (Medicare: Special coverage instructions apply) - C9800: Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and provision of radiesse or sculptra dermal filler, including all items and supplies (Medicare: Special coverage instructions apply) - C9803: Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source (Medicare: Special coverage instructions apply) - C9804: 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) (Medicare: Special coverage instructions apply) - C9806: 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) (Medicare: Special coverage instructions apply) - C9807: 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) (Medicare: Special coverage instructions apply) - C9808: 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) (Medicare: Special coverage instructions apply) - C9809: 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) (Medicare: Special coverage instructions apply) - C9810: 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) (Medicare: Special coverage instructions apply) - C9811: 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) (Medicare: Special coverage instructions apply) - C9812: 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) (Medicare: Special coverage instructions apply) - C9813: 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) (Medicare: Special coverage instructions apply) - C9814: 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) (Medicare: Special coverage instructions apply) - C9815: 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) (Medicare: Special coverage instructions apply) - C9816: 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) (Medicare: Special coverage instructions apply) - C9817: 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) (Medicare: Special coverage instructions apply) - C9818: Suzetrigine, oral, 1 mg (Medicare: Special coverage instructions apply) - C9898: Radiolabeled product provided during a hospital inpatient stay (Medicare: Special coverage instructions apply) - C9899: Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage (Medicare: Special coverage instructions apply) - C9901: 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 (Medicare: Special coverage instructions apply) - E0100: Cane, includes canes of all materials, adjustable or fixed, with tip (Medicare: Special coverage instructions apply) - E0105: Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips (Medicare: Special coverage instructions apply) - E0110: Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips (Medicare: Special coverage instructions apply) - E0111: Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips (Medicare: Special coverage instructions apply) - E0112: Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips (Medicare: Special coverage instructions apply) - E0113: Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip (Medicare: Special coverage instructions apply) - E0114: Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips (Medicare: Special coverage instructions apply) - E0116: Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each (Medicare: Special coverage instructions apply) - E0117: Crutch, underarm, articulating, spring assisted, each (Medicare: Special coverage instructions apply) - E0118: Crutch substitute, lower leg platform, with or without wheels, each (Medicare: Carrier judgment) - E0130: Walker, rigid (pickup), adjustable or fixed height (Medicare: Special coverage instructions apply) - E0135: Walker, folding (pickup), adjustable or fixed height (Medicare: Special coverage instructions apply) - E0140: Walker, with trunk support, adjustable or fixed height, any type (Medicare: Special coverage instructions apply) - E0141: Walker, rigid, wheeled, adjustable or fixed height (Medicare: Special coverage instructions apply) - E0143: Walker, folding, wheeled, adjustable or fixed height (Medicare: Special coverage instructions apply) - E0144: Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat (Medicare: Special coverage instructions apply) - E0147: Walker, heavy duty, multiple braking system, variable wheel resistance (Medicare: Special coverage instructions apply) - E0148: Walker, heavy duty, without wheels, rigid or folding, any type, each (Medicare: Carrier judgment) - E0149: Walker, heavy duty, wheeled, rigid or folding, any type (Medicare: Carrier judgment) - E0150: Combination wheeled walker with seat and transport chair, folding, adjustable or fixed height (Medicare: Non-covered by Medicare statute) - E0152: Walker, battery powered, wheeled, folding, adjustable or fixed height (Medicare: Not payable by Medicare) - E0153: Platform attachment, forearm crutch, each (Medicare: Carrier judgment) - E0154: Platform attachment, walker, each (Medicare: Carrier judgment) - E0155: Wheel attachment, rigid pick-up walker, per pair (Medicare: Carrier judgment) - E0156: Seat attachment, walker (Medicare: Carrier judgment) - E0157: Crutch attachment, walker, each (Medicare: Carrier judgment) - E0158: Leg extensions for walker, per set of four (4) (Medicare: Carrier judgment) - E0159: Brake attachment for wheeled walker, replacement, each (Medicare: Carrier judgment) - E0160: Sitz type bath or equipment, portable, used with or without commode (Medicare: Special coverage instructions apply) - E0161: Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s (Medicare: Special coverage instructions apply) - E0162: Sitz bath chair (Medicare: Special coverage instructions apply) - E0163: Commode chair, mobile or stationary, with fixed arms (Medicare: Special coverage instructions apply) - E0165: Commode chair, mobile or stationary, with detachable arms (Medicare: Special coverage instructions apply) - E0167: Pail or pan for use with commode chair, replacement only (Medicare: Special coverage instructions apply) - E0168: Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each (Medicare: Carrier judgment) - E0170: Commode chair with integrated seat lift mechanism, electric, any type (Medicare: Carrier judgment) - E0171: Commode chair with integrated seat lift mechanism, non-electric, any type (Medicare: Carrier judgment) - E0172: Seat lift mechanism placed over or on top of toilet, any type (Medicare: Non-covered by Medicare statute) - E0175: Foot rest, for use with commode chair, each (Medicare: Carrier judgment) - E0181: Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty (Medicare: Special coverage instructions apply) - E0182: Pump for alternating pressure pad, for replacement only (Medicare: Special coverage instructions apply) - E0183: Powered pressure reducing underlay/pad, alternating, with pump, includes heavy duty (Medicare: Carrier judgment) - E0184: Dry pressure mattress (Medicare: Special coverage instructions apply) - E0185: Gel or gel-like pressure pad for mattress, standard mattress length and width (Medicare: Special coverage instructions apply) - E0186: Air pressure mattress (Medicare: Special coverage instructions apply) - E0187: Water pressure mattress (Medicare: Special coverage instructions apply) - E0188: Synthetic sheepskin pad (Medicare: Special coverage instructions apply) - E0189: Lambswool sheepskin pad, any size (Medicare: Special coverage instructions apply) - E0190: Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories (Medicare: Special coverage instructions apply) - E0191: Heel or elbow protector, each (Medicare: Carrier judgment) - E0193: Powered air flotation bed (low air loss therapy) (Medicare: Carrier judgment) - E0194: Air fluidized bed (Medicare: Special coverage instructions apply) - E0196: Gel pressure mattress (Medicare: Special coverage instructions apply) - E0197: Air pressure pad for mattress, standard mattress length and width (Medicare: Special coverage instructions apply) - E0198: Water pressure pad for mattress, standard mattress length and width (Medicare: Special coverage instructions apply) - E0199: Dry pressure pad for mattress, standard mattress length and width (Medicare: Special coverage instructions apply) - E0200: Heat lamp, without stand (table model), includes bulb, or infrared element (Medicare: Special coverage instructions apply) - E0201: Penile contracture device, manual, greater than 3 lbs traction force (Medicare: Carrier judgment) - E0202: Phototherapy (bilirubin) light with photometer (Medicare: Carrier judgment) - E0203: Therapeutic lightbox, minimum 10,000 lux, table top model (Medicare: Non-covered by Medicare) - E0205: Heat lamp, with stand, includes bulb, or infrared element (Medicare: Special coverage instructions apply) - E0210: Electric heat pad, standard (Medicare: Special coverage instructions apply) - E0215: Electric heat pad, moist (Medicare: Special coverage instructions apply) - E0217: Water circulating heat pad with pump (Medicare: Special coverage instructions apply) - E0218: Fluid circulating cold pad with pump, any type (Medicare: Special coverage instructions apply) - E0221: Infrared heating pad system (Medicare: Carrier judgment) - E0225: Hydrocollator unit, includes pads (Medicare: Special coverage instructions apply) - E0231: Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover (Medicare: Non-covered by Medicare) - E0232: Warming card for use with the non contact wound warming device and non contact wound warming wound cover (Medicare: Non-covered by Medicare) - E0235: Paraffin bath unit, portable (see medical supply code a4265 for paraffin) (Medicare: Special coverage instructions apply) - E0236: Pump for water circulating pad (Medicare: Special coverage instructions apply) - E0239: Hydrocollator unit, portable (Medicare: Special coverage instructions apply) - E0240: Bath/shower chair, with or without wheels, any size (Medicare: Non-covered by Medicare) - E0241: Bath tub wall rail, each (Medicare: Non-covered by Medicare) - E0242: Bath tub rail, floor base (Medicare: Non-covered by Medicare) - E0243: Toilet rail, each (Medicare: Non-covered by Medicare) - E0244: Raised toilet seat (Medicare: Non-covered by Medicare) - E0245: Tub stool or bench (Medicare: Non-covered by Medicare) - E0246: Transfer tub rail attachment (Medicare: Carrier judgment) - E0247: Transfer bench for tub or toilet with or without commode opening (Medicare: Special coverage instructions apply) - E0248: Transfer bench, heavy duty, for tub or toilet with or without commode opening (Medicare: Special coverage instructions apply) - E0249: Pad for water circulating heat unit, for replacement only (Medicare: Special coverage instructions apply) - E0250: Hospital bed, fixed height, with any type side rails, with mattress (Medicare: Special coverage instructions apply) - E0251: Hospital bed, fixed height, with any type side rails, without mattress (Medicare: Special coverage instructions apply) - E0255: Hospital bed, variable height, hi-lo, with any type side rails, with mattress (Medicare: Special coverage instructions apply) - E0256: Hospital bed, variable height, hi-lo, with any type side rails, without mattress (Medicare: Special coverage instructions apply) - E0260: Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (Medicare: Special coverage instructions apply) - E0261: Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (Medicare: Special coverage instructions apply) - E0265: Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress (Medicare: Special coverage instructions apply) - E0266: Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress (Medicare: Special coverage instructions apply) - E0270: Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress (Medicare: Non-covered by Medicare) - E0271: Mattress, innerspring (Medicare: Special coverage instructions apply) - E0272: Mattress, foam rubber (Medicare: Special coverage instructions apply) - E0273: Bed board (Medicare: Non-covered by Medicare) - E0274: Over-bed table (Medicare: Non-covered by Medicare) - E0275: Bed pan, standard, metal or plastic (Medicare: Special coverage instructions apply) - E0276: Bed pan, fracture, metal or plastic (Medicare: Special coverage instructions apply) - E0277: Powered pressure-reducing air mattress (Medicare: Special coverage instructions apply) - E0280: Bed cradle, any type (Medicare: Carrier judgment) - E0290: Hospital bed, fixed height, without side rails, with mattress (Medicare: Special coverage instructions apply) - E0291: Hospital bed, fixed height, without side rails, without mattress (Medicare: Special coverage instructions apply) - E0292: Hospital bed, variable height, hi-lo, without side rails, with mattress (Medicare: Special coverage instructions apply) - E0293: Hospital bed, variable height, hi-lo, without side rails, without mattress (Medicare: Special coverage instructions apply) - E0294: Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress (Medicare: Special coverage instructions apply) - E0295: Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress (Medicare: Special coverage instructions apply) - E0296: Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress (Medicare: Special coverage instructions apply) - E0297: Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress (Medicare: Special coverage instructions apply) - E0300: Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (Medicare: Carrier judgment) - E0301: 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 (Medicare: Special coverage instructions apply) - E0302: Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress (Medicare: Special coverage instructions apply) - E0303: 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 (Medicare: Special coverage instructions apply) - E0304: Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress (Medicare: Special coverage instructions apply) - E0305: Bed side rails, half length (Medicare: Special coverage instructions apply) - E0310: Bed side rails, full length (Medicare: Special coverage instructions apply) - E0315: Bed accessory: board, table, or support device, any type (Medicare: Non-covered by Medicare) - E0316: Safety enclosure frame/canopy for use with hospital bed, any type (Medicare: Carrier judgment) - E0325: Urinal; male, jug-type, any material (Medicare: Special coverage instructions apply) - E0326: Urinal; female, jug-type, any material (Medicare: Special coverage instructions apply) - E0328: Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress (Medicare: Carrier judgment) - E0329: 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 (Medicare: Carrier judgment) - E0350: Control unit for electronic bowel irrigation/evacuation system (Medicare: Carrier judgment) - E0352: Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system (Medicare: Carrier judgment) - E0370: Air pressure elevator for heel (Medicare: Carrier judgment) - E0371: Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width (Medicare: Carrier judgment) - E0372: Powered air overlay for mattress, standard mattress length and width (Medicare: Carrier judgment) - E0373: Nonpowered advanced pressure reducing mattress (Medicare: Carrier judgment) - E0424: Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing (Medicare: Special coverage instructions apply) - E0425: Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing (Medicare: Special coverage instructions apply) - E0430: Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing (Medicare: Special coverage instructions apply) - E0431: Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (Medicare: Special coverage instructions apply) - E0433: 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 (Medicare: Carrier judgment) - E0434: Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing (Medicare: Special coverage instructions apply) - E0435: Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor (Medicare: Special coverage instructions apply) - E0439: Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing (Medicare: Special coverage instructions apply) - E0440: Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing (Medicare: Special coverage instructions apply) - E0441: Stationary oxygen contents, gaseous, 1 month's supply = 1 unit (Medicare: Special coverage instructions apply) - E0442: Stationary oxygen contents, liquid, 1 month's supply = 1 unit (Medicare: Special coverage instructions apply) - E0443: Portable oxygen contents, gaseous, 1 month's supply = 1 unit (Medicare: Special coverage instructions apply) - E0444: Portable oxygen contents, liquid, 1 month's supply = 1 unit (Medicare: Special coverage instructions apply) - E0445: Oximeter device for measuring blood oxygen levels non-invasively (Medicare: Carrier judgment) - E0446: Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories (Medicare: Carrier judgment) - E0447: Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm) (Medicare: Special coverage instructions apply) - E0450: Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) (Medicare: Special coverage instructions apply) - E0455: Oxygen tent, excluding croup or pediatric tents (Medicare: Special coverage instructions apply) - E0457: Chest shell (cuirass) (Medicare: Not payable by Medicare) - E0459: Chest wrap (Medicare: Not payable by Medicare) - E0460: Negative pressure ventilator; portable or stationary (Medicare: Special coverage instructions apply) - E0461: Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask) (Medicare: Special coverage instructions apply) - E0462: Rocking bed with or without side rails (Medicare: Carrier judgment) - E0463: Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) (Medicare: Carrier judgment) - E0464: Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask) (Medicare: Carrier judgment) - E0465: Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) (Medicare: Special coverage instructions apply) - E0466: Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (Medicare: Special coverage instructions apply) - E0467: 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 (Medicare: Special coverage instructions apply) - E0468: Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions (Medicare: Special coverage instructions apply) - E0469: Lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (Medicare: Carrier judgment) - E0470: 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) (Medicare: Special coverage instructions apply) - E0471: 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) (Medicare: Special coverage instructions apply) - E0472: 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) (Medicare: Special coverage instructions apply) - E0480: Percussor, electric or pneumatic, home model (Medicare: Special coverage instructions apply) - E0481: Intrapulmonary percussive ventilation system and related accessories (Medicare: Non-covered by Medicare) - E0482: Cough stimulating device, alternating positive and negative airway pressure (Medicare: Carrier judgment) - E0483: High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each (Medicare: Carrier judgment) - E0484: Oscillatory positive expiratory pressure device, non-electric, any type, each (Medicare: Carrier judgment) - E0485: Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - E0486: Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - E0487: Spirometer, electronic, includes all accessories (Medicare: Special coverage instructions apply) - E0490: Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by hardware remote (Medicare: Carrier judgment) - E0491: 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 (Medicare: Carrier judgment) - E0492: Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application (Medicare: Non-covered by Medicare statute) - E0493: 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 (Medicare: Non-covered by Medicare statute) - E0500: Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source (Medicare: Special coverage instructions apply) - E0530: Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type (Medicare: Carrier judgment) - E0550: Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery (Medicare: Special coverage instructions apply) - E0555: Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter (Medicare: Special coverage instructions apply) - E0560: Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery (Medicare: Special coverage instructions apply) - E0561: Humidifier, non-heated, used with positive airway pressure device (Medicare: Carrier judgment) - E0562: Humidifier, heated, used with positive airway pressure device (Medicare: Carrier judgment) - E0565: Compressor, air power source for equipment which is not self-contained or cylinder driven (Medicare: Carrier judgment) - E0570: Nebulizer, with compressor (Medicare: Special coverage instructions apply) - E0572: Aerosol compressor, adjustable pressure, light duty for intermittent use (Medicare: Carrier judgment) - E0574: Ultrasonic/electronic aerosol generator with small volume nebulizer (Medicare: Carrier judgment) - E0575: Nebulizer, ultrasonic, large volume (Medicare: Special coverage instructions apply) - E0580: Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter (Medicare: Special coverage instructions apply) - E0585: Nebulizer, with compressor and heater (Medicare: Special coverage instructions apply) - E0600: Respiratory suction pump, home model, portable or stationary, electric (Medicare: Special coverage instructions apply) - E0601: Continuous positive airway pressure (cpap) device (Medicare: Special coverage instructions apply) - E0602: Breast pump, manual, any type (Medicare: Carrier judgment) - E0603: Breast pump, electric (ac and/or dc), any type (Medicare: Carrier judgment) - E0604: Breast pump, hospital grade, electric (ac and / or dc), any type (Medicare: Carrier judgment) - E0605: Vaporizer, room type (Medicare: Special coverage instructions apply) - E0606: Postural drainage board (Medicare: Special coverage instructions apply) - E0607: Home blood glucose monitor (Medicare: Special coverage instructions apply) - E0610: Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) (Medicare: Special coverage instructions apply) - E0616: Implantable cardiac event recorder with memory, activator and programmer (Medicare: Carrier judgment) - E0617: External defibrillator with integrated electrocardiogram analysis (Medicare: Carrier judgment) - E0618: Apnea monitor, without recording feature (Medicare: Carrier judgment) - E0619: Apnea monitor, with recording feature (Medicare: Carrier judgment) - E0620: Skin piercing device for collection of capillary blood, laser, each (Medicare: Carrier judgment) - E0621: Sling or seat, patient lift, canvas or nylon (Medicare: Special coverage instructions apply) - E0625: Patient lift, bathroom or toilet, not otherwise classified (Medicare: Non-covered by Medicare) - E0627: Seat lift mechanism, electric, any type (Medicare: Special coverage instructions apply) - E0628: Separate seat lift mechanism for use with patient owned furniture-electric (Medicare: Special coverage instructions apply) - E0629: Seat lift mechanism, non-electric, any type (Medicare: Special coverage instructions apply) - E0630: Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (Medicare: Special coverage instructions apply) - E0635: Patient lift, electric with seat or sling (Medicare: Special coverage instructions apply) - E0636: Multipositional patient support system, with integrated lift, patient accessible controls (Medicare: Carrier judgment) - E0637: Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels (Medicare: Non-covered by Medicare) - E0638: Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels (Medicare: Non-covered by Medicare) - E0639: Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories (Medicare: Carrier judgment) - E0640: Patient lift, fixed system, includes all components/accessories (Medicare: Carrier judgment) - E0641: Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels (Medicare: Non-covered by Medicare) - E0642: Standing frame/table system, mobile (dynamic stander), any size including pediatric (Medicare: Non-covered by Medicare) - E0650: Pneumatic compressor, non-segmental home model (Medicare: Special coverage instructions apply) - E0651: Pneumatic compressor, segmental home model without calibrated gradient pressure (Medicare: Special coverage instructions apply) - E0652: Pneumatic compressor, segmental home model with calibrated gradient pressure (Medicare: Special coverage instructions apply) - E0655: Non-segmental pneumatic appliance for use with pneumatic compressor, half arm (Medicare: Special coverage instructions apply) - E0656: Segmental pneumatic appliance for use with pneumatic compressor, trunk (Medicare: Special coverage instructions apply) - E0657: Segmental pneumatic appliance for use with pneumatic compressor, chest (Medicare: Special coverage instructions apply) - E0658: Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chest (Medicare: Special coverage instructions apply) - E0659: Segmental pneumatic appliance for use with pneumatic compressor, integrated, head, neck and chest (Medicare: Special coverage instructions apply) - E0660: Non-segmental pneumatic appliance for use with pneumatic compressor, full leg (Medicare: Special coverage instructions apply) - E0665: Non-segmental pneumatic appliance for use with pneumatic compressor, full arm (Medicare: Special coverage instructions apply) - E0666: Non-segmental pneumatic appliance for use with pneumatic compressor, half leg (Medicare: Special coverage instructions apply) - E0667: Segmental pneumatic appliance for use with pneumatic compressor, full leg (Medicare: Special coverage instructions apply) - E0668: Segmental pneumatic appliance for use with pneumatic compressor, full arm (Medicare: Special coverage instructions apply) - E0669: Segmental pneumatic appliance for use with pneumatic compressor, half leg (Medicare: Special coverage instructions apply) - E0670: Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk (Medicare: Special coverage instructions apply) - E0671: Segmental gradient pressure pneumatic appliance, full leg (Medicare: Special coverage instructions apply) - E0672: Segmental gradient pressure pneumatic appliance, full arm (Medicare: Special coverage instructions apply) - E0673: Segmental gradient pressure pneumatic appliance, half leg (Medicare: Special coverage instructions apply) - E0675: Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system) (Medicare: Carrier judgment) - E0676: Intermittent limb compression device (includes all accessories), not otherwise specified (Medicare: Carrier judgment) - E0677: Non-pneumatic sequential compression garment, trunk (Medicare: Carrier judgment) - E0678: Non-pneumatic sequential compression garment, full leg (Medicare: Carrier judgment) - E0679: Non-pneumatic sequential compression garment, half leg (Medicare: Carrier judgment) - E0680: Non-pneumatic compression controller with sequential calibrated gradient pressure (Medicare: Carrier judgment) - E0681: Non-pneumatic compression controller without calibrated gradient pressure (Medicare: Carrier judgment) - E0682: Non-pneumatic sequential compression garment, full arm (Medicare: Carrier judgment) - E0683: Non-pneumatic, non-sequential, peristaltic wave compression pump (Medicare: Carrier judgment) - E0691: Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less (Medicare: Carrier judgment) - E0692: Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel (Medicare: Carrier judgment) - E0693: Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel (Medicare: Carrier judgment) - E0694: Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection (Medicare: Carrier judgment) - E0700: Safety equipment, device or accessory, any type (Medicare: Carrier judgment) - E0705: Transfer device, any type, each (Medicare: Special coverage instructions apply) - E0710: Restraints, any type (body, chest, wrist or ankle) (Medicare: Carrier judgment) - E0711: Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion (Medicare: Carrier judgment) - E0715: Intravaginal device intended to strengthen pelvic floor muscles during kegel exercises (Medicare: Non-covered by Medicare statute) - E0716: Supplies and accessories for intravaginal device intended to strengthen pelvic floor muscles during kegel exercises (Medicare: Non-covered by Medicare statute) - E0720: Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation (Medicare: Special coverage instructions apply) - E0721: Transcutaneous electrical nerve stimulator for nerves in the auricular region (Medicare: Carrier judgment) - E0730: Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation (Medicare: Special coverage instructions apply) - E0731: Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric) (Medicare: Special coverage instructions apply) - E0732: Cranial electrotherapy stimulation (ces) system, any type (Medicare: Carrier judgment) - E0733: Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve (Medicare: Carrier judgment) - E0734: External upper limb tremor stimulator of the peripheral nerves of the wrist (Medicare: Carrier judgment) - E0735: Non-invasive vagus nerve stimulator (Medicare: Carrier judgment) - E0736: Transcutaneous tibial nerve stimulator (Medicare: Carrier judgment) - E0737: Transcutaneous tibial nerve stimulator, controlled by phone application (Medicare: Non-covered by Medicare statute) - E0738: Upper extremity rehabilitation system providing active assistance to facilitate muscle re-education, include microprocessor, all components and accessories (Medicare: Carrier judgment) - E0739: Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors (Medicare: Carrier judgment) - E0740: Non-implanted pelvic floor electrical stimulator, complete system (Medicare: Special coverage instructions apply) - E0743: External lower extremity nerve stimulator for restless legs syndrome, each (Medicare: Carrier judgment) - E0744: Neuromuscular stimulator for scoliosis (Medicare: Carrier judgment) - E0745: Neuromuscular stimulator, electronic shock unit (Medicare: Special coverage instructions apply) - E0746: Electromyography (emg), biofeedback device (Medicare: Special coverage instructions apply) - E0747: Osteogenesis stimulator, electrical, non-invasive, other than spinal applications (Medicare: Special coverage instructions apply) - E0748: Osteogenesis stimulator, electrical, non-invasive, spinal applications (Medicare: Special coverage instructions apply) - E0749: Osteogenesis stimulator, electrical, surgically implanted (Medicare: Special coverage instructions apply) - E0755: Electronic salivary reflex stimulator (intra-oral/non-invasive) (Medicare: Carrier judgment) - E0760: Osteogenesis stimulator, low intensity ultrasound, non-invasive (Medicare: Carrier judgment) - E0761: Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device (Medicare: Special coverage instructions apply) - E0762: Transcutaneous electrical joint stimulation device system, includes all accessories (Medicare: Carrier judgment) - E0764: 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 (Medicare: Special coverage instructions apply) - E0765: Fda approved nerve stimulator, for treatment of nausea and vomiting (Medicare: Non-covered by Medicare statute) - E0766: Electrical stimulation device used for cancer treatment, includes all accessories, any type (Medicare: Carrier judgment) - E0767: Intrabuccal, systemic delivery of amplitude-modulated, radiofrequency electromagnetic field device, for cancer treatment, includes all accessories (Medicare: Carrier judgment) - E0769: Electrical stimulation or electromagnetic wound treatment device, not otherwise classified (Medicare: Special coverage instructions apply) - E0770: Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified (Medicare: Special coverage instructions apply) - E0776: Iv pole (Medicare: Carrier judgment) - E0779: Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater (Medicare: Carrier judgment) - E0780: Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours (Medicare: Carrier judgment) - E0781: Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient (Medicare: Special coverage instructions apply) - E0782: Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.) (Medicare: Special coverage instructions apply) - E0783: Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) (Medicare: Special coverage instructions apply) - E0784: External ambulatory infusion pump, insulin (Medicare: Special coverage instructions apply) - E0785: Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement (Medicare: Special coverage instructions apply) - E0786: Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) (Medicare: Special coverage instructions apply) - E0787: External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing (Medicare: Not payable by Medicare) - E0791: Parenteral infusion pump, stationary, single or multi-channel (Medicare: Special coverage instructions apply) - E0830: Ambulatory traction device, all types, each (Medicare: Special coverage instructions apply) - E0840: Traction frame, attached to headboard, cervical traction (Medicare: Special coverage instructions apply) - E0849: Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible (Medicare: Carrier judgment) - E0850: Traction stand, free standing, cervical traction (Medicare: Special coverage instructions apply) - E0855: Cervical traction equipment not requiring additional stand or frame (Medicare: Carrier judgment) - E0856: Cervical traction device, with inflatable air bladder(s) (Medicare: Carrier judgment) - E0860: Traction equipment, overdoor, cervical (Medicare: Special coverage instructions apply) - E0870: Traction frame, attached to footboard, extremity traction, (e.g., buck's) (Medicare: Special coverage instructions apply) - E0880: Traction stand, free standing, extremity traction (Medicare: Special coverage instructions apply) - E0890: Traction frame, attached to footboard, pelvic traction (Medicare: Special coverage instructions apply) - E0900: Traction stand, free standing, pelvic traction, (e.g., buck's) (Medicare: Special coverage instructions apply) - E0910: Trapeze bars, a/k/a patient helper, attached to bed, with grab bar (Medicare: Special coverage instructions apply) - E0911: Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar (Medicare: Special coverage instructions apply) - E0912: Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar (Medicare: Special coverage instructions apply) - E0920: Fracture frame, attached to bed, includes weights (Medicare: Special coverage instructions apply) - E0930: Fracture frame, free standing, includes weights (Medicare: Special coverage instructions apply) - E0935: Continuous passive motion exercise device for use on knee only (Medicare: Special coverage instructions apply) - E0936: Continuous passive motion exercise device for use other than knee (Medicare: Non-covered by Medicare) - E0940: Trapeze bar, free standing, complete with grab bar (Medicare: Special coverage instructions apply) - E0941: Gravity assisted traction device, any type (Medicare: Special coverage instructions apply) - E0942: Cervical head harness/halter (Medicare: Carrier judgment) - E0944: Pelvic belt/harness/boot (Medicare: Carrier judgment) - E0945: Extremity belt/harness (Medicare: Carrier judgment) - E0946: Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster) (Medicare: Special coverage instructions apply) - E0947: Fracture frame, attachments for complex pelvic traction (Medicare: Special coverage instructions apply) - E0948: Fracture frame, attachments for complex cervical traction (Medicare: Special coverage instructions apply) - E0950: Wheelchair accessory, tray, each (Medicare: Special coverage instructions apply) - E0951: Heel loop/holder, any type, with or without ankle strap, each (Medicare: Carrier judgment) - E0952: Toe loop/holder, any type, each (Medicare: Special coverage instructions apply) - E0953: Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each (Medicare: Carrier judgment) - E0954: Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot (Medicare: Carrier judgment) - E0955: Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (Medicare: Carrier judgment) - E0956: Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each (Medicare: Carrier judgment) - E0957: Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each (Medicare: Carrier judgment) - E0958: Manual wheelchair accessory, one-arm drive attachment, each (Medicare: Special coverage instructions apply) - E0959: Manual wheelchair accessory, adapter for amputee, each (Medicare: Carrier judgment) - E0960: Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware (Medicare: Carrier judgment) - E0961: Manual wheelchair accessory, wheel lock brake extension (handle), each (Medicare: Carrier judgment) - E0966: Manual wheelchair accessory, headrest extension, each (Medicare: Carrier judgment) - E0967: Manual wheelchair accessory, hand rim with projections, any type, replacement only, each (Medicare: Special coverage instructions apply) - E0968: Commode seat, wheelchair (Medicare: Special coverage instructions apply) - E0969: Narrowing device, wheelchair (Medicare: Special coverage instructions apply) - E0970: No. 2 footplates, except for elevating leg rest (Medicare: Not payable by Medicare) - E0971: Manual wheelchair accessory, anti-tipping device, each (Medicare: Carrier judgment) - E0973: Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each (Medicare: Special coverage instructions apply) - E0974: Manual wheelchair accessory, anti-rollback device, each (Medicare: Special coverage instructions apply) - E0978: Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (Medicare: Carrier judgment) - E0980: Safety vest, wheelchair (Medicare: Carrier judgment) - E0981: Wheelchair accessory, seat upholstery, replacement only, each (Medicare: Carrier judgment) - E0982: Wheelchair accessory, back upholstery, replacement only, each (Medicare: Carrier judgment) - E0983: Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control (Medicare: Carrier judgment) - E0984: Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control (Medicare: Carrier judgment) - E0985: Wheelchair accessory, seat lift mechanism (Medicare: Carrier judgment) - E0986: Manual wheelchair accessory, power assist system (Medicare: Carrier judgment) - E0988: Manual wheelchair accessory, lever-activated, wheel drive, pair (Medicare: Carrier judgment) - E0990: Wheelchair accessory, elevating leg rest, complete assembly, each (Medicare: Carrier judgment) - E0992: Manual wheelchair accessory, solid seat insert (Medicare: Carrier judgment) - E0994: Arm rest, each (Medicare: Special coverage instructions apply) - E0995: Wheelchair accessory, calf rest/pad, replacement only, each (Medicare: Carrier judgment) - E1002: Wheelchair accessory, power seating system, tilt only (Medicare: Carrier judgment) - E1003: Wheelchair accessory, power seating system, recline only, without shear reduction (Medicare: Carrier judgment) - E1004: Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (Medicare: Carrier judgment) - E1005: Wheelchair accessory, power seating system, recline only, with power shear reduction (Medicare: Carrier judgment) - E1006: Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (Medicare: Carrier judgment) - E1007: Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (Medicare: Carrier judgment) - E1008: Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (Medicare: Carrier judgment) - E1009: Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each (Medicare: Carrier judgment) - E1010: Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair (Medicare: Carrier judgment) - E1011: Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) (Medicare: Special coverage instructions apply) - E1012: Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (Medicare: Carrier judgment) - E1014: Reclining back, addition to pediatric size wheelchair (Medicare: Special coverage instructions apply) - E1015: Shock absorber for manual wheelchair, each (Medicare: Special coverage instructions apply) - E1016: Shock absorber for power wheelchair, each (Medicare: Special coverage instructions apply) - E1017: Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each (Medicare: Special coverage instructions apply) - E1018: Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each (Medicare: Special coverage instructions apply) - E1020: Residual limb support system for wheelchair, any type (Medicare: Special coverage instructions apply) - E1022: Wheelchair transportation securement system, any type includes all components and accessories (Medicare: Non-covered by Medicare statute) - E1023: Wheelchair transit securement system, includes all components and accessories (Medicare: Non-covered by Medicare statute) - E1028: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other (Medicare: Carrier judgment) - E1029: Wheelchair accessory, ventilator tray, fixed (Medicare: Carrier judgment) - E1030: Wheelchair accessory, ventilator tray, gimbaled (Medicare: Carrier judgment) - E1031: Rollabout chair, any and all types with casters 5" or greater (Medicare: Special coverage instructions apply) - E1032: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface (Medicare: Carrier judgment) - E1033: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type (Medicare: Carrier judgment) - E1034: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type (Medicare: Carrier judgment) - E1035: Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs (Medicare: Special coverage instructions apply) - E1036: Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs (Medicare: Carrier judgment) - E1037: Transport chair, pediatric size (Medicare: Special coverage instructions apply) - E1038: Transport chair, adult size, patient weight capacity up to and including 300 pounds (Medicare: Special coverage instructions apply) - E1039: Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds (Medicare: Carrier judgment) - E1050: Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (Medicare: Special coverage instructions apply) - E1060: Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests (Medicare: Special coverage instructions apply) - E1070: Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest (Medicare: Special coverage instructions apply) - E1083: Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest (Medicare: Special coverage instructions apply) - E1084: Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests (Medicare: Special coverage instructions apply) - E1085: Hemi-wheelchair, fixed full length arms, swing away detachable foot rests (Medicare: Not payable by Medicare) - E1086: Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests (Medicare: Not payable by Medicare) - E1087: High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests (Medicare: Special coverage instructions apply) - E1088: High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests (Medicare: Special coverage instructions apply) - E1089: High strength lightweight wheelchair, fixed length arms, swing away detachable footrest (Medicare: Not payable by Medicare) - E1090: High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests (Medicare: Not payable by Medicare) - E1092: Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests (Medicare: Special coverage instructions apply) - E1093: Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests (Medicare: Special coverage instructions apply) - E1100: Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (Medicare: Special coverage instructions apply) - E1110: Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest (Medicare: Special coverage instructions apply) - E1130: Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests (Medicare: Not payable by Medicare) - E1140: Wheelchair, detachable arms, desk or full length, swing away detachable footrests (Medicare: Not payable by Medicare) - E1150: Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests (Medicare: Special coverage instructions apply) - E1160: Wheelchair, fixed full length arms, swing away detachable elevating legrests (Medicare: Special coverage instructions apply) - E1161: Manual adult size wheelchair, includes tilt in space (Medicare: Carrier judgment) - E1170: Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests (Medicare: Special coverage instructions apply) - E1171: Amputee wheelchair, fixed full length arms, without footrests or legrest (Medicare: Special coverage instructions apply) - E1172: Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest (Medicare: Special coverage instructions apply) - E1180: Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests (Medicare: Special coverage instructions apply) - E1190: Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests (Medicare: Special coverage instructions apply) - E1195: Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests (Medicare: Special coverage instructions apply) - E1200: Amputee wheelchair, fixed full length arms, swing away detachable footrest (Medicare: Special coverage instructions apply) - E1220: Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification (Medicare: Special coverage instructions apply) - E1221: Wheelchair with fixed arm, footrests (Medicare: Special coverage instructions apply) - E1222: Wheelchair with fixed arm, elevating legrests (Medicare: Special coverage instructions apply) - E1223: Wheelchair with detachable arms, footrests (Medicare: Special coverage instructions apply) - E1224: Wheelchair with detachable arms, elevating legrests (Medicare: Special coverage instructions apply) - E1225: Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each (Medicare: Special coverage instructions apply) - E1226: Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each (Medicare: Special coverage instructions apply) - E1227: Special height arms for wheelchair (Medicare: Special coverage instructions apply) - E1228: Special back height for wheelchair (Medicare: Special coverage instructions apply) - E1229: Wheelchair, pediatric size, not otherwise specified (Medicare: Carrier judgment) - E1230: Power operated vehicle (three or four wheel nonhighway) specify brand name and model number (Medicare: Special coverage instructions apply) - E1231: Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system (Medicare: Special coverage instructions apply) - E1232: Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system (Medicare: Special coverage instructions apply) - E1233: Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system (Medicare: Special coverage instructions apply) - E1234: Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system (Medicare: Special coverage instructions apply) - E1235: Wheelchair, pediatric size, rigid, adjustable, with seating system (Medicare: Special coverage instructions apply) - E1236: Wheelchair, pediatric size, folding, adjustable, with seating system (Medicare: Special coverage instructions apply) - E1237: Wheelchair, pediatric size, rigid, adjustable, without seating system (Medicare: Special coverage instructions apply) - E1238: Wheelchair, pediatric size, folding, adjustable, without seating system (Medicare: Special coverage instructions apply) - E1239: Power wheelchair, pediatric size, not otherwise specified (Medicare: Carrier judgment) - E1240: Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest (Medicare: Special coverage instructions apply) - E1250: Lightweight wheelchair, fixed full length arms, swing away detachable footrest (Medicare: Not payable by Medicare) - E1260: Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest (Medicare: Not payable by Medicare) - E1270: Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests (Medicare: Special coverage instructions apply) - E1280: Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests (Medicare: Special coverage instructions apply) - E1285: Heavy duty wheelchair, fixed full length arms, swing away detachable footrest (Medicare: Not payable by Medicare) - E1290: Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest (Medicare: Not payable by Medicare) - E1295: Heavy duty wheelchair, fixed full length arms, elevating legrest (Medicare: Special coverage instructions apply) - E1296: Special wheelchair seat height from floor (Medicare: Special coverage instructions apply) - E1297: Special wheelchair seat depth, by upholstery (Medicare: Special coverage instructions apply) - E1298: Special wheelchair seat depth and/or width, by construction (Medicare: Special coverage instructions apply) - E1300: Whirlpool, portable (overtub type) (Medicare: Non-covered by Medicare) - E1301: Whirlpool tub, walk-in, portable (Medicare: Non-covered by Medicare) - E1310: Whirlpool, non-portable (built-in type) (Medicare: Special coverage instructions apply) - E1352: Oxygen accessory, flow regulator capable of positive inspiratory pressure (Medicare: Carrier judgment) - E1353: Regulator (Medicare: Special coverage instructions apply) - E1354: Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each (Medicare: Carrier judgment) - E1355: Stand/rack (Medicare: Special coverage instructions apply) - E1356: Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each (Medicare: Carrier judgment) - E1357: Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each (Medicare: Carrier judgment) - E1358: Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each (Medicare: Special coverage instructions apply) - E1372: Immersion external heater for nebulizer (Medicare: Special coverage instructions apply) - E1390: Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (Medicare: Special coverage instructions apply) - E1391: Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each (Medicare: Special coverage instructions apply) - E1392: Portable oxygen concentrator, rental (Medicare: Special coverage instructions apply) - E1399: Durable medical equipment, miscellaneous (Medicare: Carrier judgment) - E1405: Oxygen and water vapor enriching system with heated delivery (Medicare: Special coverage instructions apply) - E1406: Oxygen and water vapor enriching system without heated delivery (Medicare: Special coverage instructions apply) - E1500: Centrifuge, for dialysis (Medicare: Special coverage instructions apply) - E1510: 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 (Medicare: Special coverage instructions apply) - E1520: Heparin infusion pump for hemodialysis (Medicare: Special coverage instructions apply) - E1530: Air bubble detector for hemodialysis, each, replacement (Medicare: Special coverage instructions apply) - E1540: Pressure alarm for hemodialysis, each, replacement (Medicare: Special coverage instructions apply) - E1550: Bath conductivity meter for hemodialysis, each (Medicare: Special coverage instructions apply) - E1560: Blood leak detector for hemodialysis, each, replacement (Medicare: Special coverage instructions apply) - E1570: Adjustable chair, for esrd patients (Medicare: Special coverage instructions apply) - E1575: Transducer protectors/fluid barriers, for hemodialysis, any size, per 10 (Medicare: Special coverage instructions apply) - E1580: Unipuncture control system for hemodialysis (Medicare: Special coverage instructions apply) - E1590: Hemodialysis machine (Medicare: Special coverage instructions apply) - E1592: Automatic intermittent peritoneal dialysis system (Medicare: Special coverage instructions apply) - E1594: Cycler dialysis machine for peritoneal dialysis (Medicare: Special coverage instructions apply) - E1600: Delivery and/or installation charges for hemodialysis equipment (Medicare: Special coverage instructions apply) - E1610: Reverse osmosis water purification system, for hemodialysis (Medicare: Special coverage instructions apply) - E1615: Deionizer water purification system, for hemodialysis (Medicare: Special coverage instructions apply) - E1620: Blood pump for hemodialysis, replacement (Medicare: Special coverage instructions apply) - E1625: Water softening system, for hemodialysis (Medicare: Special coverage instructions apply) - E1629: Tablo hemodialysis system for the billable dialysis service (Medicare: Carrier judgment) - E1630: Reciprocating peritoneal dialysis system (Medicare: Carrier judgment) - E1632: Wearable artificial kidney, each (Medicare: Special coverage instructions apply) - E1634: Peritoneal dialysis clamps, each (Medicare: Special coverage instructions apply) - E1635: Compact (portable) travel hemodialyzer system (Medicare: Special coverage instructions apply) - E1636: Sorbent cartridges, for hemodialysis, per 10 (Medicare: Special coverage instructions apply) - E1637: Hemostats, each (Medicare: Special coverage instructions apply) - E1639: Scale, each (Medicare: Special coverage instructions apply) - E1699: Dialysis equipment, not otherwise specified (Medicare: Special coverage instructions apply) - E1700: Jaw motion rehabilitation system (Medicare: Carrier judgment) - E1701: Replacement cushions for jaw motion rehabilitation system, pkg. of 6 (Medicare: Carrier judgment) - E1702: Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200 (Medicare: Carrier judgment) - E1800: Dynamic adjustable elbow extension and flexion device, includes soft interface material (Medicare: Carrier judgment) - E1801: 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 (Medicare: Carrier judgment) - E1802: Dynamic adjustable forearm pronation/supination device, includes soft interface material (Medicare: Carrier judgment) - E1803: Dynamic adjustable elbow extension only device, includes soft interface material (Medicare: Carrier judgment) - E1804: Dynamic adjustable elbow flexion only device, includes soft interface material (Medicare: Carrier judgment) - E1805: Dynamic adjustable wrist extension and flexion device, includes soft interface material (Medicare: Carrier judgment) - E1806: Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (Medicare: Carrier judgment) - E1807: Dynamic adjustable wrist extension only device, includes soft interface material (Medicare: Carrier judgment) - E1808: Dynamic adjustable wrist flexion only device, includes soft interface material (Medicare: Carrier judgment) - E1810: Dynamic adjustable knee extension and flexion device, includes soft interface material (Medicare: Carrier judgment) - E1811: 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 (Medicare: Carrier judgment) - E1812: Dynamic knee, extension/flexion device with active resistance control (Medicare: Carrier judgment) - E1813: Dynamic adjustable knee extension only device, includes soft interface material (Medicare: Carrier judgment) - E1814: Dynamic adjustable knee flexion only device, includes soft interface material (Medicare: Carrier judgment) - E1815: Dynamic adjustable ankle extension and flexion device, includes soft interface material (Medicare: Carrier judgment) - E1816: 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 (Medicare: Carrier judgment) - E1818: Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories (Medicare: Carrier judgment) - E1820: Replacement soft interface material, dynamic adjustable extension/flexion device (Medicare: Carrier judgment) - E1821: Replacement soft interface material/cuffs for bi-directional static progressive stretch device (Medicare: Carrier judgment) - E1822: Dynamic adjustable ankle extension only device, includes soft interface material (Medicare: Carrier judgment) - E1823: Dynamic adjustable ankle flexion only device, includes soft interface material (Medicare: Carrier judgment) - E1825: Dynamic adjustable finger extension and flexion device, includes soft interface material (Medicare: Carrier judgment) - E1826: Dynamic adjustable finger extension only device, includes soft interface material (Medicare: Carrier judgment) - E1827: Dynamic adjustable finger flexion only device, includes soft interface material (Medicare: Carrier judgment) - E1828: Dynamic adjustable toe extension only device, includes soft interface material (Medicare: Carrier judgment) - E1829: Dynamic adjustable toe flexion only device, includes soft interface material (Medicare: Carrier judgment) - E1830: Dynamic adjustable toe extension and flexion device, includes soft interface material (Medicare: Carrier judgment) - E1831: Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (Medicare: Carrier judgment) - E1832: Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (Medicare: Carrier judgment) - E1840: Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material (Medicare: Carrier judgment) - E1841: Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories (Medicare: Carrier judgment) - E1902: Communication board, non-electronic augmentative or alternative communication device (Medicare: Carrier judgment) - E1905: Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software (Medicare: Carrier judgment) - E2000: Gastric suction pump, home model, portable or stationary, electric (Medicare: Carrier judgment) - E2001: Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system (Medicare: Carrier judgment) - E2100: Blood glucose monitor with integrated voice synthesizer (Medicare: Special coverage instructions apply) - E2101: Blood glucose monitor with integrated lancing/blood sample (Medicare: Special coverage instructions apply) - E2102: Adjunctive, non-implanted continuous glucose monitor or receiver (Medicare: Carrier judgment) - E2103: Non-adjunctive, non-implanted continuous glucose monitor or receiver (Medicare: Carrier judgment) - E2104: Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge (Medicare: Special coverage instructions apply) - E2120: Pulse generator system for tympanic treatment of inner ear endolymphatic fluid (Medicare: Carrier judgment) - E2201: Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches (Medicare: Carrier judgment) - E2202: Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches (Medicare: Carrier judgment) - E2203: Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches (Medicare: Carrier judgment) - E2204: Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches (Medicare: Carrier judgment) - E2205: Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each (Medicare: Carrier judgment) - E2206: Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each (Medicare: Carrier judgment) - E2207: Wheelchair accessory, crutch and cane holder, each (Medicare: Carrier judgment) - E2208: Wheelchair accessory, cylinder tank carrier, each (Medicare: Carrier judgment) - E2209: Accessory, arm trough, with or without hand support, each (Medicare: Carrier judgment) - E2210: Wheelchair accessory, bearings, any type, replacement only, each (Medicare: Carrier judgment) - E2211: Manual wheelchair accessory, pneumatic propulsion tire, any size, each (Medicare: Carrier judgment) - E2212: Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each (Medicare: Carrier judgment) - E2213: Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each (Medicare: Carrier judgment) - E2214: Manual wheelchair accessory, pneumatic caster tire, any size, each (Medicare: Carrier judgment) - E2215: Manual wheelchair accessory, tube for pneumatic caster tire, any size, each (Medicare: Carrier judgment) - E2216: Manual wheelchair accessory, foam filled propulsion tire, any size, each (Medicare: Carrier judgment) - E2217: Manual wheelchair accessory, foam filled caster tire, any size, each (Medicare: Carrier judgment) - E2218: Manual wheelchair accessory, foam propulsion tire, any size, each (Medicare: Carrier judgment) - E2219: Manual wheelchair accessory, foam caster tire, any size, each (Medicare: Carrier judgment) - E2220: Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each (Medicare: Carrier judgment) - E2221: Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (Medicare: Carrier judgment) - E2222: Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (Medicare: Carrier judgment) - E2224: Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each (Medicare: Carrier judgment) - E2225: Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (Medicare: Carrier judgment) - E2226: Manual wheelchair accessory, caster fork, any size, replacement only, each (Medicare: Carrier judgment) - E2227: Manual wheelchair accessory, gear reduction drive wheel, each (Medicare: Carrier judgment) - E2228: Manual wheelchair accessory, wheel braking system and lock, complete, each (Medicare: Carrier judgment) - E2230: Manual wheelchair accessory, manual standing system (Medicare: Carrier judgment) - E2231: Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware (Medicare: Carrier judgment) - E2291: Back, planar, for pediatric size wheelchair including fixed attaching hardware (Medicare: Carrier judgment) - E2292: Seat, planar, for pediatric size wheelchair including fixed attaching hardware (Medicare: Carrier judgment) - E2293: Back, contoured, for pediatric size wheelchair including fixed attaching hardware (Medicare: Carrier judgment) - E2294: Seat, contoured, for pediatric size wheelchair including fixed attaching hardware (Medicare: Carrier judgment) - E2295: Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features (Medicare: Carrier judgment) - E2298: Complex rehabilitative power wheelchair accessory, power seat elevation system, any type (Medicare: Carrier judgment) - E2300: Wheelchair accessory, power seat elevation system, any type (Medicare: Carrier judgment) - E2301: Wheelchair accessory, power standing system, any type (Medicare: Carrier judgment) - E2310: 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 (Medicare: Carrier judgment) - E2311: 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 (Medicare: Carrier judgment) - E2312: Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (Medicare: Carrier judgment) - E2313: Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each (Medicare: Carrier judgment) - E2321: Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware (Medicare: Carrier judgment) - E2322: Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware (Medicare: Carrier judgment) - E2323: Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated (Medicare: Carrier judgment) - E2324: Power wheelchair accessory, chin cup for chin control interface (Medicare: Carrier judgment) - E2325: Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware (Medicare: Carrier judgment) - E2326: Power wheelchair accessory, breath tube kit for sip and puff interface (Medicare: Carrier judgment) - E2327: Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (Medicare: Carrier judgment) - E2328: Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware (Medicare: Carrier judgment) - E2329: Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (Medicare: Carrier judgment) - E2330: Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (Medicare: Carrier judgment) - E2331: Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware (Medicare: Carrier judgment) - E2340: Power wheelchair accessory, nonstandard seat frame width, 20-23 inches (Medicare: Carrier judgment) - E2341: Power wheelchair accessory, nonstandard seat frame width, 24-27 inches (Medicare: Carrier judgment) - E2342: Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches (Medicare: Carrier judgment) - E2343: Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches (Medicare: Carrier judgment) - E2351: Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface (Medicare: Carrier judgment) - E2358: Power wheelchair accessory, group 34 non-sealed lead acid battery, each (Medicare: Carrier judgment) - E2359: Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) (Medicare: Carrier judgment) - E2360: Power wheelchair accessory, 22nf non-sealed lead acid battery, each (Medicare: Carrier judgment) - E2361: Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) (Medicare: Carrier judgment) - E2362: Power wheelchair accessory, group 24 non-sealed lead acid battery, each (Medicare: Carrier judgment) - E2363: Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) (Medicare: Carrier judgment) - E2364: Power wheelchair accessory, u-1 non-sealed lead acid battery, each (Medicare: Carrier judgment) - E2365: Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) (Medicare: Carrier judgment) - E2366: Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each (Medicare: Carrier judgment) - E2367: Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each (Medicare: Carrier judgment) - E2368: Power wheelchair component, drive wheel motor, replacement only (Medicare: Carrier judgment) - E2369: Power wheelchair component, drive wheel gear box, replacement only (Medicare: Carrier judgment) - E2370: Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (Medicare: Carrier judgment) - E2371: Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each (Medicare: Carrier judgment) - E2372: Power wheelchair accessory, group 27 non-sealed lead acid battery, each (Medicare: Carrier judgment) - E2373: Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (Medicare: Carrier judgment) - E2374: Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (Medicare: Special coverage instructions apply) - E2375: Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (Medicare: Special coverage instructions apply) - E2376: Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (Medicare: Special coverage instructions apply) - E2377: Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (Medicare: Special coverage instructions apply) - E2378: Power wheelchair component, actuator, replacement only (Medicare: Carrier judgment) - E2381: Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2382: Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2383: Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2384: Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2385: Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2386: Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2387: Power wheelchair accessory, foam filled caster tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2388: Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2389: Power wheelchair accessory, foam caster tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2390: Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2391: Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (Medicare: Special coverage instructions apply) - E2392: Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2394: Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2395: Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2396: Power wheelchair accessory, caster fork, any size, replacement only, each (Medicare: Special coverage instructions apply) - E2397: Power wheelchair accessory, lithium-based battery, each (Medicare: Carrier judgment) - E2398: Wheelchair accessory, dynamic positioning hardware for back (Medicare: Carrier judgment) - E2402: Negative pressure wound therapy electrical pump, stationary or portable (Medicare: Carrier judgment) - E2500: Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time (Medicare: Special coverage instructions apply) - E2502: Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time (Medicare: Special coverage instructions apply) - E2504: Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time (Medicare: Special coverage instructions apply) - E2506: Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time (Medicare: Special coverage instructions apply) - E2508: Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device (Medicare: Special coverage instructions apply) - E2510: Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access (Medicare: Special coverage instructions apply) - E2511: Speech generating software program, for personal computer or personal digital assistant (Medicare: Special coverage instructions apply) - E2512: Accessory for speech generating device, mounting system (Medicare: Special coverage instructions apply) - E2513: Accessory for speech generating device, electromyographic sensor (Medicare: Special coverage instructions apply) - E2599: Accessory for speech generating device, not otherwise classified (Medicare: Special coverage instructions apply) - E2601: General use wheelchair seat cushion, width less than 22 inches, any depth (Medicare: Carrier judgment) - E2602: General use wheelchair seat cushion, width 22 inches or greater, any depth (Medicare: Carrier judgment) - E2603: Skin protection wheelchair seat cushion, width less than 22 inches, any depth (Medicare: Carrier judgment) - E2604: Skin protection wheelchair seat cushion, width 22 inches or greater, any depth (Medicare: Carrier judgment) - E2605: Positioning wheelchair seat cushion, width less than 22 inches, any depth (Medicare: Carrier judgment) - E2606: Positioning wheelchair seat cushion, width 22 inches or greater, any depth (Medicare: Carrier judgment) - E2607: Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth (Medicare: Carrier judgment) - E2608: Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth (Medicare: Carrier judgment) - E2609: Custom fabricated wheelchair seat cushion, any size (Medicare: Carrier judgment) - E2610: Wheelchair seat cushion, powered (Medicare: Carrier judgment) - E2611: General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2612: General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2613: Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2614: Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2615: Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2616: Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2617: Custom fabricated wheelchair back cushion, any size, including any type mounting hardware (Medicare: Carrier judgment) - E2619: Replacement cover for wheelchair seat cushion or back cushion, each (Medicare: Carrier judgment) - E2620: Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2621: Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware (Medicare: Carrier judgment) - E2622: Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth (Medicare: Carrier judgment) - E2623: Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (Medicare: Carrier judgment) - E2624: Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth (Medicare: Carrier judgment) - E2625: Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (Medicare: Carrier judgment) - E2626: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable (Medicare: Carrier judgment) - E2627: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type (Medicare: Carrier judgment) - E2628: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining (Medicare: Carrier judgment) - E2629: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) (Medicare: Carrier judgment) - E2630: Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support (Medicare: Carrier judgment) - E2631: Wheelchair accessory, addition to mobile arm support, elevating proximal arm (Medicare: Carrier judgment) - E2632: Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control (Medicare: Carrier judgment) - E2633: Wheelchair accessory, addition to mobile arm support, supinator (Medicare: Carrier judgment) - E3000: Speech volume modulation system, any type, including all components and accessories (Medicare: Carrier judgment) - E3200: Gait modulation system, rhythmic auditory stimulation, including restricted therapy software, all components and accessories, prescription only (Medicare: Carrier judgment) - E8000: Gait trainer, pediatric size, posterior support, includes all accessories and components (Medicare: Not payable by Medicare) - E8001: Gait trainer, pediatric size, upright support, includes all accessories and components (Medicare: Not payable by Medicare) - E8002: Gait trainer, pediatric size, anterior support, includes all accessories and components (Medicare: Not payable by Medicare) - G0008: Administration of influenza virus vaccine (Medicare: Carrier judgment) - G0009: Administration of pneumococcal vaccine (Medicare: Carrier judgment) - G0010: Administration of hepatitis b vaccine (Medicare: Carrier judgment) - G0011: 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 (Medicare: Carrier judgment) - G0012: Injection of pre-exposure prophylaxis (prep) drug for hiv prevention, under skin or into muscle (Medicare: Carrier judgment) - G0013: 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 (Medicare: Carrier judgment) - G0017: 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 (Medicare: Carrier judgment) - G0018: 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) (Medicare: Carrier judgment) - G0019: 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 (Medicare: Carrier judgment) - G0022: Community health integration services, each additional 30 minutes per calendar month (list separately in addition to g0019) (Medicare: Carrier judgment) - G0023: 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 (Medicare: Carrier judgment) - G0024: Principal illness navigation services, additional 30 minutes per calendar month (list separately in addition to g0023) (Medicare: Carrier judgment) - G0027: Semen analysis; presence and/or motility of sperm excluding huhner (Medicare: Carrier judgment) - G0028: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) (Medicare: Carrier judgment) - G0029: Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period (Medicare: Carrier judgment) - G0030: 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 (Medicare: Carrier judgment) - G0031: Palliative care services given to patient any time during the measurement period (Medicare: Carrier judgment) - G0032: 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 (Medicare: Carrier judgment) - G0033: 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 (Medicare: Carrier judgment) - G0034: Patients receiving palliative care during the measurement period (Medicare: Carrier judgment) - G0035: Patient has any emergency department encounter during the performance period with place of service indicator 23 (Medicare: Carrier judgment) - G0036: Patient or care partner decline assessment (Medicare: Carrier judgment) - G0037: 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 (Medicare: Carrier judgment) - G0038: Clinician determines patient does not require referral (Medicare: Carrier judgment) - G0039: Patient not referred, reason not otherwise specified (Medicare: Carrier judgment) - G0040: Patient already receiving physical/occupational/speech/recreational therapy during the measurement period (Medicare: Carrier judgment) - G0041: Patient and/or care partner decline referral (Medicare: Carrier judgment) - G0042: Referral to physical, occupational, speech, or recreational therapy (Medicare: Carrier judgment) - G0043: Patients with mechanical prosthetic heart valve (Medicare: Carrier judgment) - G0044: Patients with moderate or severe mitral stenosis (Medicare: Carrier judgment) - G0045: Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention (Medicare: Carrier judgment) - G0046: Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention (Medicare: Carrier judgment) - G0047: Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed (Medicare: Carrier judgment) - G0048: Patients who receive palliative care services any time during the intake period through the end of the measurement year (Medicare: Carrier judgment) - G0049: With maintenance hemodialysis (in-center and home hd) for the complete reporting month (Medicare: Carrier judgment) - G0050: Patients with a catheter that have limited life expectancy (Medicare: Carrier judgment) - G0051: Patients under hospice care in the current reporting month (Medicare: Carrier judgment) - G0052: Patients on peritoneal dialysis for any portion of the reporting month (Medicare: Carrier judgment) - G0053: Advancing rheumatology patient care mips value pathways (Medicare: Carrier judgment) - G0054: Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways (Medicare: Carrier judgment) - G0055: Advancing care for heart disease mips value pathways (Medicare: Carrier judgment) - G0056: Optimizing chronic disease management mips value pathways (Medicare: Carrier judgment) - G0057: Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways (Medicare: Carrier judgment) - G0058: Improving care for lower extremity joint repair mips value pathways (Medicare: Carrier judgment) - G0059: Patient safety and support of positive experiences with anesthesia mips value pathways (Medicare: Carrier judgment) - G0060: Allergy/immunology mips specialty set (Medicare: Carrier judgment) - G0061: Anesthesiology mips specialty set (Medicare: Carrier judgment) - G0062: Audiology mips specialty set (Medicare: Carrier judgment) - G0063: Cardiology mips specialty set (Medicare: Carrier judgment) - G0064: Certified nurse midwife mips specialty set (Medicare: Carrier judgment) - G0065: Chiropractic medicine mips specialty set (Medicare: Carrier judgment) - G0066: Clinical social work mips specialty set (Medicare: Carrier judgment) - G0067: Dentistry mips specialty set (Medicare: Carrier judgment) - G0068: 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 (Medicare: Special coverage instructions apply) - G0069: 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 (Medicare: Special coverage instructions apply) - G0070: 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 (Medicare: Special coverage instructions apply) - G0071: 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 (Medicare: Carrier judgment) - G0076: 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) (Medicare: Carrier judgment) - G0077: 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) (Medicare: Carrier judgment) - G0078: 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) (Medicare: Carrier judgment) - G0079: 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) (Medicare: Carrier judgment) - G0080: 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) (Medicare: Carrier judgment) - G0081: 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) (Medicare: Carrier judgment) - G0082: 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) (Medicare: Carrier judgment) - G0083: 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) (Medicare: Carrier judgment) - G0084: 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) (Medicare: Carrier judgment) - G0085: 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) (Medicare: Carrier judgment) - G0086: 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) (Medicare: Carrier judgment) - G0087: 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) (Medicare: Carrier judgment) - G0088: 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 (Medicare: Special coverage instructions apply) - G0089: 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 (Medicare: Special coverage instructions apply) - G0090: 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 (Medicare: Special coverage instructions apply) - G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination (Medicare: Special coverage instructions apply) - G0102: Prostate cancer screening; digital rectal examination (Medicare: Special coverage instructions apply) - G0103: Prostate cancer screening; prostate specific antigen test (psa) (Medicare: Special coverage instructions apply) - G0104: Colorectal cancer screening; flexible sigmoidoscopy (Medicare: Special coverage instructions apply) - G0105: Colorectal cancer screening; colonoscopy on individual at high risk (Medicare: Special coverage instructions apply) - G0106: Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema (Medicare: Special coverage instructions apply) - G0108: Diabetes outpatient self-management training services, individual, per 30 minutes (Medicare: Carrier judgment) - G0109: Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes (Medicare: Carrier judgment) - G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist (Medicare: Carrier judgment) - G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist (Medicare: Carrier judgment) - G0120: Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema. (Medicare: Special coverage instructions apply) - G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (Medicare: Special coverage instructions apply) - G0122: Colorectal cancer screening; barium enema (Medicare: Non-covered by Medicare) - G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision (Medicare: Special coverage instructions apply) - G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician (Medicare: Special coverage instructions apply) - G0127: Trimming of dystrophic nails, any number (Medicare: Special coverage instructions apply) - G0128: 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 (Medicare: Special coverage instructions apply) - G0129: 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) (Medicare: Carrier judgment) - G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) (Medicare: Special coverage instructions apply) - G0136: Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months (Medicare: Carrier judgment) - G0137: 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 (Medicare: Carrier judgment) - G0138: 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 (Medicare: Carrier judgment) - G0140: 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 (Medicare: Carrier judgment) - G0141: Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician (Medicare: Carrier judgment) - G0143: 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 (Medicare: Carrier judgment) - G0144: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision (Medicare: Carrier judgment) - G0145: 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 (Medicare: Carrier judgment) - G0146: Principal illness navigation - peer support, additional 30 minutes per calendar month (list separately in addition to g0140) (Medicare: Carrier judgment) - G0147: Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision (Medicare: Carrier judgment) - G0148: Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening (Medicare: Carrier judgment) - G0151: Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0152: Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0153: Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0154: Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0155: Services of clinical social worker in home health or hospice settings, each 15 minutes (Medicare: Carrier judgment) - G0156: Services of home health/hospice aide in home health or hospice settings, each 15 minutes (Medicare: Carrier judgment) - G0157: Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0158: Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0159: 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 (Medicare: Carrier judgment) - G0160: 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 (Medicare: Carrier judgment) - G0161: 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 (Medicare: Carrier judgment) - G0162: 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) (Medicare: Carrier judgment) - G0163: 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) (Medicare: Carrier judgment) - G0164: 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 (Medicare: Carrier judgment) - G0166: External counterpulsation, per treatment session (Medicare: Special coverage instructions apply) - G0168: Wound closure utilizing tissue adhesive(s) only (Medicare: Carrier judgment) - G0173: Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session (Medicare: Special coverage instructions apply) - G0175: Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present (Medicare: Carrier judgment) - G0176: 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) (Medicare: Special coverage instructions apply) - G0177: Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) (Medicare: Special coverage instructions apply) - G0179: 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 (Medicare: Carrier judgment) - G0180: 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 (Medicare: Carrier judgment) - G0181: 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 (Medicare: Carrier judgment) - G0182: 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 (Medicare: Carrier judgment) - G0183: 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) (Medicare: Carrier judgment) - G0186: Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions) (Medicare: Carrier judgment) - G0202: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed (Medicare: Carrier judgment) - G0204: Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral (Medicare: Carrier judgment) - G0206: Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral (Medicare: Carrier judgment) - G0219: Pet imaging whole body; melanoma for non-covered indications (Medicare: Non-covered by Medicare) - G0235: Pet imaging, any site, not otherwise specified (Medicare: Non-covered by Medicare) - G0237: Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) (Medicare: Carrier judgment) - G0238: Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) (Medicare: Carrier judgment) - G0239: Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) (Medicare: Carrier judgment) - G0245: 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 (Medicare: Special coverage instructions apply) - G0246: 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 (Medicare: Special coverage instructions apply) - G0247: 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 (Medicare: Special coverage instructions apply) - G0248: 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 (Medicare: Special coverage instructions apply) - G0249: 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 (Medicare: Special coverage instructions apply) - G0250: 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 (Medicare: Special coverage instructions apply) - G0251: 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 (Medicare: Special coverage instructions apply) - G0252: 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) (Medicare: Non-covered by Medicare) - G0255: Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve (Medicare: Non-covered by Medicare) - G0257: Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility (Medicare: Special coverage instructions apply) - G0259: Injection procedure for sacroiliac joint; arthrography (Medicare: Special coverage instructions apply) - G0260: Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography (Medicare: Special coverage instructions apply) - G0268: Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing (Medicare: Carrier judgment) - G0269: Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug) (Medicare: Special coverage instructions apply) - G0270: 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 (Medicare: Carrier judgment) - G0271: 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 (Medicare: Carrier judgment) - G0276: 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 (Medicare: Special coverage instructions apply) - G0277: Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval (Medicare: Special coverage instructions apply) - G0278: 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) (Medicare: Carrier judgment) - G0279: Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) (Medicare: Carrier judgment) - G0281: 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 (Medicare: Carrier judgment) - G0282: Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 (Medicare: Non-covered by Medicare) - G0283: Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care (Medicare: Carrier judgment) - G0288: Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery (Medicare: Carrier judgment) - G0289: 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 (Medicare: Carrier judgment) - G0293: Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day (Medicare: Special coverage instructions apply) - G0294: Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day (Medicare: Special coverage instructions apply) - G0295: Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses (Medicare: Non-covered by Medicare) - G0296: Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) (Medicare: Carrier judgment) - G0297: Low dose ct scan (ldct) for lung cancer screening (Medicare: Carrier judgment) - G0299: Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0300: Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes (Medicare: Carrier judgment) - G0302: Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services (Medicare: Carrier judgment) - G0303: Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services (Medicare: Carrier judgment) - G0304: Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services (Medicare: Carrier judgment) - G0305: Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services (Medicare: Carrier judgment) - G0306: Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count (Medicare: Carrier judgment) - G0307: Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count) (Medicare: Carrier judgment) - G0308: Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training (Medicare: Carrier judgment) - G0309: 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 (Medicare: Carrier judgment) - G0310: 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) (Medicare: Not payable by Medicare) - G0311: 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) (Medicare: Not payable by Medicare) - G0312: 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) (Medicare: Not payable by Medicare) - G0313: 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) (Medicare: Not payable by Medicare) - G0314: 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) (Medicare: Not payable by Medicare) - G0315: 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) (Medicare: Not payable by Medicare) - G0316: 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) (Medicare: Carrier judgment) - G0317: 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) (Medicare: Carrier judgment) - G0318: 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) (Medicare: Carrier judgment) - G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system (Medicare: Carrier judgment) - G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system (Medicare: Carrier judgment) - G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring) (Medicare: Carrier judgment) - G0323: 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) (Medicare: Carrier judgment) - G0327: Colorectal cancer screening; blood-based biomarker (Medicare: Special coverage instructions apply) - G0328: Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous (Medicare: Special coverage instructions apply) - G0329: 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 (Medicare: Carrier judgment) - G0330: 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 (Medicare: Special coverage instructions apply) - G0333: Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary (Medicare: Special coverage instructions apply) - G0337: Hospice evaluation and counseling services, pre-election (Medicare: Carrier judgment) - G0339: Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment (Medicare: Carrier judgment) - G0340: 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 (Medicare: Carrier judgment) - G0341: Percutaneous islet cell transplant, includes portal vein catheterization and infusion (Medicare: Special coverage instructions apply) - G0342: Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion (Medicare: Special coverage instructions apply) - G0343: Laparotomy for islet cell transplant, includes portal vein catheterization and infusion (Medicare: Special coverage instructions apply) - G0364: Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service (Medicare: Carrier judgment) - G0365: 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) (Medicare: Carrier judgment) - G0372: Physician service required to establish and document the need for a power mobility device (Medicare: Special coverage instructions apply) - G0378: Hospital observation service, per hour (Medicare: Special coverage instructions apply) - G0379: Direct admission of patient for hospital observation care (Medicare: Special coverage instructions apply) - G0380: 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) (Medicare: Carrier judgment) - G0381: 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) (Medicare: Carrier judgment) - G0382: 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) (Medicare: Carrier judgment) - G0383: 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) (Medicare: Carrier judgment) - G0384: 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) (Medicare: Carrier judgment) - G0389: Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening (Medicare: Special coverage instructions apply) - G0390: Trauma response team associated with hospital critical care service (Medicare: Special coverage instructions apply) - G0396: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes (Medicare: Carrier judgment) - G0397: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes (Medicare: Carrier judgment) - G0398: 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 (Medicare: Carrier judgment) - G0399: 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 (Medicare: Carrier judgment) - G0400: Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels (Medicare: Carrier judgment) - G0402: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment (Medicare: Carrier judgment) - G0403: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report (Medicare: Carrier judgment) - G0404: Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination (Medicare: Carrier judgment) - G0405: Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination (Medicare: Carrier judgment) - G0406: Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth (Medicare: Carrier judgment) - G0407: Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth (Medicare: Carrier judgment) - G0408: Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth (Medicare: Carrier judgment) - G0409: 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) (Medicare: Carrier judgment) - G0410: Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes (Medicare: Carrier judgment) - G0411: Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes (Medicare: Carrier judgment) - G0412: 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 (Medicare: Carrier judgment) - G0413: 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) (Medicare: Carrier judgment) - G0414: 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) (Medicare: Carrier judgment) - G0415: 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) (Medicare: Carrier judgment) - G0416: Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method (Medicare: Carrier judgment) - G0417: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens (Medicare: Carrier judgment) - G0418: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens (Medicare: Carrier judgment) - G0419: Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens (Medicare: Carrier judgment) - G0420: Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour (Medicare: Carrier judgment) - G0421: Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour (Medicare: Carrier judgment) - G0422: Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session (Medicare: Carrier judgment) - G0423: Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session (Medicare: Carrier judgment) - G0424: Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day (Medicare: Carrier judgment) - G0425: Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth (Medicare: Carrier judgment) - G0426: Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth (Medicare: Carrier judgment) - G0427: Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth (Medicare: Carrier judgment) - G0428: Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex) (Medicare: Non-covered by Medicare) - G0429: Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) (Medicare: Carrier judgment) - G0431: Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter (Medicare: Carrier judgment) - G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening (Medicare: Carrier judgment) - G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening (Medicare: Carrier judgment) - G0434: Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter (Medicare: Carrier judgment) - G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening (Medicare: Carrier judgment) - G0436: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes (Medicare: Carrier judgment) - G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes (Medicare: Carrier judgment) - G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit (Medicare: Carrier judgment) - G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (Medicare: Carrier judgment) - G0442: Annual alcohol misuse screening, 5 to 15 minutes (Medicare: Carrier judgment) - G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes (Medicare: Carrier judgment) - G0444: Annual depression screening, 5 to 15 minutes (Medicare: Carrier judgment) - G0445: 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 (Medicare: Carrier judgment) - G0446: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes (Medicare: Carrier judgment) - G0447: Face-to-face behavioral counseling for obesity, 15 minutes (Medicare: Carrier judgment) - G0448: 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 (Medicare: Carrier judgment) - G0451: Development testing, with interpretation and report, per standardized instrument form (Medicare: Carrier judgment) - G0452: Molecular pathology procedure; physician interpretation and report (Medicare: Carrier judgment) - G0453: 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) (Medicare: Carrier judgment) - G0454: Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist (Medicare: Carrier judgment) - G0455: Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen (Medicare: Carrier judgment) - G0456: 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 (Medicare: Carrier judgment) - G0457: 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 (Medicare: Carrier judgment) - G0458: Low dose rate (ldr) prostate brachytherapy services, composite rate (Medicare: Carrier judgment) - G0459: Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy (Medicare: Carrier judgment) - G0460: 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 (Medicare: Carrier judgment) - G0461: Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain (Medicare: Carrier judgment) - G0462: Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) (Medicare: Carrier judgment) - G0463: Hospital outpatient clinic visit for assessment and management of a patient (Medicare: Carrier judgment) - G0464: Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) (Medicare: Carrier judgment) - G0465: 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) (Medicare: Carrier judgment) - G0466: 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 (Medicare: Carrier judgment) - G0467: 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 (Medicare: Carrier judgment) - G0468: 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 (Medicare: Carrier judgment) - G0469: 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 (Medicare: Carrier judgment) - G0470: 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 (Medicare: Carrier judgment) - G0471: 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) (Medicare: Carrier judgment) - G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) (Medicare: Special coverage instructions apply) - G0473: Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes (Medicare: Carrier judgment) - G0475: Hiv antigen/antibody, combination assay, screening (Medicare: Carrier judgment) - G0476: 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 (Medicare: Carrier judgment) - G0477: 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 (Medicare: Carrier judgment) - G0478: 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 (Medicare: Carrier judgment) - G0479: 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 (Medicare: Carrier judgment) - G0480: 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 (Medicare: Carrier judgment) - G0481: 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 (Medicare: Carrier judgment) - G0482: 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 (Medicare: Carrier judgment) - G0483: 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 (Medicare: Carrier judgment) - G0490: 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) (Medicare: Carrier judgment) - G0491: Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd (Medicare: Carrier judgment) - G0492: Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd (Medicare: Carrier judgment) - G0493: 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) (Medicare: Carrier judgment) - G0494: 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) (Medicare: Carrier judgment) - G0495: 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 (Medicare: Carrier judgment) - G0496: 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 (Medicare: Carrier judgment) - G0498: 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 (Medicare: Carrier judgment) - G0499: 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 (Medicare: Carrier judgment) - G0500: 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) (Medicare: Carrier judgment) - G0501: 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) (Medicare: Carrier judgment) - G0502: 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 (Medicare: Carrier judgment) - G0503: 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 (Medicare: Carrier judgment) - G0504: 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) (Medicare: Carrier judgment) - G0505: 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 (Medicare: Carrier judgment) - G0506: Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) (Medicare: Carrier judgment) - G0507: 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 (Medicare: Carrier judgment) - G0508: Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth (Medicare: Carrier judgment) - G0509: Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth (Medicare: Carrier judgment) - G0511: 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 (Medicare: Special coverage instructions apply) - G0512: 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 (Medicare: Special coverage instructions apply) - G0513: 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) (Medicare: Carrier judgment) - G0514: 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) (Medicare: Carrier judgment) - G0515: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes (Medicare: Carrier judgment) - G0516: Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant) (Medicare: Carrier judgment) - G0517: Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) (Medicare: Carrier judgment) - G0518: Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants) (Medicare: Carrier judgment) - G0519: Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model (Medicare: Carrier judgment) - G0520: Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model (Medicare: Carrier judgment) - G0521: Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model (Medicare: Carrier judgment) - G0522: Management of a new patient with dementia, low complexity, for use in cmmi model (Medicare: Carrier judgment) - G0523: Management of a new patient with dementia, moderate to high complexity, for use in cmmi model (Medicare: Carrier judgment) - G0524: Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model (Medicare: Carrier judgment) - G0525: Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model (Medicare: Carrier judgment) - G0526: Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model (Medicare: Carrier judgment) - G0527: Management of established patient with dementia, low complexity, for use in cmmi model (Medicare: Carrier judgment) - G0528: Management of established patient with dementia, moderate to high complexity, for use in cmmi model (Medicare: Carrier judgment) - G0529: In-home respite care, 4-hour unit, for use in cmmi model (Medicare: Carrier judgment) - G0530: Adult day center, 8-hour unit, for use in cmmi model (Medicare: Carrier judgment) - G0531: Facility-based respite, 24-hour unit, for use in cmmi model (Medicare: Carrier judgment) - G0532: 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) (Medicare: Carrier judgment) - G0533: 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) (Medicare: Carrier judgment) - G0534: 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) (Medicare: Carrier judgment) - G0535: 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) (Medicare: Carrier judgment) - G0536: 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) (Medicare: Carrier judgment) - G0537: Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months (Medicare: Carrier judgment) - G0538: Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month (Medicare: Carrier judgment) - G0539: 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 (Medicare: Carrier judgment) - G0540: 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 (Medicare: Carrier judgment) - G0541: 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 (Medicare: Carrier judgment) - G0542: 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) (Medicare: Carrier judgment) - G0543: 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 (Medicare: Carrier judgment) - G0544: 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 (Medicare: Carrier judgment) - G0545: 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) (Medicare: Carrier judgment) - G0546: 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 (Medicare: Carrier judgment) - G0547: 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 (Medicare: Carrier judgment) - G0548: 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 (Medicare: Carrier judgment) - G0549: 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 (Medicare: Carrier judgment) - G0550: 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 (Medicare: Carrier judgment) - G0551: 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 (Medicare: Carrier judgment) - G0552: Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan (Medicare: Carrier judgment) - G0553: 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 (Medicare: Carrier judgment) - G0554: 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 (Medicare: Carrier judgment) - G0555: Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring (Medicare: Carrier judgment) - G0556: 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 (Medicare: Carrier judgment) - G0557: 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 (Medicare: Carrier judgment) - G0558: 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 (Medicare: Carrier judgment) - G0559: 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) (Medicare: Carrier judgment) - G0560: 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 (Medicare: Carrier judgment) - G0561: 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) (Medicare: Carrier judgment) - G0562: 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) (Medicare: Carrier judgment) - G0563: 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 (Medicare: Carrier judgment) - G0564: Creation of subcutaneous pocket with insertion of 365 day implantable interstitial glucose sensor, including system activation and patient training (Medicare: Carrier judgment) - G0565: 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 (Medicare: Carrier judgment) - G0566: 3d radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy (Medicare: Carrier judgment) - G0567: Infectious agent detection by nucleic acid (dna or rna); hepatitis c, screening, amplified probe technique (Medicare: Carrier judgment) - G0568: 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) (Medicare: Carrier judgment) - G0569: 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) (Medicare: Carrier judgment) - G0570: 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) (Medicare: Carrier judgment) - G0571: Intraoperative nerve(s) cryoablation for post-surgical pain relief (list separately in addition to code for primary service) (Medicare: Carrier judgment) - G0659: 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 (Medicare: Carrier judgment) - G0660: Team remote e/m new pt 10mins (Medicare: Carrier judgment) - G0661: Team remote e/m new pt 20mins (Medicare: Carrier judgment) - G0662: Team remote e/m new pt 30 mins (Medicare: Carrier judgment) - G0663: Team remote e/m new pt 45mins (Medicare: Carrier judgment) - G0664: Team remote e/m new pt 60mins (Medicare: Carrier judgment) - G0665: Team remote e/m est. pt 10mins (Medicare: Carrier judgment) - G0666: Team remote e/m est. pt 15mins (Medicare: Carrier judgment) - G0667: Team remote e/m est. pt 25mins (Medicare: Carrier judgment) - G0668: Team remote e/m est. pt 40mins (Medicare: Carrier judgment) - G0680: Detection and quantification of coronary artery calcium and/or aortic valve calcification from algorithmic analysis of computed tomography of the chest with report (Medicare: Special coverage instructions apply) - G0681: 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 (Medicare: Carrier judgment) - G0682: 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) (Medicare: Carrier judgment) - G0683: 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 (Medicare: Carrier judgment) - G0684: 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) (Medicare: Carrier judgment) - G0908: Most recent hemoglobin (hgb) level > 12.0 g/dl (Medicare: Carrier judgment) - G0909: Hemoglobin level measurement not documented, reason not given (Medicare: Carrier judgment) - G0910: Most recent hemoglobin level <= 12.0 g/dl (Medicare: Carrier judgment) - G0913: Improvement in visual function achieved within 90 days following cataract surgery (Medicare: Carrier judgment) - G0914: Patient care survey was not completed by patient (Medicare: Carrier judgment) - G0915: Improvement in visual function not achieved within 90 days following cataract surgery (Medicare: Carrier judgment) - G0916: Satisfaction with care achieved within 90 days following cataract surgery (Medicare: Carrier judgment) - G0917: Patient care survey was not completed by patient (Medicare: Carrier judgment) - G0918: Satisfaction with care not achieved within 90 days following cataract surgery (Medicare: Carrier judgment) - G0919: Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit (Medicare: Carrier judgment) - G0920: Type, anatomic location, and activity all documented (Medicare: Carrier judgment) - G0921: Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment) (Medicare: Carrier judgment) - G0922: No documentation of disease type, anatomic location, and activity, reason not given (Medicare: Carrier judgment) - G1000: Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1001: Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1002: Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1003: Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1004: Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1005: Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1006: Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1007: Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1008: Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1009: Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1010: Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1011: Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1012: Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1013: Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1014: Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1015: Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1016: Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1017: Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1018: Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1019: Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1020: Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1021: Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1022: Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1023: Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1024: Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program (Medicare: Carrier judgment) - G1025: Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month (Medicare: Carrier judgment) - G1026: 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 (Medicare: Carrier judgment) - G1027: 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 (Medicare: Carrier judgment) - G1028: 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 (Medicare: Carrier judgment) - G2000: 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 (Medicare: Carrier judgment) - G2001: 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.) (Medicare: Carrier judgment) - G2002: 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.) (Medicare: Carrier judgment) - G2003: 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.) (Medicare: Carrier judgment) - G2004: 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.) (Medicare: Carrier judgment) - G2005: 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.) (Medicare: Carrier judgment) - G2006: 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.) (Medicare: Carrier judgment) - G2007: 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.) (Medicare: Carrier judgment) - G2008: 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.) (Medicare: Carrier judgment) - G2009: 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.) (Medicare: Carrier judgment) - G2010: 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 (Medicare: Carrier judgment) - G2011: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes (Medicare: Carrier judgment) - G2012: 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 (Medicare: Carrier judgment) - G2013: 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.) (Medicare: Carrier judgment) - G2014: 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.) (Medicare: Carrier judgment) - G2015: 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.) (Medicare: Carrier judgment) - G2020: 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) (Medicare: Carrier judgment) - G2021: Health care practitioners rendering treatment in place (tip) (Medicare: Carrier judgment) - G2022: A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place) (Medicare: Carrier judgment) - G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source (Medicare: Carrier judgment) - G2024: 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 (Medicare: Carrier judgment) - G2025: Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only (Medicare: Carrier judgment) - G2058: 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)). (Medicare: Carrier judgment) - G2061: 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 (Medicare: Carrier judgment) - G2062: 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 (Medicare: Carrier judgment) - G2063: 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 (Medicare: Carrier judgment) - G2064: 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 (Medicare: Carrier judgment) - G2065: 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 (Medicare: Carrier judgment) - G2066: 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 (Medicare: Carrier judgment) - G2067: 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) (Medicare: Carrier judgment) - G2068: 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) (Medicare: Carrier judgment) - G2069: 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) (Medicare: Carrier judgment) - G2070: 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) (Medicare: Carrier judgment) - G2071: 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) (Medicare: Carrier judgment) - G2072: 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) (Medicare: Carrier judgment) - G2073: 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) (Medicare: Carrier judgment) - G2074: 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) (Medicare: Carrier judgment) - G2075: 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) (Medicare: Carrier judgment) - G2076: 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 (Medicare: Carrier judgment) - G2077: 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 (Medicare: Carrier judgment) - G2078: 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 (Medicare: Carrier judgment) - G2079: 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 (Medicare: Carrier judgment) - G2080: 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 (Medicare: Carrier judgment) - G2081: 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 (Medicare: Carrier judgment) - G2082: 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 (Medicare: Carrier judgment) - G2083: 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 (Medicare: Carrier judgment) - G2086: 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 (Medicare: Carrier judgment) - G2087: 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 (Medicare: Carrier judgment) - G2088: 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) (Medicare: Carrier judgment) - G2089: Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0% (Medicare: Carrier judgment) - G2090: 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 (Medicare: Carrier judgment) - G2091: 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 (Medicare: Carrier judgment) - G2092: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken (Medicare: Carrier judgment) - G2093: 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) (Medicare: Carrier judgment) - G2094: Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons) (Medicare: Carrier judgment) - G2095: Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons) (Medicare: Carrier judgment) - G2096: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given (Medicare: Carrier judgment) - G2097: 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) (Medicare: Carrier judgment) - G2098: 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 (Medicare: Carrier judgment) - G2099: 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 (Medicare: Carrier judgment) - G2100: 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 (Medicare: Carrier judgment) - G2101: 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 (Medicare: Carrier judgment) - G2102: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed (Medicare: Carrier judgment) - G2103: Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed (Medicare: Carrier judgment) - G2104: Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed (Medicare: Carrier judgment) - G2105: 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 (Medicare: Carrier judgment) - G2106: 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 (Medicare: Carrier judgment) - G2107: 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 (Medicare: Carrier judgment) - G2108: 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 (Medicare: Carrier judgment) - G2109: 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 (Medicare: Carrier judgment) - G2110: 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 (Medicare: Carrier judgment) - G2112: Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months (Medicare: Carrier judgment) - G2113: Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity (Medicare: Carrier judgment) - G2114: 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 (Medicare: Carrier judgment) - G2115: 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 (Medicare: Carrier judgment) - G2116: 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 (Medicare: Carrier judgment) - G2117: 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 (Medicare: Carrier judgment) - G2118: Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period (Medicare: Carrier judgment) - G2119: Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed (Medicare: Carrier judgment) - G2120: Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed (Medicare: Carrier judgment) - G2121: Depression, anxiety, apathy, and psychosis assessed (Medicare: Carrier judgment) - G2122: Depression, anxiety, apathy, and psychosis not assessed (Medicare: Carrier judgment) - G2123: 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 (Medicare: Carrier judgment) - G2124: Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication (Medicare: Carrier judgment) - G2125: 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 (Medicare: Carrier judgment) - G2126: 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 (Medicare: Carrier judgment) - G2127: 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 (Medicare: Carrier judgment) - G2128: 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) (Medicare: Carrier judgment) - G2129: 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 (Medicare: Carrier judgment) - G2130: 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 (Medicare: Carrier judgment) - G2131: Patients 81 years and older with a diagnosis of frailty (Medicare: Carrier judgment) - G2132: 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 (Medicare: Carrier judgment) - G2133: 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 (Medicare: Carrier judgment) - G2134: 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 (Medicare: Carrier judgment) - G2135: 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 (Medicare: Carrier judgment) - G2136: 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 (Medicare: Carrier judgment) - G2137: 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 (Medicare: Carrier judgment) - G2138: 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 (Medicare: Carrier judgment) - G2139: 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 (Medicare: Carrier judgment) - G2140: 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 (Medicare: Carrier judgment) - G2141: 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 (Medicare: Carrier judgment) - G2142: 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 (Medicare: Carrier judgment) - G2143: 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 (Medicare: Carrier judgment) - G2144: 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 (Medicare: Carrier judgment) - G2145: 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 (Medicare: Carrier judgment) - G2146: 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 (Medicare: Carrier judgment) - G2147: 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 (Medicare: Carrier judgment) - G2148: Multimodal pain management was used (Medicare: Carrier judgment) - G2149: 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)) (Medicare: Carrier judgment) - G2150: Multimodal pain management was not used (Medicare: Carrier judgment) - G2151: 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 (Medicare: Carrier judgment) - G2152: Residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) (Medicare: Carrier judgment) - G2153: In hospice or using hospice services during the measurement period (Medicare: Carrier judgment) - G2154: 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 (Medicare: Carrier judgment) - G2155: 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.) (Medicare: Carrier judgment) - G2156: 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.) (Medicare: Carrier judgment) - G2157: 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 (Medicare: Carrier judgment) - G2158: Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period (Medicare: Carrier judgment) - G2159: 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 (Medicare: Carrier judgment) - G2160: 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 (Medicare: Carrier judgment) - G2161: Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period (Medicare: Carrier judgment) - G2162: 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 (Medicare: Carrier judgment) - G2163: 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 (Medicare: Carrier judgment) - G2164: Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period (Medicare: Carrier judgment) - G2165: 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 (Medicare: Carrier judgment) - G2166: 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 (Medicare: Carrier judgment) - G2167: Residual score for the neck impairment successfully calculated and the score was less than zero (< 0) (Medicare: Carrier judgment) - G2168: 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 (Medicare: Carrier judgment) - G2169: 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 (Medicare: Carrier judgment) - G2170: 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 (Medicare: Carrier judgment) - G2171: 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 (Medicare: Carrier judgment) - G2172: All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project (Medicare: Carrier judgment) - G2173: 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) (Medicare: Carrier judgment) - G2174: Uri episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date (Medicare: Carrier judgment) - G2175: 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) (Medicare: Carrier judgment) - G2176: Outpatient, ed, or observation visits that result in an inpatient admission (Medicare: Carrier judgment) - G2177: 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 (Medicare: Carrier judgment) - G2178: 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 (Medicare: Carrier judgment) - G2179: Clinician documented that patient had medical reason for not performing lower extremity neurological exam (Medicare: Carrier judgment) - G2180: Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee (Medicare: Carrier judgment) - G2181: Bmi not documented due to medical reason or patient refusal of height or weight measurement (Medicare: Carrier judgment) - G2182: Patient receiving first-time biologic and/or immune response modifier therapy (Medicare: Carrier judgment) - G2183: Documentation patient unable to communicate and informant not available (Medicare: Carrier judgment) - G2184: Patient does not have a caregiver (Medicare: Carrier judgment) - G2185: Documentation caregiver is trained and certified in dementia care (Medicare: Carrier judgment) - G2186: Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed (Medicare: Carrier judgment) - G2187: Patients with clinical indications for imaging of the head: head trauma (Medicare: Carrier judgment) - G2188: Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age (Medicare: Carrier judgment) - G2189: Patients with clinical indications for imaging of the head: abnormal neurologic exam (Medicare: Carrier judgment) - G2190: Patients with clinical indications for imaging of the head: headache radiating to the neck (Medicare: Carrier judgment) - G2191: Patients with clinical indications for imaging of the head: positional headaches (Medicare: Carrier judgment) - G2192: Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age (Medicare: Carrier judgment) - G2193: Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age) (Medicare: Carrier judgment) - G2194: 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 (Medicare: Carrier judgment) - G2195: Patients with clinical indications for imaging of the head: occipital headache in children (Medicare: Carrier judgment) - G2196: Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method (Medicare: Carrier judgment) - G2197: Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user (Medicare: Carrier judgment) - G2198: 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) (Medicare: Carrier judgment) - G2199: Patient not screened for unhealthy alcohol use using a systematic screening method (Medicare: Carrier judgment) - G2200: Patient identified as an unhealthy alcohol user received brief counseling (Medicare: Carrier judgment) - G2201: Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons) (Medicare: Carrier judgment) - G2202: Patient did not receive brief counseling if identified as an unhealthy alcohol user (Medicare: Carrier judgment) - G2203: 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) (Medicare: Carrier judgment) - G2204: Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period (Medicare: Carrier judgment) - G2205: Patients with pregnancy during adjuvant treatment course (Medicare: Carrier judgment) - G2206: Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy (Medicare: Carrier judgment) - G2207: 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) (Medicare: Carrier judgment) - G2208: Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy (Medicare: Carrier judgment) - G2209: Patient refused to participate (Medicare: Carrier judgment) - G2210: 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 (Medicare: Carrier judgment) - G2211: 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) (Medicare: Carrier judgment) - G2212: 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) (Medicare: Carrier judgment) - G2213: 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) (Medicare: Carrier judgment) - G2214: 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 (Medicare: Carrier judgment) - G2215: 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 (Medicare: Carrier judgment) - G2216: 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 (Medicare: Carrier judgment) - G2250: 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 (Medicare: Carrier judgment) - G2251: 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 (Medicare: Carrier judgment) - G2252: 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 (Medicare: Carrier judgment) - G3001: Administration and supply of tositumomab, 450 mg (Medicare: Carrier judgment) - G3002: 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.) (Medicare: Carrier judgment) - G3003: 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.) (Medicare: Carrier judgment) - G4000: Dermatology mips specialty set (Medicare: Carrier judgment) - G4001: Diagnostic radiology mips specialty set (Medicare: Carrier judgment) - G4002: Electrophysiology cardiac specialist mips specialty set (Medicare: Carrier judgment) - G4003: Emergency medicine mips specialty set (Medicare: Carrier judgment) - G4004: Endocrinology mips specialty set (Medicare: Carrier judgment) - G4005: Family medicine mips specialty set (Medicare: Carrier judgment) - G4006: Gastro-enterology mips specialty set (Medicare: Carrier judgment) - G4007: General surgery mips specialty set (Medicare: Carrier judgment) - G4008: Geriatrics mips specialty set (Medicare: Carrier judgment) - G4009: Hospitalists mips specialty set (Medicare: Carrier judgment) - G4010: Infectious disease mips specialty set (Medicare: Carrier judgment) - G4011: Internal medicine mips specialty set (Medicare: Carrier judgment) - G4012: Interventional radiology mips specialty set (Medicare: Carrier judgment) - G4013: Mental/behavioral and psychiatry mips specialty set (Medicare: Carrier judgment) - G4014: Nephrology mips specialty set (Medicare: Carrier judgment) - G4015: Neurology mips specialty set (Medicare: Carrier judgment) - G4016: Neurosurgical mips specialty set (Medicare: Carrier judgment) - G4017: Nutrition/dietician mips specialty set (Medicare: Carrier judgment) - G4018: Obstetrics/gynecology mips specialty set (Medicare: Carrier judgment) - G4019: Oncology/hematology mips specialty set (Medicare: Carrier judgment) - G4020: Ophthalmology/optometry mips specialty set (Medicare: Carrier judgment) - G4021: Orthopedic surgery mips specialty set (Medicare: Carrier judgment) - G4022: Otolaryngology mips specialty set (Medicare: Carrier judgment) - G4023: Pathology mips specialty set (Medicare: Carrier judgment) - G4024: Pediatrics mips specialty set (Medicare: Carrier judgment) - G4025: Physical medicine mips specialty set (Medicare: Carrier judgment) - G4026: Physical therapy/occupational therapy mips specialty set (Medicare: Carrier judgment) - G4027: Plastic surgery mips specialty set (Medicare: Carrier judgment) - G4028: Podiatry mips specialty set (Medicare: Carrier judgment) - G4029: Preventive medicine mips specialty set (Medicare: Carrier judgment) - G4030: Pulmonology mips specialty set (Medicare: Carrier judgment) - G4031: Radiation oncology mips specialty set (Medicare: Carrier judgment) - G4032: Rheumatology mips specialty set (Medicare: Carrier judgment) - G4033: Skilled nursing facility mips specialty set (Medicare: Carrier judgment) - G4034: Speech language pathology mips specialty set (Medicare: Carrier judgment) - G4035: Thoracic surgery mips specialty set (Medicare: Carrier judgment) - G4036: Urgent care mips specialty set (Medicare: Carrier judgment) - G4037: Urology mips specialty set (Medicare: Carrier judgment) - G4038: Vascular surgery mips specialty set (Medicare: Carrier judgment) - G6001: Ultrasonic guidance for placement of radiation therapy fields (Medicare: Special coverage instructions apply) - G6002: Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy (Medicare: Carrier judgment) - G6003: Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev (Medicare: Carrier judgment) - G6004: Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev (Medicare: Carrier judgment) - G6005: Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev (Medicare: Carrier judgment) - G6006: Radiation treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater (Medicare: Carrier judgment) - G6007: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev (Medicare: Carrier judgment) - G6008: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev (Medicare: Carrier judgment) - G6009: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev (Medicare: Carrier judgment) - G6010: Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater (Medicare: Carrier judgment) - G6011: Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev (Medicare: Carrier judgment) - G6012: Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev (Medicare: Carrier judgment) - G6013: Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev (Medicare: Carrier judgment) - G6014: Radiation treatment delivery, 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater (Medicare: Carrier judgment) - G6015: Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session (Medicare: Carrier judgment) - G6016: 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 (Medicare: Carrier judgment) - G6017: 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 (Medicare: Carrier judgment) - G6018: Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation) (Medicare: Carrier judgment) - G6019: 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 (Medicare: Carrier judgment) - G6020: Colonoscopy through stoma; with transendoscopic stent placement (includes predilation) (Medicare: Carrier judgment) - G6021: Unlisted procedure, intestine (Medicare: Carrier judgment) - G6022: 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 (Medicare: Carrier judgment) - G6023: Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation) (Medicare: Carrier judgment) - G6024: 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 (Medicare: Carrier judgment) - G6025: Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation) (Medicare: Carrier judgment) - G6027: Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed (Medicare: Carrier judgment) - G6028: Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies) (Medicare: Carrier judgment) - G6030: Amitriptyline (Medicare: Carrier judgment) - G6031: Benzodiazepines (Medicare: Carrier judgment) - G6032: Desipramine (Medicare: Carrier judgment) - G6034: Doxepin (Medicare: Carrier judgment) - G6035: Gold (Medicare: Carrier judgment) - G6036: Assay of imipramine (Medicare: Carrier judgment) - G6037: Nortriptyline (Medicare: Carrier judgment) - G6038: Salicylate (Medicare: Carrier judgment) - G6039: Acetaminophen (Medicare: Carrier judgment) - G6040: Alcohol (ethanol); any specimen except breath (Medicare: Carrier judgment) - G6041: Alkaloids, urine, quantitative (Medicare: Carrier judgment) - G6042: Amphetamine or methamphetamine (Medicare: Carrier judgment) - G6043: Barbiturates, not elsewhere specified (Medicare: Carrier judgment) - G6044: Cocaine or metabolite (Medicare: Carrier judgment) - G6045: Dihydrocodeinone (Medicare: Carrier judgment) - G6046: Dihydromorphinone (Medicare: Carrier judgment) - G6047: Dihydrotestosterone (Medicare: Carrier judgment) - G6048: Dimethadione (Medicare: Carrier judgment) - G6049: Epiandrosterone (Medicare: Carrier judgment) - G6050: Ethchlorvynol (Medicare: Carrier judgment) - G6051: Flurazepam (Medicare: Carrier judgment) - G6052: Meprobamate (Medicare: Carrier judgment) - G6053: Methadone (Medicare: Carrier judgment) - G6054: Methsuximide (Medicare: Carrier judgment) - G6055: Nicotine (Medicare: Carrier judgment) - G6056: Opiate(s), drug and metabolites, each procedure (Medicare: Carrier judgment) - G6057: Phenothiazine (Medicare: Carrier judgment) - G6058: Drug confirmation, each procedure (Medicare: Carrier judgment) - G8126: Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase (Medicare: Carrier judgment) - G8127: 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 (Medicare: Carrier judgment) - G8128: Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure (Medicare: Carrier judgment) - G8395: Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function (Medicare: Carrier judgment) - G8396: Left ventricular ejection fraction (lvef) not performed or documented (Medicare: Carrier judgment) - G8397: Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy (Medicare: Carrier judgment) - G8398: Dilated macular or fundus exam not performed (Medicare: Carrier judgment) - G8399: Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed (Medicare: Carrier judgment) - G8400: Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given (Medicare: Carrier judgment) - G8401: Clinician documented that patient was not an eligible candidate for screening (Medicare: Carrier judgment) - G8404: Lower extremity neurological exam performed and documented (Medicare: Carrier judgment) - G8405: Lower extremity neurological exam not performed (Medicare: Carrier judgment) - G8406: Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure (Medicare: Carrier judgment) - G8410: Footwear evaluation performed and documented (Medicare: Carrier judgment) - G8415: Footwear evaluation was not performed (Medicare: Carrier judgment) - G8416: Clinician documented that patient was not an eligible candidate for footwear evaluation measure (Medicare: Carrier judgment) - G8417: Bmi is documented above normal parameters and a follow-up plan is documented (Medicare: Carrier judgment) - G8418: Bmi is documented below normal parameters and a follow-up plan is documented (Medicare: Carrier judgment) - G8419: Bmi documented outside normal parameters, no follow-up plan documented, no reason given (Medicare: Carrier judgment) - G8420: Bmi is documented within normal parameters and no follow-up plan is required (Medicare: Carrier judgment) - G8421: Bmi not documented and no reason is given (Medicare: Carrier judgment) - G8422: Bmi not documented, documentation the patient is not eligible for bmi calculation (Medicare: Carrier judgment) - G8427: Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications (Medicare: Carrier judgment) - G8428: Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given (Medicare: Carrier judgment) - G8430: 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) (Medicare: Carrier judgment) - G8431: Screening for depression is documented as being positive and a follow-up plan is documented (Medicare: Carrier judgment) - G8432: Depression screening not documented, reason not given (Medicare: Carrier judgment) - G8433: Screening for depression not completed, documented patient or medical reason (Medicare: Carrier judgment) - G8442: 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 (Medicare: Carrier judgment) - G8450: Beta-blocker therapy prescribed (Medicare: Carrier judgment) - G8451: 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) (Medicare: Carrier judgment) - G8452: Beta-blocker therapy not prescribed (Medicare: Carrier judgment) - G8458: 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) (Medicare: Carrier judgment) - G8460: Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c (Medicare: Carrier judgment) - G8461: Patient receiving antiviral treatment for hepatitis c during the measurement period (Medicare: Carrier judgment) - G8464: 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 (Medicare: Carrier judgment) - G8465: High or very high risk of recurrence of prostate cancer (Medicare: Carrier judgment) - G8473: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed (Medicare: Carrier judgment) - G8474: 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) (Medicare: Carrier judgment) - G8475: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given (Medicare: Carrier judgment) - G8476: Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg (Medicare: Carrier judgment) - G8477: Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg (Medicare: Carrier judgment) - G8478: Blood pressure measurement not performed or documented, reason not given (Medicare: Carrier judgment) - G8482: Influenza immunization administered or previously received (Medicare: Carrier judgment) - G8483: 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) (Medicare: Carrier judgment) - G8484: Influenza immunization was not administered, reason not given (Medicare: Carrier judgment) - G8485: I intend to report the diabetes mellitus (dm) measures group (Medicare: Carrier judgment) - G8486: I intend to report the preventive care measures group (Medicare: Carrier judgment) - G8487: I intend to report the chronic kidney disease (ckd) measures group (Medicare: Carrier judgment) - G8489: I intend to report the coronary artery disease (cad) measures group (Medicare: Carrier judgment) - G8490: I intend to report the rheumatoid arthritis (ra) measures group (Medicare: Carrier judgment) - G8491: I intend to report the hiv/aids measures group (Medicare: Carrier judgment) - G8492: I intend to report the perioperative care measures group (Medicare: Carrier judgment) - G8493: I intend to report the back pain measures group (Medicare: Carrier judgment) - G8494: All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient (Medicare: Carrier judgment) - G8495: All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient (Medicare: Carrier judgment) - G8496: All quality actions for the applicable measures in the preventive care measures group have been performed for this patient (Medicare: Carrier judgment) - G8497: All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient (Medicare: Carrier judgment) - G8498: All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient (Medicare: Carrier judgment) - G8499: All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient (Medicare: Carrier judgment) - G8500: All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient (Medicare: Carrier judgment) - G8501: All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient (Medicare: Carrier judgment) - G8502: All quality actions for the applicable measures in the back pain measures group have been performed for this patient (Medicare: Carrier judgment) - G8506: Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (Medicare: Carrier judgment) - G8509: Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given (Medicare: Carrier judgment) - G8510: Screening for depression is documented as negative, a follow-up plan is not required (Medicare: Carrier judgment) - G8511: Screening for depression documented as positive, follow-up plan not documented, reason not given (Medicare: Carrier judgment) - G8530: Autogenous av fistula received (Medicare: Carrier judgment) - G8531: Clinician documented that patient was not an eligible candidate for autogenous av fistula (Medicare: Carrier judgment) - G8532: Clinician documented that patient received vascular access other than autogenous av fistula, reason not given (Medicare: Carrier judgment) - G8535: 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 (Medicare: Carrier judgment) - G8536: No documentation of an elder maltreatment screen, reason not given (Medicare: Carrier judgment) - G8539: 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 (Medicare: Carrier judgment) - G8540: 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 (Medicare: Carrier judgment) - G8541: Functional outcome assessment using a standardized tool not documented, reason not given (Medicare: Carrier judgment) - G8542: Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required (Medicare: Carrier judgment) - G8543: Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given (Medicare: Carrier judgment) - G8544: I intend to report the coronary artery bypass graft (cabg) measures group (Medicare: Carrier judgment) - G8545: I intend to report the hepatitis c measures group (Medicare: Carrier judgment) - G8547: I intend to report the ischemic vascular disease (ivd) measures group (Medicare: Carrier judgment) - G8548: I intend to report the heart failure (hf) measures group (Medicare: Carrier judgment) - G8549: All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient (Medicare: Carrier judgment) - G8551: All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient (Medicare: Carrier judgment) - G8552: All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient (Medicare: Carrier judgment) - G8559: Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation (Medicare: Carrier judgment) - G8560: Patient has a history of active drainage from the ear within the previous 90 days (Medicare: Carrier judgment) - G8561: Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure (Medicare: Carrier judgment) - G8562: Patient does not have a history of active drainage from the ear within the previous 90 days (Medicare: Carrier judgment) - G8563: Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given (Medicare: Carrier judgment) - G8564: Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified) (Medicare: Carrier judgment) - G8565: Verification and documentation of sudden or rapidly progressive hearing loss (Medicare: Carrier judgment) - G8566: Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure (Medicare: Carrier judgment) - G8567: Patient does not have verification and documentation of sudden or rapidly progressive hearing loss (Medicare: Carrier judgment) - G8568: Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given (Medicare: Carrier judgment) - G8569: Prolonged postoperative intubation (> 24 hrs) required (Medicare: Carrier judgment) - G8570: Prolonged postoperative intubation (> 24 hrs) not required (Medicare: Carrier judgment) - G8571: Development of deep sternal wound infection/mediastinitis within 30 days postoperatively (Medicare: Carrier judgment) - G8572: No deep sternal wound infection/mediastinitis (Medicare: Carrier judgment) - G8573: Stroke following isolated cabg surgery (Medicare: Carrier judgment) - G8574: No stroke following isolated cabg surgery (Medicare: Carrier judgment) - G8575: Developed postoperative renal failure or required dialysis (Medicare: Carrier judgment) - G8576: No postoperative renal failure/dialysis not required (Medicare: Carrier judgment) - G8577: 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 (Medicare: Carrier judgment) - G8578: 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 (Medicare: Carrier judgment) - G8579: Antiplatelet medication at discharge (Medicare: Carrier judgment) - G8580: Antiplatelet medication contraindicated (Medicare: Carrier judgment) - G8581: No antiplatelet medication at discharge (Medicare: Carrier judgment) - G8582: Beta-blocker at discharge (Medicare: Carrier judgment) - G8583: Beta-blocker contraindicated (Medicare: Carrier judgment) - G8584: No beta-blocker at discharge (Medicare: Carrier judgment) - G8585: Anti-lipid treatment at discharge (Medicare: Carrier judgment) - G8586: Anti-lipid treatment contraindicated (Medicare: Carrier judgment) - G8587: No anti-lipid treatment at discharge (Medicare: Carrier judgment) - G8593: Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) (Medicare: Carrier judgment) - G8594: Lipid profile not performed, reason not given (Medicare: Carrier judgment) - G8595: Most recent ldl-c < 100 mg/dl (Medicare: Carrier judgment) - G8597: Most recent ldl-c >= 100 mg/dl (Medicare: Carrier judgment) - G8598: Aspirin or another antiplatelet therapy used (Medicare: Carrier judgment) - G8599: Aspirin or another antiplatelet therapy not used, reason not given (Medicare: Carrier judgment) - G8600: Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well (Medicare: Carrier judgment) - G8601: 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) (Medicare: Carrier judgment) - G8602: Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given (Medicare: Carrier judgment) - G8627: 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) (Medicare: Carrier judgment) - G8628: 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) (Medicare: Carrier judgment) - G8629: 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) (Medicare: Carrier judgment) - G8630: 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 (Medicare: Carrier judgment) - G8631: 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) (Medicare: Carrier judgment) - G8632: 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 (Medicare: Carrier judgment) - G8633: Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (Medicare: Carrier judgment) - G8634: Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis (Medicare: Carrier judgment) - G8635: Pharmacologic therapy for osteoporosis was not prescribed, reason not given (Medicare: Carrier judgment) - G8645: I intend to report the asthma measures group (Medicare: Carrier judgment) - G8646: All quality actions for the applicable measures in the asthma measures group have been performed for this patient (Medicare: Carrier judgment) - G8647: Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) (Medicare: Carrier judgment) - G8648: Residual score for the knee impairment successfully calculated and the score was less than zero (< 0) (Medicare: Carrier judgment) - G8649: 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 (Medicare: Carrier judgment) - G8650: 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 (Medicare: Carrier judgment) - G8651: Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) (Medicare: Carrier judgment) - G8652: Residual score for the hip impairment successfully calculated and the score was less than zero (< 0) (Medicare: Carrier judgment) - G8653: 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 (Medicare: Carrier judgment) - G8654: 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 (Medicare: Carrier judgment) - G8655: 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) (Medicare: Carrier judgment) - G8656: Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0) (Medicare: Carrier judgment) - G8657: 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 (Medicare: Carrier judgment) - G8658: 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 (Medicare: Carrier judgment) - G8659: Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) (Medicare: Carrier judgment) - G8660: Residual score for the low back impairment successfully calculated and the score was less than zero (< 0) (Medicare: Carrier judgment) - G8661: 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 (Medicare: Carrier judgment) - G8662: 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 (Medicare: Carrier judgment) - G8663: Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) (Medicare: Carrier judgment) - G8664: Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0) (Medicare: Carrier judgment) - G8665: 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 (Medicare: Carrier judgment) - G8666: 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 (Medicare: Carrier judgment) - G8667: Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) (Medicare: Carrier judgment) - G8668: Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0) (Medicare: Carrier judgment) - G8669: 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 (Medicare: Carrier judgment) - G8670: 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 (Medicare: Carrier judgment) - G8671: 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) (Medicare: Carrier judgment) - G8672: 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) (Medicare: Carrier judgment) - G8673: 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 (Medicare: Carrier judgment) - G8674: 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 (Medicare: Carrier judgment) - G8682: Lvf testing documented as being performed prior to discharge or in the previous 12 months (Medicare: Carrier judgment) - G8683: Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason (Medicare: Carrier judgment) - G8685: Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given (Medicare: Carrier judgment) - G8694: Current or prior left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd (Medicare: Carrier judgment) - G8696: Antithrombotic therapy prescribed at discharge (Medicare: Carrier judgment) - G8697: 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)) (Medicare: Carrier judgment) - G8698: Antithrombotic therapy was not prescribed at discharge, reason not given (Medicare: Carrier judgment) - G8699: Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge (Medicare: Carrier judgment) - G8700: Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge (Medicare: Carrier judgment) - G8701: Rehabilitation services were not ordered, reason not otherwise specified (Medicare: Carrier judgment) - G8702: Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively (Medicare: Carrier judgment) - G8703: Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively (Medicare: Carrier judgment) - G8704: 12-lead electrocardiogram (ecg) performed (Medicare: Carrier judgment) - G8705: Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg) (Medicare: Carrier judgment) - G8706: Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg) (Medicare: Carrier judgment) - G8707: 12-lead electrocardiogram (ecg) not performed, reason not given (Medicare: Carrier judgment) - G8708: Patient not prescribed antibiotic (Medicare: Carrier judgment) - G8709: 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) (Medicare: Carrier judgment) - G8710: Patient prescribed antibiotic (Medicare: Carrier judgment) - G8711: Prescribed antibiotic on or within 3 days after the episode date (Medicare: Carrier judgment) - G8712: Antibiotic not prescribed or dispensed (Medicare: Carrier judgment) - G8713: Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v]) (Medicare: Carrier judgment) - G8714: Hemodialysis treatment performed exactly three times per week for > 90 days (Medicare: Carrier judgment) - G8717: Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given (Medicare: Carrier judgment) - G8718: Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v]) (Medicare: Carrier judgment) - G8720: Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v]) (Medicare: Carrier judgment) - G8721: Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report (Medicare: Carrier judgment) - G8722: 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) (Medicare: Carrier judgment) - G8723: Specimen site is other than anatomic location of primary tumor (Medicare: Carrier judgment) - G8724: Pt category, pn category and histologic grade were not documented in the pathology report, reason not given (Medicare: Carrier judgment) - G8725: Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol) (Medicare: Carrier judgment) - G8726: Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons) (Medicare: Carrier judgment) - G8728: Fasting lipid profile not performed, reason not given (Medicare: Carrier judgment) - G8730: Pain assessment documented as positive using a standardized tool and a follow-up plan is documented (Medicare: Carrier judgment) - G8731: Pain assessment using a standardized tool is documented as negative, no follow-up plan required (Medicare: Carrier judgment) - G8732: No documentation of pain assessment, reason not given (Medicare: Carrier judgment) - G8733: Elder maltreatment screen documented as positive and a follow-up plan is documented (Medicare: Carrier judgment) - G8734: Elder maltreatment screen documented as negative, follow-up is not required (Medicare: Carrier judgment) - G8735: Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given (Medicare: Carrier judgment) - G8736: Most current ldl-c <100mg/dl (Medicare: Carrier judgment) - G8737: Most current ldl-c >=100mg/dl (Medicare: Carrier judgment) - G8738: Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function (Medicare: Carrier judgment) - G8739: Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function (Medicare: Carrier judgment) - G8740: Left ventricular ejection fraction (lvef) not performed or assessed, reason not given (Medicare: Carrier judgment) - G8749: 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) (Medicare: Carrier judgment) - G8751: Smoking status and exposure to second hand smoke in the home not assessed, reason not given (Medicare: Carrier judgment) - G8752: Most recent systolic blood pressure < 140 mmhg (Medicare: Carrier judgment) - G8753: Most recent systolic blood pressure >= 140 mmhg (Medicare: Carrier judgment) - G8754: Most recent diastolic blood pressure < 90 mmhg (Medicare: Carrier judgment) - G8755: Most recent diastolic blood pressure >= 90 mmhg (Medicare: Carrier judgment) - G8756: No documentation of blood pressure measurement, reason not given (Medicare: Carrier judgment) - G8757: All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient (Medicare: Carrier judgment) - G8758: All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient (Medicare: Carrier judgment) - G8759: All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient (Medicare: Carrier judgment) - G8761: All quality actions for the applicable measures in the dementia measures group have been performed for this patient (Medicare: Carrier judgment) - G8762: All quality actions for the applicable measures in the parkinson's disease measures group have been performed for this patient (Medicare: Carrier judgment) - G8763: All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient (Medicare: Carrier judgment) - G8764: All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient (Medicare: Carrier judgment) - G8765: All quality actions for the applicable measures in the cataract measures group have been performed for this patient (Medicare: Carrier judgment) - G8767: Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) (Medicare: Carrier judgment) - G8768: 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) (Medicare: Carrier judgment) - G8769: Lipid profile not performed, reason not given (Medicare: Carrier judgment) - G8770: Urine protein test result documented and reviewed (Medicare: Carrier judgment) - G8771: Documentation of diagnosis of chronic kidney disease (Medicare: Carrier judgment) - G8772: 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) (Medicare: Carrier judgment) - G8773: Urine protein test was not performed, reason not given (Medicare: Carrier judgment) - G8774: Serum creatinine test result documented and reviewed (Medicare: Carrier judgment) - G8775: 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) (Medicare: Carrier judgment) - G8776: Serum creatinine test not performed, reason not given (Medicare: Carrier judgment) - G8777: Diabetes screening test performed (Medicare: Carrier judgment) - G8778: 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) (Medicare: Carrier judgment) - G8779: Diabetes screening test not performed, reason not given (Medicare: Carrier judgment) - G8780: Counseling for diet and physical activity performed (Medicare: Carrier judgment) - G8781: 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) (Medicare: Carrier judgment) - G8782: Counseling for diet and physical activity not performed, reason not given (Medicare: Carrier judgment) - G8783: Normal blood pressure reading documented, follow-up not required (Medicare: Carrier judgment) - G8784: Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation) (Medicare: Carrier judgment) - G8785: Blood pressure reading not documented, reason not given (Medicare: Carrier judgment) - G8797: Specimen site other than anatomic location of esophagus (Medicare: Carrier judgment) - G8798: Specimen site other than anatomic location of prostate (Medicare: Carrier judgment) - G8806: Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented (Medicare: Carrier judgment) - G8807: Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup]) (Medicare: Carrier judgment) - G8808: Trans-abdominal or trans-vaginal ultrasound not performed, reason not given (Medicare: Carrier judgment) - G8809: Rh-immunoglobulin (rhogam) ordered (Medicare: Carrier judgment) - G8810: Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal) (Medicare: Carrier judgment) - G8811: Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given (Medicare: Carrier judgment) - G8815: 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) (Medicare: Carrier judgment) - G8816: Statin medication prescribed at discharge (Medicare: Carrier judgment) - G8817: Statin therapy not prescribed at discharge, reason not given (Medicare: Carrier judgment) - G8818: Patient discharge to home no later than post-operative day #7 (Medicare: Carrier judgment) - G8825: Patient not discharged to home by post-operative day #7 (Medicare: Carrier judgment) - G8826: Patient discharged to home no later than post-operative day #2 following evar (Medicare: Carrier judgment) - G8833: Patient not discharged to home by post-operative day #2 following evar (Medicare: Carrier judgment) - G8834: Patient discharged to home no later than post-operative day #2 following cea (Medicare: Carrier judgment) - G8838: Patient not discharged to home by post-operative day #2 following cea (Medicare: Carrier judgment) - G8839: Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness (Medicare: Carrier judgment) - G8840: 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) (Medicare: Carrier judgment) - G8841: Sleep apnea symptoms not assessed, reason not given (Medicare: Carrier judgment) - G8842: 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 (Medicare: Carrier judgment) - G8843: 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) (Medicare: Carrier judgment) - G8844: 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 (Medicare: Carrier judgment) - G8845: Positive airway pressure therapy prescribed (Medicare: Carrier judgment) - G8846: Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater) (Medicare: Carrier judgment) - G8848: Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15) (Medicare: Carrier judgment) - G8849: 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) (Medicare: Carrier judgment) - G8850: Positive airway pressure therapy not prescribed, reason not given (Medicare: Carrier judgment) - G8852: Positive airway pressure therapy was prescribed (Medicare: Carrier judgment) - G8853: Positive airway pressure therapy not prescribed (Medicare: Carrier judgment) - G8854: 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) (Medicare: Carrier judgment) - G8855: 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 (Medicare: Carrier judgment) - G8856: Referral to a physician for an otologic evaluation performed (Medicare: Carrier judgment) - G8857: 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) (Medicare: Carrier judgment) - G8858: Referral to a physician for an otologic evaluation not performed, reason not given (Medicare: Carrier judgment) - G8859: Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days (Medicare: Carrier judgment) - G8860: Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days (Medicare: Carrier judgment) - G8861: 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 (Medicare: Carrier judgment) - G8862: Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days (Medicare: Carrier judgment) - G8863: Patients not assessed for risk of bone loss, reason not given (Medicare: Carrier judgment) - G8864: Pneumococcal vaccine administered or previously received (Medicare: Carrier judgment) - G8865: Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction) (Medicare: Carrier judgment) - G8866: Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) (Medicare: Carrier judgment) - G8867: Pneumococcal vaccine not administered or previously received, reason not given (Medicare: Carrier judgment) - G8868: Patients receiving a first course of anti-tnf therapy (Medicare: Carrier judgment) - G8869: Patient has documented immunity to hepatitis b and initiating anti-tnf therapy (Medicare: Carrier judgment) - G8870: Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy (Medicare: Carrier judgment) - G8871: Patient not receiving a first course of anti-tnf therapy (Medicare: Carrier judgment) - G8872: Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion (Medicare: Carrier judgment) - G8873: 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) (Medicare: Carrier judgment) - G8874: Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion (Medicare: Carrier judgment) - G8875: Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method (Medicare: Carrier judgment) - G8876: 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) (Medicare: Carrier judgment) - G8877: Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given (Medicare: Carrier judgment) - G8878: Sentinel lymph node biopsy procedure performed (Medicare: Carrier judgment) - G8879: Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer (Medicare: Carrier judgment) - G8880: 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) (Medicare: Carrier judgment) - G8881: Stage of breast cancer is greater than t1n0m0 or t2n0m0 (Medicare: Carrier judgment) - G8882: Sentinel lymph node biopsy procedure not performed, reason not given (Medicare: Carrier judgment) - G8883: Biopsy results reviewed, communicated, tracked and documented (Medicare: Carrier judgment) - G8884: Clinician documented reason that patient's biopsy results were not reviewed (Medicare: Carrier judgment) - G8885: Biopsy results not reviewed, communicated, tracked or documented (Medicare: Carrier judgment) - G8886: Most recent blood pressure under control (Medicare: Carrier judgment) - G8887: 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) (Medicare: Carrier judgment) - G8888: Most recent blood pressure not under control, results documented and reviewed (Medicare: Carrier judgment) - G8889: No documentation of blood pressure measurement, reason not given (Medicare: Carrier judgment) - G8890: Most recent ldl-c under control, results documented and reviewed (Medicare: Carrier judgment) - G8891: 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) (Medicare: Carrier judgment) - G8892: 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) (Medicare: Carrier judgment) - G8893: Most recent ldl-c not under control, results documented and reviewed (Medicare: Carrier judgment) - G8894: Ldl-c not performed, reason not given (Medicare: Carrier judgment) - G8895: Oral aspirin or other antithrombotic therapy prescribed (Medicare: Carrier judgment) - G8896: 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) (Medicare: Carrier judgment) - G8897: Oral aspirin or other antithrombotic therapy was not prescribed, reason not given (Medicare: Carrier judgment) - G8898: I intend to report the chronic obstructive pulmonary disease (copd) measures group (Medicare: Carrier judgment) - G8899: I intend to report the inflammatory bowel disease (ibd) measures group (Medicare: Carrier judgment) - G8900: I intend to report the sleep apnea measures group (Medicare: Carrier judgment) - G8902: I intend to report the dementia measures group (Medicare: Carrier judgment) - G8903: I intend to report the parkinson's disease measures group (Medicare: Carrier judgment) - G8904: I intend to report the hypertension (htn) measures group (Medicare: Carrier judgment) - G8905: I intend to report the cardiovascular prevention measures group (Medicare: Carrier judgment) - G8906: I intend to report the cataract measures group (Medicare: Carrier judgment) - G8907: 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 (Medicare: Carrier judgment) - G8908: Patient documented to have received a burn prior to discharge (Medicare: Carrier judgment) - G8909: Patient documented not to have received a burn prior to discharge (Medicare: Carrier judgment) - G8910: Patient documented to have experienced a fall within asc (Medicare: Carrier judgment) - G8911: Patient documented not to have experienced a fall within ambulatory surgical center (Medicare: Carrier judgment) - G8912: Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event (Medicare: Carrier judgment) - G8913: Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event (Medicare: Carrier judgment) - G8914: Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc (Medicare: Carrier judgment) - G8915: Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc (Medicare: Carrier judgment) - G8916: Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time (Medicare: Carrier judgment) - G8917: Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time (Medicare: Carrier judgment) - G8918: Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis (Medicare: Carrier judgment) - G8923: Current or prior left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function (Medicare: Carrier judgment) - G8924: Spirometry results documented (fev1/fvc < 70%) (Medicare: Carrier judgment) - G8925: Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms (Medicare: Carrier judgment) - G8926: Spirometry test not performed or documented, reason not given (Medicare: Carrier judgment) - G8927: Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer (Medicare: Carrier judgment) - G8928: 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) (Medicare: Carrier judgment) - G8929: Adjuvant chemotherapy not prescribed or previously received, reason not given (Medicare: Carrier judgment) - G8930: Assessment of depression severity at the initial evaluation (Medicare: Carrier judgment) - G8931: Assessment of depression severity not documented, reason not given (Medicare: Carrier judgment) - G8932: Suicide risk assessed at the initial evaluation (Medicare: Carrier judgment) - G8933: Suicide risk not assessed at the initial evaluation, reason not given (Medicare: Carrier judgment) - G8934: Current or prior left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function (Medicare: Carrier judgment) - G8935: Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (Medicare: Carrier judgment) - G8936: 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) (Medicare: Carrier judgment) - G8937: Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given (Medicare: Carrier judgment) - G8938: Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible (Medicare: Carrier judgment) - G8939: Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter (Medicare: Carrier judgment) - G8940: Screening for depression documented as positive, a follow-up plan not completed, documented reason (Medicare: Carrier judgment) - G8941: 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 (Medicare: Carrier judgment) - G8942: 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 (Medicare: Carrier judgment) - G8943: Ldl-c result not present or not within 12 months prior (Medicare: Carrier judgment) - G8944: Ajcc melanoma cancer stage 0 through iic melanoma (Medicare: Carrier judgment) - G8946: 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) (Medicare: Carrier judgment) - G8947: One or more neuropsychiatric symptoms (Medicare: Carrier judgment) - G8948: No neuropsychiatric symptoms (Medicare: Carrier judgment) - G8949: 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) (Medicare: Carrier judgment) - G8950: Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented (Medicare: Carrier judgment) - G8951: Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible (Medicare: Carrier judgment) - G8952: Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given (Medicare: Carrier judgment) - G8953: All quality actions for the applicable measures in the oncology measures group have been performed for this patient (Medicare: Carrier judgment) - G8955: Most recent assessment of adequacy of volume management documented (Medicare: Carrier judgment) - G8956: Patient receiving maintenance hemodialysis in an outpatient dialysis facility (Medicare: Carrier judgment) - G8957: Patient not receiving maintenance hemodialysis in an outpatient dialysis facility (Medicare: Carrier judgment) - G8958: Assessment of adequacy of volume management not documented, reason not given (Medicare: Carrier judgment) - G8959: Clinician treating major depressive disorder communicates to clinician treating comorbid condition (Medicare: Carrier judgment) - G8960: Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given (Medicare: Carrier judgment) - G8961: Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery (Medicare: Carrier judgment) - G8962: 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 (Medicare: Carrier judgment) - G8963: Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years (Medicare: Carrier judgment) - G8964: 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) (Medicare: Carrier judgment) - G8965: Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment (Medicare: Carrier judgment) - G8966: 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 (Medicare: Carrier judgment) - G8967: Fda approved oral anticoagulant is prescribed (Medicare: Carrier judgment) - G8968: 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) (Medicare: Carrier judgment) - G8969: 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) (Medicare: Carrier judgment) - G8970: No risk factors or one moderate risk factor for thromboembolism (Medicare: Carrier judgment) - G8971: Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given (Medicare: Carrier judgment) - G8972: One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism (Medicare: Carrier judgment) - G8973: Most recent hemoglobin (hgb) level < 10 g/dl (Medicare: Carrier judgment) - G8974: Hemoglobin level measurement not documented, reason not given (Medicare: Carrier judgment) - G8975: 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) (Medicare: Carrier judgment) - G8976: Most recent hemoglobin (hgb) level >= 10 g/dl (Medicare: Carrier judgment) - G8977: I intend to report the oncology measures group (Medicare: Carrier judgment) - G8978: Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G8979: Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G8980: Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G8981: Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G8982: Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G8983: Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G8984: Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G8985: Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G8986: Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G8987: Self care functional limitation, current status, at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G8988: Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G8989: Self care functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G8990: Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G8991: 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 (Medicare: Carrier judgment) - G8992: Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G8993: Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G8994: 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 (Medicare: Carrier judgment) - G8995: Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G8996: Swallowing functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G8997: Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G8998: Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G8999: Motor speech functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G9001: Coordinated care fee, initial rate (Medicare: Special coverage instructions apply) - G9002: Coordinated care fee, maintenance rate (Medicare: Special coverage instructions apply) - G9003: Coordinated care fee, risk adjusted high, initial (Medicare: Special coverage instructions apply) - G9004: Coordinated care fee, risk adjusted low, initial (Medicare: Special coverage instructions apply) - G9005: Coordinated care fee, risk adjusted maintenance (Medicare: Special coverage instructions apply) - G9006: Coordinated care fee, home monitoring (Medicare: Special coverage instructions apply) - G9007: Coordinated care fee, scheduled team conference (Medicare: Special coverage instructions apply) - G9008: Coordinated care fee, physician coordinated care oversight services (Medicare: Special coverage instructions apply) - G9009: Coordinated care fee, risk adjusted maintenance, level 3 (Medicare: Special coverage instructions apply) - G9010: Coordinated care fee, risk adjusted maintenance, level 4 (Medicare: Special coverage instructions apply) - G9011: Coordinated care fee, risk adjusted maintenance, level 5 (Medicare: Special coverage instructions apply) - G9012: Other specified case management service not elsewhere classified (Medicare: Special coverage instructions apply) - G9013: Esrd demo basic bundle level i (Medicare: Non-covered by Medicare) - G9014: Esrd demo expanded bundle including venous access and related services (Medicare: Non-covered by Medicare) - G9016: 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] (Medicare: Non-covered by Medicare) - G9017: Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9018: Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9019: Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9020: Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9033: Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9034: Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9035: Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9036: Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9037: 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 (Medicare: Carrier judgment) - G9038: 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 (Medicare: Carrier judgment) - G9050: 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) (Medicare: Not payable by Medicare) - G9051: 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) (Medicare: Not payable by Medicare) - G9052: 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) (Medicare: Not payable by Medicare) - G9053: 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) (Medicare: Not payable by Medicare) - G9054: 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) (Medicare: Not payable by Medicare) - G9055: Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project) (Medicare: Not payable by Medicare) - G9056: Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project) (Medicare: Not payable by Medicare) - G9057: 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) (Medicare: Not payable by Medicare) - G9058: Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project) (Medicare: Not payable by Medicare) - G9059: 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) (Medicare: Not payable by Medicare) - G9060: 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) (Medicare: Not payable by Medicare) - G9061: Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project) (Medicare: Not payable by Medicare) - G9062: Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project) (Medicare: Not payable by Medicare) - G9063: 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) (Medicare: Carrier judgment) - G9064: 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) (Medicare: Carrier judgment) - G9065: 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) (Medicare: Carrier judgment) - G9066: 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) (Medicare: Carrier judgment) - G9067: 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) (Medicare: Carrier judgment) - G9068: 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) (Medicare: Carrier judgment) - G9069: 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) (Medicare: Carrier judgment) - G9070: 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) (Medicare: Carrier judgment) - G9071: 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) (Medicare: Carrier judgment) - G9072: 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) (Medicare: Carrier judgment) - G9073: 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) (Medicare: Carrier judgment) - G9074: 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) (Medicare: Carrier judgment) - G9075: 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) (Medicare: Carrier judgment) - G9077: 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) (Medicare: Carrier judgment) - G9078: 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) (Medicare: Carrier judgment) - G9079: 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) (Medicare: Carrier judgment) - G9080: 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) (Medicare: Carrier judgment) - G9083: 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) (Medicare: Carrier judgment) - G9084: 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) (Medicare: Carrier judgment) - G9085: 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) (Medicare: Carrier judgment) - G9086: 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) (Medicare: Carrier judgment) - G9087: 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) (Medicare: Carrier judgment) - G9088: 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) (Medicare: Carrier judgment) - G9089: 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) (Medicare: Carrier judgment) - G9091: 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) (Medicare: Carrier judgment) - G9092: 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) (Medicare: Carrier judgment) - G9093: 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) (Medicare: Carrier judgment) - G9094: 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) (Medicare: Carrier judgment) - G9095: 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) (Medicare: Carrier judgment) - G9096: 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) (Medicare: Carrier judgment) - G9097: 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) (Medicare: Carrier judgment) - G9098: 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) (Medicare: Carrier judgment) - G9099: 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) (Medicare: Carrier judgment) - G9100: 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) (Medicare: Carrier judgment) - G9101: 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) (Medicare: Carrier judgment) - G9102: 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) (Medicare: Carrier judgment) - G9103: 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) (Medicare: Carrier judgment) - G9104: 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) (Medicare: Carrier judgment) - G9105: 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) (Medicare: Carrier judgment) - G9106: 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) (Medicare: Carrier judgment) - G9107: 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) (Medicare: Carrier judgment) - G9108: 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) (Medicare: Carrier judgment) - G9109: 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) (Medicare: Carrier judgment) - G9110: 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) (Medicare: Carrier judgment) - G9111: 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) (Medicare: Carrier judgment) - G9112: 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) (Medicare: Carrier judgment) - G9113: 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) (Medicare: Carrier judgment) - G9114: 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) (Medicare: Carrier judgment) - G9115: 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) (Medicare: Carrier judgment) - G9116: 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) (Medicare: Carrier judgment) - G9117: 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) (Medicare: Carrier judgment) - G9123: 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) (Medicare: Carrier judgment) - G9124: 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) (Medicare: Carrier judgment) - G9125: 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) (Medicare: Carrier judgment) - G9126: 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) (Medicare: Carrier judgment) - G9128: Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9129: Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9130: 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) (Medicare: Carrier judgment) - G9131: 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) (Medicare: Carrier judgment) - G9132: 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) (Medicare: Carrier judgment) - G9133: Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9134: 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) (Medicare: Carrier judgment) - G9135: 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) (Medicare: Carrier judgment) - G9136: 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) (Medicare: Carrier judgment) - G9137: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project) (Medicare: Carrier judgment) - G9138: 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) (Medicare: Carrier judgment) - G9139: 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) (Medicare: Carrier judgment) - G9140: 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 (Medicare: Carrier judgment) - G9143: Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) (Medicare: Carrier judgment) - G9147: 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 (Medicare: Non-covered by Medicare) - G9148: National committee for quality assurance - level 1 medical home (Medicare: Carrier judgment) - G9149: National committee for quality assurance - level 2 medical home (Medicare: Carrier judgment) - G9150: National committee for quality assurance - level 3 medical home (Medicare: Carrier judgment) - G9151: Mapcp demonstration - state provided services (Medicare: Carrier judgment) - G9152: Mapcp demonstration - community health teams (Medicare: Carrier judgment) - G9153: Mapcp demonstration - physician incentive pool (Medicare: Carrier judgment) - G9156: Evaluation for wheelchair requiring face to face visit with physician (Medicare: Carrier judgment) - G9157: Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes (Medicare: Carrier judgment) - G9158: Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G9159: Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G9160: Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G9161: Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G9162: Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G9163: Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G9164: Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G9165: Attention functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G9166: Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G9167: Attention functional limitation, discharge status at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G9168: Memory functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G9169: Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G9170: Memory functional limitation, discharge status at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G9171: Voice functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G9172: Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G9173: Voice functional limitation, discharge status at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G9174: Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals (Medicare: Carrier judgment) - G9175: Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G9176: Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting (Medicare: Carrier judgment) - G9186: Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting (Medicare: Carrier judgment) - G9187: 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 (Medicare: Carrier judgment) - G9188: Beta-blocker therapy not prescribed, reason not given (Medicare: Carrier judgment) - G9189: Beta-blocker therapy prescribed or currently being taken (Medicare: Carrier judgment) - G9190: Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) (Medicare: Carrier judgment) - G9191: Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) (Medicare: Carrier judgment) - G9192: Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system) (Medicare: Carrier judgment) - G9193: 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 (Medicare: Carrier judgment) - G9194: Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase (Medicare: Carrier judgment) - G9195: 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 (Medicare: Carrier judgment) - G9196: 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)) (Medicare: Carrier judgment) - G9197: Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis (Medicare: Carrier judgment) - G9198: Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given (Medicare: Carrier judgment) - G9199: 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)) (Medicare: Carrier judgment) - G9200: Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given (Medicare: Carrier judgment) - G9201: Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission (Medicare: Carrier judgment) - G9202: Patients with a positive hepatitis c antibody test (Medicare: Carrier judgment) - G9203: Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c (Medicare: Carrier judgment) - G9204: 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 (Medicare: Carrier judgment) - G9205: Patient starting antiviral treatmentfor hepatitis c during the measurement period (Medicare: Carrier judgment) - G9206: Patient starting antiviral treatment for hepatitis c during the measurement period (Medicare: Carrier judgment) - G9207: Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c (Medicare: Carrier judgment) - G9208: Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given (Medicare: Carrier judgment) - G9209: Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment (Medicare: Carrier judgment) - G9210: 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) (Medicare: Carrier judgment) - G9211: Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given (Medicare: Carrier judgment) - G9212: Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation (Medicare: Carrier judgment) - G9213: Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified (Medicare: Carrier judgment) - G9214: Cd4+ cell count or cd4+ cell percentage results documented (Medicare: Carrier judgment) - G9215: Cd4+ cell count or percentage not documented as performed, reason not given (Medicare: Carrier judgment) - G9216: Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given (Medicare: Carrier judgment) - G9217: Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given (Medicare: Carrier judgment) - G9218: 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 (Medicare: Carrier judgment) - G9219: 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) (Medicare: Carrier judgment) - G9220: 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) (Medicare: Carrier judgment) - G9221: Pneumocystis jiroveci pneumonia prophlaxis prescribed (Medicare: Carrier judgment) - G9222: Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3 (Medicare: Carrier judgment) - G9223: Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% (Medicare: Carrier judgment) - G9224: Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation) (Medicare: Carrier judgment) - G9225: Foot exam was not performed, reason not given (Medicare: Carrier judgment) - G9226: 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) (Medicare: Carrier judgment) - G9227: Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter (Medicare: Carrier judgment) - G9228: Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) (Medicare: Carrier judgment) - G9229: Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception) (Medicare: Carrier judgment) - G9230: Chlamydia, gonorrhea, and syphilis not screened, reason not given (Medicare: Carrier judgment) - G9231: Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period (Medicare: Carrier judgment) - G9232: 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) (Medicare: Carrier judgment) - G9233: All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient (Medicare: Carrier judgment) - G9234: I intend to report the total knee replacement measures group (Medicare: Carrier judgment) - G9235: All quality actions for the applicable measures in the general surgery measures group have been performed for this patient (Medicare: Carrier judgment) - G9236: All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient (Medicare: Carrier judgment) - G9237: I intend to report the general surgery measures group (Medicare: Carrier judgment) - G9238: I intend to report the optimizing patient exposure to ionizing radiation measures group (Medicare: Carrier judgment) - G9239: 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) (Medicare: Carrier judgment) - G9240: Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated (Medicare: Carrier judgment) - G9241: Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated (Medicare: Carrier judgment) - G9242: Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed (Medicare: Carrier judgment) - G9243: Documentation of viral load less than 200 copies/ml (Medicare: Carrier judgment) - G9244: Antiretroviral thereapy not prescribed (Medicare: Carrier judgment) - G9245: Antiretroviral therapy prescribed (Medicare: Carrier judgment) - G9246: 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 (Medicare: Carrier judgment) - G9247: 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 (Medicare: Carrier judgment) - G9248: Patient did not have a medical visit in the last 6 months (Medicare: Carrier judgment) - G9249: Patient had a medical visit in the last 6 months (Medicare: Carrier judgment) - G9250: Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment (Medicare: Carrier judgment) - G9251: Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment (Medicare: Carrier judgment) - G9252: Adenoma(s) or other neoplasm detected during screening colonoscopy (Medicare: Carrier judgment) - G9253: Adenoma(s) or other neoplasm not detected during screening colonoscopy (Medicare: Carrier judgment) - G9254: Documentation of patient discharged to home later than post-operative day 2 following cea or cas (Medicare: Carrier judgment) - G9255: Documentation of patient discharged to home no later than post operative day 2 following cea or cas (Medicare: Carrier judgment) - G9256: Documentation of patient death following cas (Medicare: Carrier judgment) - G9257: Documentation of patient stroke following cas (Medicare: Carrier judgment) - G9258: Documentation of patient stroke following cea (Medicare: Carrier judgment) - G9259: Documentation of patient survival and absence of stroke following cas (Medicare: Carrier judgment) - G9260: Documentation of patient death following cea (Medicare: Carrier judgment) - G9261: Documentation of patient survival and absence of stroke following cea (Medicare: Carrier judgment) - G9262: Documentation of patient death in the hospital following endovascular aaa repair (Medicare: Carrier judgment) - G9263: Documentation of patient discharged alive following endovascular aaa repair (Medicare: Carrier judgment) - G9264: 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) (Medicare: Carrier judgment) - G9265: Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access (Medicare: Carrier judgment) - G9266: Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access (Medicare: Carrier judgment) - G9267: Documentation of patient with one or more complications or mortality within 30 days (Medicare: Carrier judgment) - G9268: Documentation of patient with one or more complications within 90 days (Medicare: Carrier judgment) - G9269: Documentation of patient without one or more complications and without mortality within 30 days (Medicare: Carrier judgment) - G9270: Documentation of patient without one or more complications within 90 days (Medicare: Carrier judgment) - G9271: Ldl value < 100 (Medicare: Carrier judgment) - G9272: Ldl value >= 100 (Medicare: Carrier judgment) - G9273: Blood pressure has a systolic value of < 140 and a diastolic value of < 90 (Medicare: Carrier judgment) - G9274: 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 (Medicare: Carrier judgment) - G9275: Documentation that patient is a current non-tobacco user (Medicare: Carrier judgment) - G9276: Documentation that patient is a current tobacco user (Medicare: Carrier judgment) - G9277: 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) (Medicare: Carrier judgment) - G9278: Documentation that the patient is not on daily aspirin or anti-platelet regimen (Medicare: Carrier judgment) - G9279: Pneumococcal screening performed and documentation of vaccination received prior to discharge (Medicare: Carrier judgment) - G9280: Pneumococcal vaccination not administered prior to discharge, reason not specified (Medicare: Carrier judgment) - G9281: Screening performed and documentation that vaccination not indicated/patient refusal (Medicare: Carrier judgment) - G9282: 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) (Medicare: Carrier judgment) - G9283: Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation (Medicare: Carrier judgment) - G9284: 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 (Medicare: Carrier judgment) - G9285: Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer (Medicare: Carrier judgment) - G9286: Antibiotic regimen prescribed within 10 days after onset of symptoms (Medicare: Carrier judgment) - G9287: Antibiotic regimen not prescribed within 10 days after onset of symptoms (Medicare: Carrier judgment) - G9288: 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) (Medicare: Carrier judgment) - G9289: Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation (Medicare: Carrier judgment) - G9290: 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 (Medicare: Carrier judgment) - G9291: Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos (Medicare: Carrier judgment) - G9292: 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) (Medicare: Carrier judgment) - G9293: Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate (Medicare: Carrier judgment) - G9294: Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate (Medicare: Carrier judgment) - G9295: Specimen site other than anatomic cutaneous location (Medicare: Carrier judgment) - G9296: 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 (Medicare: Carrier judgment) - G9297: 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 (Medicare: Carrier judgment) - G9298: 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) (Medicare: Carrier judgment) - G9299: 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) (Medicare: Carrier judgment) - G9300: 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) (Medicare: Carrier judgment) - G9301: Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet (Medicare: Carrier judgment) - G9302: Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given (Medicare: Carrier judgment) - G9303: 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 (Medicare: Carrier judgment) - G9304: 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 (Medicare: Carrier judgment) - G9305: Intervention for presence of leak of endoluminal contents through an anastomosis not required (Medicare: Carrier judgment) - G9306: Intervention for presence of leak of endoluminal contents through an anastomosis required (Medicare: Carrier judgment) - G9307: 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 (Medicare: Carrier judgment) - G9308: 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 (Medicare: Carrier judgment) - G9309: No unplanned hospital readmission within 30 days of principal procedure (Medicare: Carrier judgment) - G9310: Unplanned hospital readmission within 30 days of principal procedure (Medicare: Carrier judgment) - G9312: Surgical site infection (Medicare: Carrier judgment) - G9313: Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason (Medicare: Carrier judgment) - G9314: Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given (Medicare: Carrier judgment) - G9315: Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis (Medicare: Carrier judgment) - G9316: 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 (Medicare: Carrier judgment) - G9317: 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 (Medicare: Carrier judgment) - G9318: Imaging study named according to standardized nomenclature (Medicare: Carrier judgment) - G9319: Imaging study not named according to standardized nomenclature, reason not given (Medicare: Carrier judgment) - G9320: 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) (Medicare: Carrier judgment) - G9321: 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 (Medicare: Carrier judgment) - G9322: 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 (Medicare: Carrier judgment) - G9323: 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) (Medicare: Carrier judgment) - G9324: All necessary data elements not included, reason not given (Medicare: Carrier judgment) - G9325: 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) (Medicare: Carrier judgment) - G9326: 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 (Medicare: Carrier judgment) - G9327: Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements (Medicare: Carrier judgment) - G9328: 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) (Medicare: Carrier judgment) - G9329: 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 (Medicare: Carrier judgment) - G9340: 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 (Medicare: Carrier judgment) - G9341: 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 (Medicare: Carrier judgment) - G9343: 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) (Medicare: Carrier judgment) - G9344: 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) (Medicare: Carrier judgment) - G9345: 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 (Medicare: Carrier judgment) - G9346: 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) (Medicare: Carrier judgment) - G9347: Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given (Medicare: Carrier judgment) - G9348: Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons (Medicare: Carrier judgment) - G9349: Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis (Medicare: Carrier judgment) - G9350: Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis (Medicare: Carrier judgment) - G9351: More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis (Medicare: Carrier judgment) - G9352: More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given (Medicare: Carrier judgment) - G9353: 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) (Medicare: Carrier judgment) - G9354: One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis (Medicare: Carrier judgment) - G9355: Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation) (Medicare: Carrier judgment) - G9356: Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation) (Medicare: Carrier judgment) - G9357: Post-partum screenings, evaluations and education performed (Medicare: Carrier judgment) - G9358: Post-partum screenings, evaluations and education not performed (Medicare: Carrier judgment) - G9359: 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 (Medicare: Carrier judgment) - G9360: No documentation of negative or managed positive tb screen (Medicare: Carrier judgment) - G9361: 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)] (Medicare: Carrier judgment) - G9362: 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 (Medicare: Carrier judgment) - G9363: 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 (Medicare: Carrier judgment) - G9364: Sinusitis caused by, or presumed to be caused by, bacterial infection (Medicare: Carrier judgment) - G9365: One high-risk medication ordered (Medicare: Carrier judgment) - G9366: One high-risk medication not ordered (Medicare: Carrier judgment) - G9367: At least two orders for high-risk medications from the same drug class (Medicare: Carrier judgment) - G9368: At least two orders for high-risk medications from the same drug class not ordered (Medicare: Carrier judgment) - G9369: Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater (Medicare: Carrier judgment) - G9370: Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater (Medicare: Carrier judgment) - G9376: Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery (Medicare: Carrier judgment) - G9377: Patient did not have the retina attached after 6 months following only one surgery (Medicare: Carrier judgment) - G9378: Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) (Medicare: Carrier judgment) - G9379: Patient did not achieve flat retinas six months post surgery (Medicare: Carrier judgment) - G9380: Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period (Medicare: Carrier judgment) - G9381: 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 (Medicare: Carrier judgment) - G9382: Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period (Medicare: Carrier judgment) - G9383: Patient received screening for hcv infection within the 12 month reporting period (Medicare: Carrier judgment) - G9384: 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) (Medicare: Carrier judgment) - G9385: Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons) (Medicare: Carrier judgment) - G9386: Screening for hcv infection not received within the 12 month reporting period, reason not given (Medicare: Carrier judgment) - G9389: Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery (Medicare: Carrier judgment) - G9390: No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery (Medicare: Carrier judgment) - G9391: Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit (Medicare: Carrier judgment) - G9392: Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit (Medicare: Carrier judgment) - G9393: 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 (Medicare: Carrier judgment) - G9394: 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 (Medicare: Carrier judgment) - G9395: 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 (Medicare: Carrier judgment) - G9396: Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days) (Medicare: Carrier judgment) - G9399: 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 (Medicare: Carrier judgment) - G9400: 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 (Medicare: Carrier judgment) - G9401: 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 (Medicare: Carrier judgment) - G9402: Patient received follow-up within 30 days after discharge (Medicare: Carrier judgment) - G9403: 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) (Medicare: Carrier judgment) - G9404: Patient did not receive follow-up within 30 days after discharge (Medicare: Carrier judgment) - G9405: Patient received follow-up within 7 days after discharge (Medicare: Carrier judgment) - G9406: 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) (Medicare: Carrier judgment) - G9407: Patient did not receive follow-up within 7 days after discharge (Medicare: Carrier judgment) - G9408: Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days (Medicare: Carrier judgment) - G9409: Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days (Medicare: Carrier judgment) - G9410: Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision (Medicare: Carrier judgment) - G9411: Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision (Medicare: Carrier judgment) - G9412: Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision (Medicare: Carrier judgment) - G9413: Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision (Medicare: Carrier judgment) - G9414: 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 (Medicare: Carrier judgment) - G9415: 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 (Medicare: Carrier judgment) - G9416: Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays (Medicare: Carrier judgment) - G9417: Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays (Medicare: Carrier judgment) - G9418: 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 (Medicare: Carrier judgment) - G9419: 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) (Medicare: Carrier judgment) - G9420: Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer (Medicare: Carrier judgment) - G9421: 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 (Medicare: Carrier judgment) - G9422: 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) (Medicare: Carrier judgment) - G9423: 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)] (Medicare: Carrier judgment) - G9424: Specimen site other than anatomic location of lung, or classified as nsclc-nos (Medicare: Carrier judgment) - G9425: 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) (Medicare: Carrier judgment) - G9426: Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients (Medicare: Carrier judgment) - G9427: Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients (Medicare: Carrier judgment) - G9428: 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 (Medicare: Carrier judgment) - G9429: 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) (Medicare: Carrier judgment) - G9430: Specimen site other than anatomic cutaneous location (Medicare: Carrier judgment) - G9431: 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 (Medicare: Carrier judgment) - G9432: Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented (Medicare: Carrier judgment) - G9433: Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period (Medicare: Carrier judgment) - G9434: Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given (Medicare: Carrier judgment) - G9435: Aspirin prescribed at discharge (Medicare: Carrier judgment) - G9436: Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) (Medicare: Carrier judgment) - G9437: Aspirin not prescribed at discharge (Medicare: Carrier judgment) - G9438: P2y inhibitor prescribed at discharge (Medicare: Carrier judgment) - G9439: P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) (Medicare: Carrier judgment) - G9440: P2y inhibitor not prescribed at discharge (Medicare: Carrier judgment) - G9441: Statin prescribed at discharge (Medicare: Carrier judgment) - G9442: Statin not prescribed for documented reasons (e.g., allergy, medical intolerance) (Medicare: Carrier judgment) - G9443: Statin not prescribed at discharge (Medicare: Carrier judgment) - G9448: Patients who were born in the years 1945 to 1965 (Medicare: Carrier judgment) - G9449: History of receiving blood transfusions prior to 1992 (Medicare: Carrier judgment) - G9450: History of injection drug use (Medicare: Carrier judgment) - G9451: Patient received one-time screening for hcv infection (Medicare: Carrier judgment) - G9452: Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy (Medicare: Carrier judgment) - G9453: Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons) (Medicare: Carrier judgment) - G9454: 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 (Medicare: Carrier judgment) - G9455: Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc (Medicare: Carrier judgment) - G9456: 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) (Medicare: Carrier judgment) - G9457: Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period (Medicare: Carrier judgment) - G9458: 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 (Medicare: Carrier judgment) - G9459: Currently a tobacco non-user (Medicare: Carrier judgment) - G9460: Tobacco assessment or tobacco cessation intervention not performed, reason not given (Medicare: Carrier judgment) - G9463: I intend to report the sinusitis measures group (Medicare: Carrier judgment) - G9464: All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient (Medicare: Carrier judgment) - G9465: I intend to report the acute otitis externa (aoe) measures group (Medicare: Carrier judgment) - G9466: All quality actions for the applicable measures in the aoe measures group have been performed for this patient (Medicare: Carrier judgment) - G9467: 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 (Medicare: Carrier judgment) - G9468: 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 (Medicare: Carrier judgment) - G9469: 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 (Medicare: Carrier judgment) - G9470: 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 (Medicare: Carrier judgment) - G9471: Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented (Medicare: Carrier judgment) - G9472: 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 (Medicare: Carrier judgment) - G9473: Services performed by chaplain in the hospice setting, each 15 minutes (Medicare: Carrier judgment) - G9474: Services performed by dietary counselor in the hospice setting, each 15 minutes (Medicare: Carrier judgment) - G9475: Services performed by other counselor in the hospice setting, each 15 minutes (Medicare: Carrier judgment) - G9476: Services performed by volunteer in the hospice setting, each 15 minutes (Medicare: Carrier judgment) - G9477: Services performed by care coordinator in the hospice setting, each 15 minutes (Medicare: Carrier judgment) - G9478: Services performed by other qualified therapist in the hospice setting, each 15 minutes (Medicare: Carrier judgment) - G9479: Services performed by qualified pharmacist in the hospice setting, each 15 minutes (Medicare: Carrier judgment) - G9480: Admission to medicare care choice model program (mccm) (Medicare: Carrier judgment) - G9481: 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 (Medicare: Carrier judgment) - G9482: 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 (Medicare: Carrier judgment) - G9483: 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 (Medicare: Carrier judgment) - G9484: 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 (Medicare: Carrier judgment) - G9485: 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 (Medicare: Carrier judgment) - G9486: 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 (Medicare: Carrier judgment) - G9487: 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 (Medicare: Carrier judgment) - G9488: 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 (Medicare: Carrier judgment) - G9489: 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 (Medicare: Carrier judgment) - G9490: 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 (Medicare: Carrier judgment) - G9496: 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 (Medicare: Carrier judgment) - G9497: Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery (Medicare: Carrier judgment) - G9498: Antibiotic regimen prescribed (Medicare: Carrier judgment) - G9499: Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period (Medicare: Carrier judgment) - G9500: Radiation exposure indices documented in final report for procedure using fluoroscopy (Medicare: Carrier judgment) - G9501: Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given (Medicare: Carrier judgment) - G9502: 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) (Medicare: Carrier judgment) - G9503: Patient taking tamsulosin hydrochloride (Medicare: Carrier judgment) - G9504: 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 (Medicare: Carrier judgment) - G9505: Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason (Medicare: Carrier judgment) - G9506: Biologic immune response modifier prescribed (Medicare: Carrier judgment) - G9507: 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) (Medicare: Carrier judgment) - G9508: Documentation that the patient is not on a statin medication (Medicare: Carrier judgment) - G9509: 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 (Medicare: Carrier judgment) - G9510: 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 (Medicare: Carrier judgment) - G9511: Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period (Medicare: Carrier judgment) - G9512: Individual had a pdc of 0.8 or greater (Medicare: Carrier judgment) - G9513: Individual did not have a pdc of 0.8 or greater (Medicare: Carrier judgment) - G9514: Patient required a return to the operating room within 90 days of surgery (Medicare: Carrier judgment) - G9515: Patient did not require a return to the operating room within 90 days of surgery (Medicare: Carrier judgment) - G9516: Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery (Medicare: Carrier judgment) - G9517: Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given (Medicare: Carrier judgment) - G9518: Documentation of active injection drug use (Medicare: Carrier judgment) - G9519: Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery (Medicare: Carrier judgment) - G9520: Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery (Medicare: Carrier judgment) - G9521: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months (Medicare: Carrier judgment) - G9522: 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 (Medicare: Carrier judgment) - G9523: Patient discontinued from hemodialysis or peritoneal dialysis (Medicare: Carrier judgment) - G9524: Patient was referred to hospice care (Medicare: Carrier judgment) - G9525: Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons) (Medicare: Carrier judgment) - G9526: Patient was not referred to hospice care, reason not given (Medicare: Carrier judgment) - G9529: Patient with minor blunt head trauma had an appropriate indication(s) for a head ct (Medicare: Carrier judgment) - G9530: Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider (Medicare: Carrier judgment) - G9531: 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 (Medicare: Carrier judgment) - G9532: 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 (Medicare: Carrier judgment) - G9533: Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct (Medicare: Carrier judgment) - G9534: Advanced brain imaging (cta, ct, mra or mri) was not ordered (Medicare: Carrier judgment) - G9535: Patients with a normal neurological examination (Medicare: Carrier judgment) - G9536: 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) (Medicare: Carrier judgment) - G9537: Imaging needed as part of a clinical trial; or other clinician ordered the study (Medicare: Carrier judgment) - G9538: Advanced brain imaging (cta, ct, mra or mri) was ordered (Medicare: Carrier judgment) - G9539: Intent for potential removal at time of placement (Medicare: Carrier judgment) - G9540: Patient alive 3 months post procedure (Medicare: Carrier judgment) - G9541: Filter removed within 3 months of placement (Medicare: Carrier judgment) - G9542: Documented re-assessment for the appropriateness of filter removal within 3 months of placement (Medicare: Carrier judgment) - G9543: 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 (Medicare: Carrier judgment) - G9544: 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 (Medicare: Carrier judgment) - G9547: 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 (Medicare: Carrier judgment) - G9548: Final reports for imaging studies stating no follow-up imaging is recommended (Medicare: Carrier judgment) - G9549: 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)) (Medicare: Carrier judgment) - G9550: Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up (Medicare: Carrier judgment) - G9551: Final reports for imaging studies without an incidentally found lesion noted (Medicare: Carrier judgment) - G9552: Incidental thyroid nodule < 1.0 cm noted in report (Medicare: Carrier judgment) - G9553: Prior thyroid disease diagnosis (Medicare: Carrier judgment) - G9554: Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended (Medicare: Carrier judgment) - G9555: 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)) (Medicare: Carrier judgment) - G9556: Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended (Medicare: Carrier judgment) - G9557: 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 (Medicare: Carrier judgment) - G9558: Patient treated with a beta-lactam antibiotic as definitive therapy (Medicare: Carrier judgment) - G9559: Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics) (Medicare: Carrier judgment) - G9560: Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given (Medicare: Carrier judgment) - G9561: Patients prescribed opiates for longer than six weeks (Medicare: Carrier judgment) - G9562: Patients who had a follow-up evaluation conducted at least every three months during opioid therapy (Medicare: Carrier judgment) - G9563: Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy (Medicare: Carrier judgment) - G9572: Index date phq-score greater than 9 documented during the twelve month denominator identification period (Medicare: Carrier judgment) - G9573: 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 (Medicare: Carrier judgment) - G9574: 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 (Medicare: Carrier judgment) - G9577: Patients prescribed opiates for longer than six weeks (Medicare: Carrier judgment) - G9578: Documentation of signed opioid treatment agreement at least once during opioid therapy (Medicare: Carrier judgment) - G9579: No documentation of signed an opioid treatment agreement at least once during opioid therapy (Medicare: Carrier judgment) - G9580: Door to puncture time of 90 minutes or less (Medicare: Carrier judgment) - G9581: 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) (Medicare: Carrier judgment) - G9582: Door to puncture time of greater than 90 minutes, no reason given (Medicare: Carrier judgment) - G9583: Patients prescribed opiates for longer than six weeks (Medicare: Carrier judgment) - G9584: 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 (Medicare: Carrier judgment) - G9585: 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 (Medicare: Carrier judgment) - G9593: Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules (Medicare: Carrier judgment) - G9594: Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider (Medicare: Carrier judgment) - G9595: Patient has documentation of ventricular shunt, brain tumor, or coagulopathy (Medicare: Carrier judgment) - G9596: 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 (Medicare: Carrier judgment) - G9597: Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules (Medicare: Carrier judgment) - G9598: Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct (Medicare: Carrier judgment) - G9599: Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct (Medicare: Carrier judgment) - G9600: Symptomatic aaas that required urgent/emergent (non-elective) repair (Medicare: Carrier judgment) - G9601: Patient discharge to home no later than post-operative day #7 (Medicare: Carrier judgment) - G9602: Patient not discharged to home by post-operative day #7 (Medicare: Carrier judgment) - G9603: Patient survey score improved from baseline following treatment (Medicare: Carrier judgment) - G9604: Patient survey results not available (Medicare: Carrier judgment) - G9605: Patient survey score did not improve from baseline following treatment (Medicare: Carrier judgment) - G9606: Intraoperative cystoscopy performed to evaluate for lower tract injury (Medicare: Carrier judgment) - G9607: 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 (Medicare: Carrier judgment) - G9608: Intraoperative cystoscopy not performed to evaluate for lower tract injury (Medicare: Carrier judgment) - G9609: Documentation of an order for anti-platelet agents (Medicare: Carrier judgment) - G9610: Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents (Medicare: Carrier judgment) - G9611: Order for anti-platelet agents was not documented in the patient's record, reason not given (Medicare: Carrier judgment) - G9612: Photodocumentation of two or more cecal landmarks to establish a complete examination (Medicare: Carrier judgment) - G9613: Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.) (Medicare: Carrier judgment) - G9614: Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination (Medicare: Carrier judgment) - G9615: Preoperative assessment documented (Medicare: Carrier judgment) - G9616: 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) (Medicare: Carrier judgment) - G9617: Preoperative assessment not documented, reason not given (Medicare: Carrier judgment) - G9618: Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind (Medicare: Carrier judgment) - G9619: Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy) (Medicare: Carrier judgment) - G9620: Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given (Medicare: Carrier judgment) - G9621: Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling (Medicare: Carrier judgment) - G9622: Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method (Medicare: Carrier judgment) - G9623: Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) (Medicare: Carrier judgment) - G9624: 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 (Medicare: Carrier judgment) - G9625: Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery (Medicare: Carrier judgment) - G9626: 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) (Medicare: Carrier judgment) - G9627: Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery (Medicare: Carrier judgment) - G9628: Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery (Medicare: Carrier judgment) - G9629: 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) (Medicare: Carrier judgment) - G9630: Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery (Medicare: Carrier judgment) - G9631: Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery (Medicare: Carrier judgment) - G9632: 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) (Medicare: Carrier judgment) - G9633: Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery (Medicare: Carrier judgment) - G9634: Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved (Medicare: Carrier judgment) - G9635: 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) (Medicare: Carrier judgment) - G9636: Health-related quality of life not assessed with tool during at least two visits or quality of life score declined (Medicare: Carrier judgment) - G9637: 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) (Medicare: Carrier judgment) - G9638: 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) (Medicare: Carrier judgment) - G9639: Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure (Medicare: Carrier judgment) - G9640: Documentation of planned hybrid or staged procedure (Medicare: Carrier judgment) - G9641: Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure (Medicare: Carrier judgment) - G9642: Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) (Medicare: Carrier judgment) - G9643: Elective surgery (Medicare: Carrier judgment) - G9644: Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure (Medicare: Carrier judgment) - G9645: Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure (Medicare: Carrier judgment) - G9646: Patients with 90 day mrs score of 0 to 2 (Medicare: Carrier judgment) - G9647: Patients in whom mrs score could not be obtained at 90 day follow-up (Medicare: Carrier judgment) - G9648: Patients with 90 day mrs score greater than 2 (Medicare: Carrier judgment) - G9649: 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)) (Medicare: Carrier judgment) - G9650: 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 (Medicare: Carrier judgment) - G9651: 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 (Medicare: Carrier judgment) - G9652: Patient has been treated with a systemic or biologic medication for psoriasis for at least six months (Medicare: Carrier judgment) - G9653: Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months (Medicare: Carrier judgment) - G9654: Monitored anesthesia care (mac) (Medicare: Carrier judgment) - G9655: A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used (Medicare: Carrier judgment) - G9656: Patient transferred directly from anesthetizing location to pacu or other non-icu location (Medicare: Carrier judgment) - G9657: Transfer of care during an anesthetic or to the intensive care unit (Medicare: Carrier judgment) - G9658: A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used (Medicare: Carrier judgment) - G9659: 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 (Medicare: Carrier judgment) - G9660: 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) (Medicare: Carrier judgment) - G9661: 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 (Medicare: Carrier judgment) - G9662: Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure (Medicare: Carrier judgment) - G9663: Any ldl-c laboratory result >= 190 mg/dl (Medicare: Carrier judgment) - G9664: Patients who are currently statin therapy users or received an order (prescription) for statin therapy (Medicare: Carrier judgment) - G9665: Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy (Medicare: Carrier judgment) - G9666: 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 (Medicare: Carrier judgment) - G9667: 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) (Medicare: Carrier judgment) - G9669: I intend to report the multiple chronic conditions measures group (Medicare: Carrier judgment) - G9670: All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient (Medicare: Carrier judgment) - G9671: I intend to report the diabetic retinopathy measures group (Medicare: Carrier judgment) - G9672: All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient (Medicare: Carrier judgment) - G9673: I intend to report the cardiovascular prevention measures group (Medicare: Carrier judgment) - G9674: Patients with clinical ascvd diagnosis (Medicare: Carrier judgment) - G9675: Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl (Medicare: Carrier judgment) - G9676: 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 (Medicare: Carrier judgment) - G9677: All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient (Medicare: Carrier judgment) - G9678: 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 (Medicare: Carrier judgment) - G9679: This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary (Medicare: Carrier judgment) - G9680: This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary (Medicare: Carrier judgment) - G9681: This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary (Medicare: Carrier judgment) - G9682: 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 (Medicare: Carrier judgment) - G9683: 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 (Medicare: Carrier judgment) - G9684: 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 (Medicare: Carrier judgment) - G9685: 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 (Medicare: Carrier judgment) - G9686: 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 (Medicare: Carrier judgment) - G9687: Hospice services provided to patient any time during the measurement period (Medicare: Carrier judgment) - G9688: Patients using hospice services any time during the measurement period (Medicare: Carrier judgment) - G9689: Patient admitted for performance of elective carotid intervention (Medicare: Carrier judgment) - G9690: Patient receiving hospice services any time during the measurement period (Medicare: Carrier judgment) - G9691: Patient had hospice services any time during the measurement period (Medicare: Carrier judgment) - G9692: Hospice services received by patient any time during the measurement period (Medicare: Carrier judgment) - G9693: Patient use of hospice services any time during the measurement period (Medicare: Carrier judgment) - G9694: Hospice services utilized by patient any time during the measurement period (Medicare: Carrier judgment) - G9695: Long-acting inhaled bronchodilator prescribed (Medicare: Carrier judgment) - G9696: Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects) (Medicare: Carrier judgment) - G9697: Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator (Medicare: Carrier judgment) - G9698: Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance) (Medicare: Carrier judgment) - G9699: Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified (Medicare: Carrier judgment) - G9700: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9701: Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established (Medicare: Carrier judgment) - G9702: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9703: Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date (Medicare: Carrier judgment) - G9704: Ajcc breast cancer stage i: t1 mic or t1a documented (Medicare: Carrier judgment) - G9705: Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented (Medicare: Carrier judgment) - G9706: Low (or very low) risk of recurrence, prostate cancer (Medicare: Carrier judgment) - G9707: Patient received hospice services any time during the measurement period (Medicare: Carrier judgment) - G9708: 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 (Medicare: Carrier judgment) - G9709: Hospice services used by patient any time during the measurement period (Medicare: Carrier judgment) - G9710: Patient was provided hospice services any time during the measurement period (Medicare: Carrier judgment) - G9711: Patients with a diagnosis or past history of total colectomy or colorectal cancer (Medicare: Carrier judgment) - G9712: 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 (Medicare: Carrier judgment) - G9713: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9714: Patient is using hospice services any time during the measurement period (Medicare: Carrier judgment) - G9715: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9716: Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason (Medicare: Carrier judgment) - G9717: Documentation stating the patient has had a diagnosis of bipolar disorder (Medicare: Carrier judgment) - G9718: Hospice services for patient provided any time during the measurement period (Medicare: Carrier judgment) - G9719: 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 (Medicare: Carrier judgment) - G9720: Hospice services for patient occurred any time during the measurement period (Medicare: Carrier judgment) - G9721: Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair (Medicare: Carrier judgment) - G9722: 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 (Medicare: Carrier judgment) - G9723: Hospice services for patient received any time during the measurement period (Medicare: Carrier judgment) - G9724: Patients who had documentation of use of anticoagulant medications overlapping the measurement year (Medicare: Carrier judgment) - G9725: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9726: Patient refused to participate (Medicare: Carrier judgment) - G9727: 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 (Medicare: Carrier judgment) - G9728: Patient refused to participate (Medicare: Carrier judgment) - G9729: 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 (Medicare: Carrier judgment) - G9730: Patient refused to participate (Medicare: Carrier judgment) - G9731: 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 (Medicare: Carrier judgment) - G9732: Patient refused to participate (Medicare: Carrier judgment) - G9733: 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 (Medicare: Carrier judgment) - G9734: Patient refused to participate (Medicare: Carrier judgment) - G9735: 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 (Medicare: Carrier judgment) - G9736: Patient refused to participate (Medicare: Carrier judgment) - G9737: 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 (Medicare: Carrier judgment) - G9738: Patient refused to participate (Medicare: Carrier judgment) - G9739: 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 (Medicare: Carrier judgment) - G9740: Hospice services given to patient any time during the measurement period (Medicare: Carrier judgment) - G9741: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9742: Psychiatric symptoms assessed (Medicare: Carrier judgment) - G9743: Psychiatric symptoms not assessed, reason not otherwise specified (Medicare: Carrier judgment) - G9744: Patient not eligible due to active diagnosis of hypertension (Medicare: Carrier judgment) - G9745: Documented reason for not screening or recommending a follow-up for high blood pressure (Medicare: Carrier judgment) - G9746: Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) (Medicare: Carrier judgment) - G9747: Patient is undergoing palliative dialysis with a catheter (Medicare: Carrier judgment) - G9748: Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant (Medicare: Carrier judgment) - G9749: Patient is undergoing palliative dialysis with a catheter (Medicare: Carrier judgment) - G9750: Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant (Medicare: Carrier judgment) - G9751: Patient died at any time during the 24-month measurement period (Medicare: Carrier judgment) - G9752: Emergency surgery (Medicare: Carrier judgment) - G9753: 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) (Medicare: Carrier judgment) - G9754: A finding of an incidental pulmonary nodule (Medicare: Carrier judgment) - G9755: 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) (Medicare: Carrier judgment) - G9756: Surgical procedures that included the use of silicone oil (Medicare: Carrier judgment) - G9757: Surgical procedures that included the use of silicone oil (Medicare: Carrier judgment) - G9758: Patient in hospice at any time during the measurement period (Medicare: Carrier judgment) - G9759: History of preoperative posterior capsule rupture (Medicare: Carrier judgment) - G9760: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9761: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9762: 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 (Medicare: Carrier judgment) - G9763: 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 (Medicare: Carrier judgment) - G9764: Patient has been treated with a systemic medication for psoriasis vulgaris (Medicare: Carrier judgment) - G9765: 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 (Medicare: Carrier judgment) - G9766: Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment (Medicare: Carrier judgment) - G9767: Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment (Medicare: Carrier judgment) - G9768: Patients who utilize hospice services any time during the measurement period (Medicare: Carrier judgment) - G9769: Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months (Medicare: Carrier judgment) - G9770: Peripheral nerve block (pnb) (Medicare: Carrier judgment) - G9771: 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 (Medicare: Carrier judgment) - G9772: 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.) (Medicare: Carrier judgment) - G9773: 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 (Medicare: Carrier judgment) - G9774: Patients who have had a hysterectomy (Medicare: Carrier judgment) - G9775: Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (Medicare: Carrier judgment) - G9776: 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) (Medicare: Carrier judgment) - G9777: Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (Medicare: Carrier judgment) - G9778: Patients who have a diagnosis of pregnancy at any time during the measurement period (Medicare: Carrier judgment) - G9779: Patients who are breastfeeding at any time during the performance period (Medicare: Carrier judgment) - G9780: Patients who have a diagnosis of rhabdomyolysis at any time during the performance period (Medicare: Carrier judgment) - G9781: 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) (Medicare: Carrier judgment) - G9782: History of or active diagnosis of familial hypercholesterolemia (Medicare: Carrier judgment) - G9783: 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 (Medicare: Carrier judgment) - G9784: Pathologists/dermatopathologists providing a second opinion on a biopsy (Medicare: Carrier judgment) - G9785: 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 (Medicare: Carrier judgment) - G9786: 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 (Medicare: Carrier judgment) - G9787: Patient alive as of the last day of the measurement year (Medicare: Carrier judgment) - G9788: Most recent bp is less than or equal to 130/80 mm hg (Medicare: Carrier judgment) - G9789: Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits (Medicare: Carrier judgment) - G9790: Most recent bp is greater than 130/80 mm hg, or blood pressure not documented (Medicare: Carrier judgment) - G9791: Most recent tobacco status is tobacco free (Medicare: Carrier judgment) - G9792: Most recent tobacco status is not tobacco free (Medicare: Carrier judgment) - G9793: Patient is currently on a daily aspirin or other antiplatelet (Medicare: Carrier judgment) - G9794: 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) (Medicare: Carrier judgment) - G9795: Patient is not currently on a daily aspirin or other antiplatelet (Medicare: Carrier judgment) - G9796: Patient is currently on a high intensity statin therapy (Medicare: Carrier judgment) - G9797: Patient is not on a high intensity statin therapy (Medicare: Carrier judgment) - G9798: Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period (Medicare: Carrier judgment) - G9799: 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 (Medicare: Carrier judgment) - G9800: Patients who are identified as having an intolerance or allergy to beta-blocker therapy (Medicare: Carrier judgment) - G9801: Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis (Medicare: Carrier judgment) - G9802: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9803: Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami (Medicare: Carrier judgment) - G9804: Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami (Medicare: Carrier judgment) - G9805: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9806: Patients who received cervical cytology or an hpv test (Medicare: Carrier judgment) - G9807: Patients who did not receive cervical cytology or an hpv test (Medicare: Carrier judgment) - G9808: Any patients who had no asthma controller medications dispensed during the measurement year (Medicare: Carrier judgment) - G9809: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9810: Patient achieved a pdc of at least 75% for their asthma controller medication (Medicare: Carrier judgment) - G9811: Patient did not achieve a pdc of at least 75% for their asthma controller medication (Medicare: Carrier judgment) - G9812: 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 (Medicare: Carrier judgment) - G9813: Patient did not die within 30 days of the procedure or during the index hospitalization (Medicare: Carrier judgment) - G9814: Death occurring during the index acute care hospitalization (Medicare: Carrier judgment) - G9815: Death did not occur during the index acute care hospitalization (Medicare: Carrier judgment) - G9816: Death occurring after discharge from the hospital but within 30 days post procedure (Medicare: Carrier judgment) - G9817: Death did not occur after discharge from the hospital within 30 days post procedure (Medicare: Carrier judgment) - G9818: Documentation of sexual activity (Medicare: Carrier judgment) - G9819: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - G9820: Documentation of a chlamydia screening test with proper follow-up (Medicare: Carrier judgment) - G9821: No documentation of a chlamydia screening test with proper follow-up (Medicare: Carrier judgment) - G9822: Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date) (Medicare: Carrier judgment) - G9823: 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 (Medicare: Carrier judgment) - G9824: 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 (Medicare: Carrier judgment) - G9825: Her-2/neu negative or undocumented/unknown (Medicare: Carrier judgment) - G9826: Patient transferred to practice after initiation of chemotherapy (Medicare: Carrier judgment) - G9827: Her2-targeted therapies not administered during the initial course of treatment (Medicare: Carrier judgment) - G9828: Her2-targeted therapies administered during the initial course of treatment (Medicare: Carrier judgment) - G9829: Breast adjuvant chemotherapy administered (Medicare: Carrier judgment) - G9830: Her-2/neu positive (Medicare: Carrier judgment) - G9831: Ajcc stage at breast cancer diagnosis = ii or iii (Medicare: Carrier judgment) - G9832: Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis = t1c (Medicare: Carrier judgment) - G9833: Patient transfer to practice after initiation of chemotherapy (Medicare: Carrier judgment) - G9834: Patient has metastatic disease at diagnosis (Medicare: Carrier judgment) - G9835: Trastuzumab administered within 12 months of diagnosis (Medicare: Carrier judgment) - G9836: 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) (Medicare: Carrier judgment) - G9837: Trastuzumab not administered within 12 months of diagnosis (Medicare: Carrier judgment) - G9838: Patient has metastatic disease at diagnosis (Medicare: Carrier judgment) - G9839: Anti-egfr monoclonal antibody therapy (Medicare: Carrier judgment) - G9840: Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab (Medicare: Carrier judgment) - G9841: Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab (Medicare: Carrier judgment) - G9842: Patient has metastatic disease at diagnosis (Medicare: Carrier judgment) - G9843: Ras (kras or nras) gene mutation (Medicare: Carrier judgment) - G9844: Patient did not receive anti-egfr monoclonal antibody therapy (Medicare: Carrier judgment) - G9845: Patient received anti-egfr monoclonal antibody therapy (Medicare: Carrier judgment) - G9846: Patients who died from cancer (Medicare: Carrier judgment) - G9847: Patient received systemic cancer-directed therapy in the last 14 days of life (Medicare: Carrier judgment) - G9848: Patient did not receive systemic cancer-directed therapy in the last 14 days of life (Medicare: Carrier judgment) - G9849: Patients who died from cancer (Medicare: Carrier judgment) - G9850: Patient had more than one emergency department visit in the last 30 days of life (Medicare: Carrier judgment) - G9851: Patient had one or less emergency department visits in the last 30 days of life (Medicare: Carrier judgment) - G9852: Patients who died from cancer (Medicare: Carrier judgment) - G9853: Patient admitted to the icu in the last 30 days of life (Medicare: Carrier judgment) - G9854: Patient was not admitted to the icu in the last 30 days of life (Medicare: Carrier judgment) - G9855: Patients who died from cancer (Medicare: Carrier judgment) - G9856: Patient was not admitted to hospice (Medicare: Carrier judgment) - G9857: Patient admitted to hospice (Medicare: Carrier judgment) - G9858: Patient enrolled in hospice (Medicare: Carrier judgment) - G9859: Patients who died from cancer (Medicare: Carrier judgment) - G9860: Patient spent less than three days in hospice care (Medicare: Carrier judgment) - G9861: Patient spent greater than or equal to three days in hospice care (Medicare: Carrier judgment) - G9862: 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) (Medicare: Carrier judgment) - G9868: 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 (Medicare: Carrier judgment) - G9869: 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 (Medicare: Carrier judgment) - G9870: 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 (Medicare: Carrier judgment) - G9871: Behavioral counseling for diabetes prevention, online, 60 minutes (Medicare: Carrier judgment) - G9873: 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 (Medicare: Carrier judgment) - G9874: 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 (Medicare: Carrier judgment) - G9875: 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 (Medicare: Carrier judgment) - G9876: 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 (Medicare: Carrier judgment) - G9877: 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 (Medicare: Carrier judgment) - G9878: 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 (Medicare: Carrier judgment) - G9879: 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 (Medicare: Carrier judgment) - G9880: 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 (Medicare: Carrier judgment) - G9881: 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 (Medicare: Carrier judgment) - G9882: 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 (Medicare: Carrier judgment) - G9883: 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 (Medicare: Carrier judgment) - G9884: 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 (Medicare: Carrier judgment) - G9885: 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 (Medicare: Carrier judgment) - G9886: Behavioral counseling for diabetes prevention, in-person, group, 60 minutes (Medicare: Carrier judgment) - G9887: Behavioral counseling for diabetes prevention, distance learning, 60 minutes (Medicare: Carrier judgment) - G9888: Maintenance 5% wl from baseline weight in months 7-12 (Medicare: Carrier judgment) - G9890: 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 (Medicare: Carrier judgment) - G9891: 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) (Medicare: Carrier judgment) - G9892: Documentation of patient reason(s) for not performing a dilated macular examination (Medicare: Carrier judgment) - G9893: Dilated macular exam was not performed, reason not otherwise specified (Medicare: Carrier judgment) - G9894: Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate (Medicare: Carrier judgment) - G9895: 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) (Medicare: Carrier judgment) - G9896: Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (Medicare: Carrier judgment) - G9897: Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given (Medicare: Carrier judgment) - G9898: 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 (Medicare: Carrier judgment) - G9899: Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed (Medicare: Carrier judgment) - G9900: Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified (Medicare: Carrier judgment) - G9901: 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 (Medicare: Carrier judgment) - G9902: Patient screened for tobacco use and identified as a tobacco user (Medicare: Carrier judgment) - G9903: Patient screened for tobacco use and identified as a tobacco non-user (Medicare: Carrier judgment) - G9904: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) (Medicare: Carrier judgment) - G9905: Patient not screened for tobacco use (Medicare: Carrier judgment) - G9906: 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) (Medicare: Carrier judgment) - G9907: 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) (Medicare: Carrier judgment) - G9908: 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) (Medicare: Carrier judgment) - G9909: 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) (Medicare: Carrier judgment) - G9910: 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 (Medicare: Carrier judgment) - G9911: Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy (Medicare: Carrier judgment) - G9912: Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy (Medicare: Carrier judgment) - G9913: Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified (Medicare: Carrier judgment) - G9914: Patient initiated an anti-tnf agent (Medicare: Carrier judgment) - G9915: No record of hbv results documented (Medicare: Carrier judgment) - G9916: Functional status performed once in the last 12 months (Medicare: Carrier judgment) - G9917: Documentation of advanced stage dementia and caregiver knowledge is limited (Medicare: Carrier judgment) - G9918: Functional status not performed, reason not otherwise specified (Medicare: Carrier judgment) - G9919: Screening performed and positive and provision of recommendations (Medicare: Not payable by Medicare) - G9920: Screening performed and negative (Medicare: Not payable by Medicare) - G9921: No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified (Medicare: Carrier judgment) - G9922: Safety concerns screen provided and if positive then documented mitigation recommendations (Medicare: Carrier judgment) - G9923: Safety concerns screen provided and negative (Medicare: Carrier judgment) - G9924: 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) (Medicare: Carrier judgment) - G9925: Safety concerns screening not provided, reason not otherwise specified (Medicare: Carrier judgment) - G9926: Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources (Medicare: Carrier judgment) - G9927: 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 (Medicare: Carrier judgment) - G9928: Fda-approved anticoagulant not prescribed, reason not given (Medicare: Carrier judgment) - G9929: Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) (Medicare: Carrier judgment) - G9930: Patients who are receiving comfort care only (Medicare: Carrier judgment) - G9931: Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women (Medicare: Carrier judgment) - G9932: 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) (Medicare: Carrier judgment) - G9933: Adenoma(s) or colorectal cancer detected during screening colonoscopy (Medicare: Carrier judgment) - G9934: Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma (Medicare: Carrier judgment) - G9935: Adenoma(s) or colorectal cancer not detected during screening colonoscopy (Medicare: Carrier judgment) - G9936: Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus (Medicare: Carrier judgment) - G9937: Diagnostic colonoscopy (Medicare: Carrier judgment) - G9938: 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 (Medicare: Carrier judgment) - G9939: Pathologists/dermatopathologists is the same clinician who performed the biopsy (Medicare: Carrier judgment) - G9940: 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) (Medicare: Carrier judgment) - G9941: Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively (Medicare: Carrier judgment) - G9942: Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy (Medicare: Carrier judgment) - G9943: Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively (Medicare: Carrier judgment) - G9944: Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively (Medicare: Carrier judgment) - G9945: Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis (Medicare: Carrier judgment) - G9946: Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively (Medicare: Carrier judgment) - G9947: Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively (Medicare: Carrier judgment) - G9948: Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy (Medicare: Carrier judgment) - G9949: Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively (Medicare: Carrier judgment) - G9954: Patient exhibits 2 or more risk factors for post-operative vomiting (Medicare: Carrier judgment) - G9955: Cases in which an inhalational anesthetic is used only for induction (Medicare: Carrier judgment) - G9956: Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (Medicare: Carrier judgment) - G9957: 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) (Medicare: Carrier judgment) - G9958: Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (Medicare: Carrier judgment) - G9959: Systemic antimicrobials not prescribed (Medicare: Carrier judgment) - G9960: Documentation of medical reason(s) for prescribing systemic antimicrobials (Medicare: Carrier judgment) - G9961: Systemic antimicrobials prescribed (Medicare: Carrier judgment) - G9962: Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy (Medicare: Carrier judgment) - G9963: 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 (Medicare: Carrier judgment) - G9964: Patient received at least one well-child visit with a pcp during the performance period (Medicare: Carrier judgment) - G9965: Patient did not receive at least one well-child visit with a pcp during the performance period (Medicare: Carrier judgment) - G9966: Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report (Medicare: Carrier judgment) - G9967: Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report (Medicare: Carrier judgment) - G9968: Patient was referred to another clinician or specialist during the measurement period (Medicare: Carrier judgment) - G9969: Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred (Medicare: Carrier judgment) - G9970: Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred (Medicare: Carrier judgment) - G9974: 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 (Medicare: Carrier judgment) - G9975: Documentation of medical reason(s) for not performing a dilated macular examination (Medicare: Carrier judgment) - G9978: 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 (Medicare: Carrier judgment) - G9979: 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 (Medicare: Carrier judgment) - G9980: 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 (Medicare: Carrier judgment) - G9981: 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 (Medicare: Carrier judgment) - G9982: 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 (Medicare: Carrier judgment) - G9983: 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 (Medicare: Carrier judgment) - G9984: 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 (Medicare: Carrier judgment) - G9985: 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 (Medicare: Carrier judgment) - G9986: 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 (Medicare: Carrier judgment) - G9987: 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 (Medicare: Carrier judgment) - G9988: Palliative care services provided to patient any time during the measurement period (Medicare: Carrier judgment) - G9989: Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine) (Medicare: Carrier judgment) - G9990: Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period (Medicare: Carrier judgment) - G9991: Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period (Medicare: Carrier judgment) - G9992: Palliative care services used by patient any time during the measurement period (Medicare: Carrier judgment) - G9993: Patient was provided palliative care services any time during the measurement period (Medicare: Carrier judgment) - G9994: Patient is using palliative care services any time during the measurement period (Medicare: Carrier judgment) - G9995: Patients who use palliative care services any time during the measurement period (Medicare: Carrier judgment) - G9996: Documentation stating the patient has received or is currently receiving palliative or hospice care (Medicare: Carrier judgment) - G9997: Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter (Medicare: Carrier judgment) - G9998: 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]) (Medicare: Carrier judgment) - G9999: 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) (Medicare: Carrier judgment) - H0001: Alcohol and/or drug assessment (Medicare: Not payable by Medicare) - H0002: Behavioral health screening to determine eligibility for admission to treatment program (Medicare: Not payable by Medicare) - H0003: Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs (Medicare: Not payable by Medicare) - H0004: Behavioral health counseling and therapy, per 15 minutes (Medicare: Not payable by Medicare) - H0005: Alcohol and/or drug services; group counseling by a clinician (Medicare: Not payable by Medicare) - H0006: Alcohol and/or drug services; case management (Medicare: Not payable by Medicare) - H0007: Alcohol and/or drug services; crisis intervention (outpatient) (Medicare: Not payable by Medicare) - H0008: Alcohol and/or drug services; sub-acute detoxification (hospital inpatient) (Medicare: Not payable by Medicare) - H0009: Alcohol and/or drug services; acute detoxification (hospital inpatient) (Medicare: Not payable by Medicare) - H0010: Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) (Medicare: Not payable by Medicare) - H0011: Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (Medicare: Not payable by Medicare) - H0012: Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient) (Medicare: Not payable by Medicare) - H0013: Alcohol and/or drug services; acute detoxification (residential addiction program outpatient) (Medicare: Not payable by Medicare) - H0014: Alcohol and/or drug services; ambulatory detoxification (Medicare: Not payable by Medicare) - H0015: 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 (Medicare: Not payable by Medicare) - H0016: Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) (Medicare: Not payable by Medicare) - H0017: Behavioral health; residential (hospital residential treatment program), without room and board, per diem (Medicare: Not payable by Medicare) - H0018: Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem (Medicare: Not payable by Medicare) - H0019: 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 (Medicare: Not payable by Medicare) - H0020: Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) (Medicare: Not payable by Medicare) - H0021: Alcohol and/or drug training service (for staff and personnel not employed by providers) (Medicare: Not payable by Medicare) - H0022: Alcohol and/or drug intervention service (planned facilitation) (Medicare: Not payable by Medicare) - H0023: Behavioral health outreach service (planned approach to reach a targeted population) (Medicare: Not payable by Medicare) - H0024: Behavioral health prevention information dissemination service (one-way direct or non-direct contact with service audiences to affect knowledge and attitude) (Medicare: Not payable by Medicare) - H0025: Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior) (Medicare: Not payable by Medicare) - H0026: Alcohol and/or drug prevention process service, community-based (delivery of services to develop skills of impactors) (Medicare: Not payable by Medicare) - H0027: 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) (Medicare: Not payable by Medicare) - H0028: Alcohol and/or drug prevention problem identification and referral service (e.g., student assistance and employee assistance programs), does not include assessment (Medicare: Not payable by Medicare) - H0029: Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other drug use e.g., alcohol free social events) (Medicare: Not payable by Medicare) - H0030: Behavioral health hotline service (Medicare: Not payable by Medicare) - H0031: Mental health assessment, by non-physician (Medicare: Not payable by Medicare) - H0032: Mental health service plan development by non-physician (Medicare: Not payable by Medicare) - H0033: Oral medication administration, direct observation (Medicare: Not payable by Medicare) - H0034: Medication training and support, per 15 minutes (Medicare: Not payable by Medicare) - H0035: Mental health partial hospitalization, treatment, less than 24 hours (Medicare: Not payable by Medicare) - H0036: Community psychiatric supportive treatment, face-to-face, per 15 minutes (Medicare: Not payable by Medicare) - H0037: Community psychiatric supportive treatment program, per diem (Medicare: Not payable by Medicare) - H0038: Self-help/peer services, per 15 minutes (Medicare: Not payable by Medicare) - H0039: Assertive community treatment, face-to-face, per 15 minutes (Medicare: Not payable by Medicare) - H0040: Assertive community treatment program, per diem (Medicare: Not payable by Medicare) - H0041: Foster care, child, non-therapeutic, per diem (Medicare: Not payable by Medicare) - H0042: Foster care, child, non-therapeutic, per month (Medicare: Not payable by Medicare) - H0043: Supported housing, per diem (Medicare: Not payable by Medicare) - H0044: Supported housing, per month (Medicare: Not payable by Medicare) - H0045: Respite care services, not in the home, per diem (Medicare: Not payable by Medicare) - H0046: Mental health services, not otherwise specified (Medicare: Not payable by Medicare) - H0047: Alcohol and/or other drug abuse services, not otherwise specified (Medicare: Not payable by Medicare) - H0048: Alcohol and/or other drug testing: collection and handling only, specimens other than blood (Medicare: Not payable by Medicare) - H0049: Alcohol and/or drug screening (Medicare: Not payable by Medicare) - H0050: Alcohol and/or drug services, brief intervention, per 15 minutes (Medicare: Not payable by Medicare) - H0051: Traditional healing service (Medicare: Not payable by Medicare) - H0052: Missing and murdered indigenous persons (mmip) mental health and clinical care (Medicare: Not payable by Medicare) - H0053: Historical trauma (ht) mental health and clinical care for indigenous persons (Medicare: Not payable by Medicare) - H1000: Prenatal care, at-risk assessment (Medicare: Not payable by Medicare) - H1001: Prenatal care, at-risk enhanced service; antepartum management (Medicare: Not payable by Medicare) - H1002: Prenatal care, at risk enhanced service; care coordination (Medicare: Not payable by Medicare) - H1003: Prenatal care, at-risk enhanced service; education (Medicare: Not payable by Medicare) - H1004: Prenatal care, at-risk enhanced service; follow-up home visit (Medicare: Not payable by Medicare) - H1005: Prenatal care, at-risk enhanced service package (includes h1001-h1004) (Medicare: Not payable by Medicare) - H1010: Non-medical family planning education, per session (Medicare: Not payable by Medicare) - H1011: Family assessment by licensed behavioral health professional for state defined purposes (Medicare: Not payable by Medicare) - H2000: Comprehensive multidisciplinary evaluation (Medicare: Not payable by Medicare) - H2001: Rehabilitation program, per 1/2 day (Medicare: Not payable by Medicare) - H2010: Comprehensive medication services, per 15 minutes (Medicare: Not payable by Medicare) - H2011: Crisis intervention service, per 15 minutes (Medicare: Not payable by Medicare) - H2012: Behavioral health day treatment, per hour (Medicare: Not payable by Medicare) - H2013: Psychiatric health facility service, per diem (Medicare: Not payable by Medicare) - H2014: Skills training and development, per 15 minutes (Medicare: Not payable by Medicare) - H2015: Comprehensive community support services, per 15 minutes (Medicare: Not payable by Medicare) - H2016: Comprehensive community support services, per diem (Medicare: Not payable by Medicare) - H2017: Psychosocial rehabilitation services, per 15 minutes (Medicare: Not payable by Medicare) - H2018: Psychosocial rehabilitation services, per diem (Medicare: Not payable by Medicare) - H2019: Therapeutic behavioral services, per 15 minutes (Medicare: Not payable by Medicare) - H2020: Therapeutic behavioral services, per diem (Medicare: Not payable by Medicare) - H2021: Community-based wrap-around services, per 15 minutes (Medicare: Not payable by Medicare) - H2022: Community-based wrap-around services, per diem (Medicare: Not payable by Medicare) - H2023: Supported employment, per 15 minutes (Medicare: Not payable by Medicare) - H2024: Supported employment, per diem (Medicare: Not payable by Medicare) - H2025: Ongoing support to maintain employment, per 15 minutes (Medicare: Not payable by Medicare) - H2026: Ongoing support to maintain employment, per diem (Medicare: Not payable by Medicare) - H2027: Psychoeducational service, per 15 minutes (Medicare: Not payable by Medicare) - H2028: Sexual offender treatment service, per 15 minutes (Medicare: Not payable by Medicare) - H2029: Sexual offender treatment service, per diem (Medicare: Not payable by Medicare) - H2030: Mental health clubhouse services, per 15 minutes (Medicare: Not payable by Medicare) - H2031: Mental health clubhouse services, per diem (Medicare: Not payable by Medicare) - H2032: Activity therapy, per 15 minutes (Medicare: Not payable by Medicare) - H2033: Multisystemic therapy for juveniles, per 15 minutes (Medicare: Not payable by Medicare) - H2034: Alcohol and/or drug abuse halfway house services, per diem (Medicare: Not payable by Medicare) - H2035: Alcohol and/or other drug treatment program, per hour (Medicare: Not payable by Medicare) - H2036: Alcohol and/or other drug treatment program, per diem (Medicare: Not payable by Medicare) - H2037: Developmental delay prevention activities, dependent child of client, per 15 minutes (Medicare: Not payable by Medicare) - H2038: Skills training and development, per diem (Medicare: Not payable by Medicare) - H2040: Coordinated specialty care, team-based, for first episode psychosis, per month (Medicare: Not payable by Medicare) - H2041: Coordinated specialty care, team-based, for first episode psychosis, per encounter (Medicare: Not payable by Medicare) - J0013: Esketamine, nasal spray, 1 mg (Medicare: Not payable by Medicare) - J0120: Injection, tetracycline, up to 250 mg (Medicare: Special coverage instructions apply) - J0121: Injection, omadacycline, 1 mg (Medicare: Carrier judgment) - J0122: Injection, eravacycline, 1 mg (Medicare: Carrier judgment) - J0129: 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) (Medicare: Carrier judgment) - J0130: Injection abciximab, 10 mg (Medicare: Special coverage instructions apply) - J0131: Injection, acetaminophen, not otherwise specified,10 mg (Medicare: Carrier judgment) - J0132: Injection, acetylcysteine, 100 mg (Medicare: Carrier judgment) - J0133: Injection, acyclovir, 5 mg (Medicare: Carrier judgment) - J0134: Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg (Medicare: Carrier judgment) - J0135: Injection, adalimumab, 20 mg (Medicare: Carrier judgment) - J0136: Injection, acetaminophen (b braun), not therapeutically equivalent to j0131, 10 mg (Medicare: Carrier judgment) - J0137: Injection, acetaminophen (hikma), not therapeutically equivalent to j0131, 10 mg (Medicare: Carrier judgment) - J0138: Injection, acetaminophen 10 mg and ibuprofen 3 mg (Medicare: Carrier judgment) - J0139: Injection, adalimumab, 1 mg (Medicare: Carrier judgment) - J0150: Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270) (Medicare: Special coverage instructions apply) - J0151: Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270) (Medicare: Carrier judgment) - J0153: Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) (Medicare: Special coverage instructions apply) - J0162: Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg (Medicare: Special coverage instructions apply) - J0163: Injection, epinephrine in sodium chloride (endo), 0.1 mg (Medicare: Special coverage instructions apply) - J0164: Injection, epinephrine in sodium chloride (baxter), 0.1 mg (Medicare: Special coverage instructions apply) - J0165: Injection, epinephrine, not otherwise specified, 0.1 mg (Medicare: Special coverage instructions apply) - J0166: Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg (Medicare: Special coverage instructions apply) - J0167: Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg (Medicare: Special coverage instructions apply) - J0168: Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg (Medicare: Special coverage instructions apply) - J0169: Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg (Medicare: Special coverage instructions apply) - J0171: Injection, adrenalin, epinephrine, 0.1 mg (Medicare: Special coverage instructions apply) - J0172: Injection, aducanumab-avwa, 2 mg (Medicare: Special coverage instructions apply) - J0173: Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg (Medicare: Special coverage instructions apply) - J0174: Lecanemab-irmb, for intravenous injection, 1 mg (Medicare: Carrier judgment) - J0175: Injection, donanemab-azbt, 2 mg (Medicare: Carrier judgment) - J0177: Injection, aflibercept hd, 1 mg (Medicare: Carrier judgment) - J0178: Injection, aflibercept, 1 mg (Medicare: Carrier judgment) - J0179: Injection, brolucizumab-dbll, 1 mg (Medicare: Carrier judgment) - J0180: Injection, agalsidase beta, 1 mg (Medicare: Carrier judgment) - J0184: Injection, amisulpride, 1 mg (Medicare: Carrier judgment) - J0185: Injection, aprepitant, 1 mg (Medicare: Carrier judgment) - J0190: Injection, biperiden lactate, per 5 mg (Medicare: Special coverage instructions apply) - J0200: Injection, alatrofloxacin mesylate, 100 mg (Medicare: Special coverage instructions apply) - J0202: Injection, alemtuzumab, 1 mg (Medicare: Carrier judgment) - J0205: Injection, alglucerase, per 10 units (Medicare: Special coverage instructions apply) - J0206: Injection, allopurinol sodium, 1 mg (Medicare: Carrier judgment) - J0207: Injection, amifostine, 500 mg (Medicare: Special coverage instructions apply) - J0208: Injection, sodium thiosulfate (pedmark), 100 mg (Medicare: Carrier judgment) - J0209: Injection, sodium thiosulfate (hope), 100 mg (Medicare: Carrier judgment) - J0210: Injection, methyldopate hcl, up to 250 mg (Medicare: Special coverage instructions apply) - J0211: Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (nithiodote) (Medicare: Carrier judgment) - J0215: Injection, alefacept, 0.5 mg (Medicare: Carrier judgment) - J0216: Injection, alfentanil hydrochloride, 500 micrograms (Medicare: Carrier judgment) - J0217: Injection, velmanase alfa-tycv, 1 mg (Medicare: Carrier judgment) - J0218: Injection, olipudase alfa-rpcp, 1 mg (Medicare: Carrier judgment) - J0219: Injection, avalglucosidase alfa-ngpt, 4 mg (Medicare: Carrier judgment) - J0220: Injection, alglucosidase alfa, 10 mg, not otherwise specified (Medicare: Carrier judgment) - J0221: Injection, alglucosidase alfa, (lumizyme), 10 mg (Medicare: Carrier judgment) - J0222: Injection, patisiran, 0.1 mg (Medicare: Carrier judgment) - J0223: Injection, givosiran, 0.5 mg (Medicare: Carrier judgment) - J0224: Injection, lumasiran, 0.5 mg (Medicare: Carrier judgment) - J0225: Injection, vutrisiran, 1 mg (Medicare: Carrier judgment) - J0248: Injection, remdesivir, 1 mg (Medicare: Carrier judgment) - J0256: Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg (Medicare: Special coverage instructions apply) - J0257: Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg (Medicare: Special coverage instructions apply) - J0270: 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) (Medicare: Special coverage instructions apply) - J0275: 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) (Medicare: Special coverage instructions apply) - J0278: Injection, amikacin sulfate, 100 mg (Medicare: Carrier judgment) - J0280: Injection, aminophyllin, up to 250 mg (Medicare: Special coverage instructions apply) - J0281: Injection, aminocaproic acid, 1 gram (Medicare: Carrier judgment) - J0282: Injection, amiodarone hydrochloride, 30 mg (Medicare: Special coverage instructions apply) - J0283: Injection, amiodarone hydrochloride (nexterone), 30 mg (Medicare: Special coverage instructions apply) - J0285: Injection, amphotericin b, 50 mg (Medicare: Special coverage instructions apply) - J0287: Injection, amphotericin b lipid complex, 10 mg (Medicare: Special coverage instructions apply) - J0288: Injection, amphotericin b cholesteryl sulfate complex, 10 mg (Medicare: Special coverage instructions apply) - J0289: Injection, amphotericin b liposome, 10 mg (Medicare: Special coverage instructions apply) - J0290: Injection, ampicillin sodium, 500 mg (Medicare: Special coverage instructions apply) - J0291: Injection, plazomicin, 5 mg (Medicare: Carrier judgment) - J0295: Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm (Medicare: Special coverage instructions apply) - J0300: Injection, amobarbital, up to 125 mg (Medicare: Special coverage instructions apply) - J0330: Injection, succinylcholine chloride, up to 20 mg (Medicare: Special coverage instructions apply) - J0348: Injection, anidulafungin, 1 mg (Medicare: Carrier judgment) - J0349: Injection, rezafungin, 1 mg (Medicare: Carrier judgment) - J0350: Injection, anistreplase, per 30 units (Medicare: Special coverage instructions apply) - J0360: Injection, hydralazine hcl, up to 20 mg (Medicare: Special coverage instructions apply) - J0364: Injection, apomorphine hydrochloride, 1 mg (Medicare: Carrier judgment) - J0365: Injection, aprotonin, 10,000 kiu (Medicare: Special coverage instructions apply) - J0380: Injection, metaraminol bitartrate, per 10 mg (Medicare: Special coverage instructions apply) - J0390: Injection, chloroquine hydrochloride, up to 250 mg (Medicare: Special coverage instructions apply) - J0391: Injection, artesunate, 1 mg (Medicare: Carrier judgment) - J0395: Injection, arbutamine hcl, 1 mg (Medicare: Special coverage instructions apply) - J0400: Injection, aripiprazole, intramuscular, 0.25 mg (Medicare: Carrier judgment) - J0401: Injection, aripiprazole (abilify maintena), 1 mg (Medicare: Carrier judgment) - J0402: Injection, aripiprazole (abilify asimtufii), 1 mg (Medicare: Carrier judgment) - J0456: Injection, azithromycin, 500 mg (Medicare: Special coverage instructions apply) - J0457: Injection, aztreonam, 100 mg (Medicare: Carrier judgment) - J0458: Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg) (Medicare: Carrier judgment) - J0461: Injection, atropine sulfate, 0.01 mg (Medicare: Special coverage instructions apply) - J0462: Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg (Medicare: Special coverage instructions apply) - J0463: Injection, atropine sulfate (fresenius and therapeutically equivalent), 0.01 mg (Medicare: Special coverage instructions apply) - J0470: Injection, dimercaprol, per 100 mg (Medicare: Special coverage instructions apply) - J0475: Injection, baclofen, 10 mg (Medicare: Special coverage instructions apply) - J0476: Injection, baclofen, 50 mcg for intrathecal trial (Medicare: Special coverage instructions apply) - J0480: Injection, basiliximab, 20 mg (Medicare: Special coverage instructions apply) - J0485: Injection, belatacept, 1 mg (Medicare: Carrier judgment) - J0490: Injection, belimumab, 10 mg (Medicare: Carrier judgment) - J0491: Injection, anifrolumab-fnia, 1 mg (Medicare: Carrier judgment) - J0500: Injection, dicyclomine hcl, up to 20 mg (Medicare: Special coverage instructions apply) - J0515: Injection, benztropine mesylate, per 1 mg (Medicare: Special coverage instructions apply) - J0517: Injection, benralizumab, 1 mg (Medicare: Carrier judgment) - J0520: Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg (Medicare: Special coverage instructions apply) - J0525: Injection, cefotetan disodium, 10 mg (Medicare: Carrier judgment) - J0558: Injection, penicillin g benzathine and penicillin g procaine, 100,000 units (Medicare: Carrier judgment) - J0561: Injection, penicillin g benzathine, 100,000 units (Medicare: Special coverage instructions apply) - J0565: Injection, bezlotoxumab, 10 mg (Medicare: Carrier judgment) - J0567: Injection, cerliponase alfa, 1 mg (Medicare: Carrier judgment) - J0570: Buprenorphine implant, 74.2 mg (Medicare: Carrier judgment) - J0571: Buprenorphine, oral, 1 mg (Medicare: Special coverage instructions apply) - J0572: Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine (Medicare: Special coverage instructions apply) - J0573: Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine (Medicare: Special coverage instructions apply) - J0574: Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine (Medicare: Special coverage instructions apply) - J0575: Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine (Medicare: Special coverage instructions apply) - J0576: Injection, buprenorphine extended-release (brixadi), 1 mg (Medicare: Carrier judgment) - J0577: Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy (Medicare: Carrier judgment) - J0578: Injection, buprenorphine extended release (brixadi), greater than 7 days and up to 28 days of therapy (Medicare: Carrier judgment) - J0582: Injection, bivalirudin (endo), not therapeutically equivalent to j0583, 1 mg (Medicare: Carrier judgment) - J0583: Injection, bivalirudin, 1 mg (Medicare: Carrier judgment) - J0584: Injection, burosumab-twza 1 mg (Medicare: Carrier judgment) - J0585: Injection, onabotulinumtoxina, 1 unit (Medicare: Special coverage instructions apply) - J0586: Injection, abobotulinumtoxina, 5 units (Medicare: Carrier judgment) - J0587: Injection, rimabotulinumtoxinb, 100 units (Medicare: Special coverage instructions apply) - J0588: Injection, incobotulinumtoxin a, 1 unit (Medicare: Carrier judgment) - J0589: Injection, daxibotulinumtoxina-lanm, 1 unit (Medicare: Carrier judgment) - J0591: Injection, deoxycholic acid, 1 mg (Medicare: Carrier judgment) - J0592: Injection, buprenorphine hydrochloride, 0.1 mg (Medicare: Special coverage instructions apply) - J0593: 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) (Medicare: Carrier judgment) - J0594: injection, busulfan, 1 mg (Medicare: Carrier judgment) - J0595: Injection, butorphanol tartrate, 1 mg (Medicare: Carrier judgment) - J0596: Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units (Medicare: Carrier judgment) - J0597: Injection, c-1 esterase inhibitor (human), berinert, 10 units (Medicare: Carrier judgment) - J0598: Injection, c-1 esterase inhibitor (human), cinryze, 10 units (Medicare: Carrier judgment) - J0599: Injection, c-1 esterase inhibitor (human), (haegarda), 10 units (Medicare: Carrier judgment) - J0600: Injection, edetate calcium disodium, up to 1000 mg (Medicare: Special coverage instructions apply) - J0601: Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0602: Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0603: Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0604: Cinacalcet, oral, 1 mg, (for esrd on dialysis) (Medicare: Special coverage instructions apply) - J0605: Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0606: Injection, etelcalcetide, 0.1 mg (Medicare: Special coverage instructions apply) - J0607: Lanthanum carbonate, oral, 5 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0608: Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis) (Medicare: Carrier judgment) - J0609: Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis) (Medicare: Carrier judgment) - J0610: Injection, calcium gluconate (fresenius kabi), per 10 ml (Medicare: Special coverage instructions apply) - J0611: Injection, calcium gluconate (wg critical care), per 10 ml (Medicare: Special coverage instructions apply) - J0612: Injection, calcium gluconate, not otherwise specified, 10 mg (Medicare: Special coverage instructions apply) - J0613: Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg (Medicare: Special coverage instructions apply) - J0614: Injection, treosulfan, 50 mg (Medicare: Carrier judgment) - J0615: Calcium acetate, oral, 23 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0616: Injection, metoprolol tartrate, 1 mg (Medicare: Carrier judgment) - J0618: Injection, calcium chloride, 2 mg (Medicare: Carrier judgment) - J0620: Injection, calcium glycerophosphate and calcium lactate, per 10 ml (Medicare: Special coverage instructions apply) - J0630: Injection, calcitonin salmon, up to 400 units (Medicare: Special coverage instructions apply) - J0636: Injection, calcitriol, 0.1 mcg (Medicare: Special coverage instructions apply) - J0637: Injection, caspofungin acetate, 5 mg (Medicare: Carrier judgment) - J0638: Injection, canakinumab, 1 mg (Medicare: Carrier judgment) - J0640: Injection, leucovorin calcium, per 50 mg (Medicare: Special coverage instructions apply) - J0641: Injection, levoleucovorin, not otherwise specified, 0.5 mg (Medicare: Special coverage instructions apply) - J0642: Injection, levoleucovorin (khapzory), 0.5 mg (Medicare: Carrier judgment) - J0650: Injection, levothyroxine sodium, not otherwise specified, 10 mcg (Medicare: Carrier judgment) - J0651: Injection, levothyroxine sodium (fresenius kabi), not therapeutically equivalent to j0650, 10 mcg (Medicare: Carrier judgment) - J0652: Injection, levothyroxine sodium (hikma), not therapeutically equivalent to j0650, 10 mcg (Medicare: Carrier judgment) - J0654: Injection, liothyronine, 1 mcg (Medicare: Carrier judgment) - J0665: Injection, bupivicaine, not otherwise specified, 0.5 mg (Medicare: Carrier judgment) - J0666: Injection, bupivacaine liposome, 1 mg (Medicare: Carrier judgment) - J0668: Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg (Medicare: Carrier judgment) - J0670: Injection, mepivacaine hydrochloride, per 10 ml (Medicare: Special coverage instructions apply) - J0675: Injection, carboprost tromethamine, 0.1 mg (Medicare: Carrier judgment) - J0681: Injection, ceftobiprole medocaril sodium, 3 mg (Medicare: Carrier judgment) - J0687: Injection, cefazolin sodium (wg critical care), not therapeutically equivalent to j0690, 500 mg (Medicare: Special coverage instructions apply) - J0688: Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mg (Medicare: Special coverage instructions apply) - J0689: Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg (Medicare: Special coverage instructions apply) - J0690: Injection, cefazolin sodium, 500 mg (Medicare: Special coverage instructions apply) - J0691: Injection, lefamulin, 1 mg (Medicare: Carrier judgment) - J0692: Injection, cefepime hydrochloride, 500 mg (Medicare: Carrier judgment) - J0693: Injection, cefiderocol, 5 mg (Medicare: Carrier judgment) - J0694: Injection, cefoxitin sodium, 1 gm (Medicare: Special coverage instructions apply) - J0695: Injection, ceftolozane 50 mg and tazobactam 25 mg (Medicare: Carrier judgment) - J0696: Injection, ceftriaxone sodium, per 250 mg (Medicare: Special coverage instructions apply) - J0697: Injection, sterile cefuroxime sodium, per 750 mg (Medicare: Special coverage instructions apply) - J0698: Injection, cefotaxime sodium, per gm (Medicare: Special coverage instructions apply) - J0699: Injection, cefiderocol, 10 mg (Medicare: Carrier judgment) - J0701: Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg (Medicare: Carrier judgment) - J0702: Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg (Medicare: Special coverage instructions apply) - J0703: Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg (Medicare: Carrier judgment) - J0706: Injection, caffeine citrate, 5 mg (Medicare: Carrier judgment) - J0710: Injection, cephapirin sodium, up to 1 gm (Medicare: Special coverage instructions apply) - J0712: Injection, ceftaroline fosamil, 10 mg (Medicare: Carrier judgment) - J0713: Injection, ceftazidime, per 500 mg (Medicare: Special coverage instructions apply) - J0714: Injection, ceftazidime and avibactam, 0.5 g/0.125 g (Medicare: Carrier judgment) - J0715: Injection, ceftizoxime sodium, per 500 mg (Medicare: Special coverage instructions apply) - J0716: Injection, centruroides immune f(ab)2, up to 120 milligrams (Medicare: Carrier judgment) - J0717: 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) (Medicare: Carrier judgment) - J0720: Injection, chloramphenicol sodium succinate, up to 1 gm (Medicare: Special coverage instructions apply) - J0725: Injection, chorionic gonadotropin, per 1,000 usp units (Medicare: Special coverage instructions apply) - J0735: Injection, clonidine hydrochloride, 1 mg (Medicare: Special coverage instructions apply) - J0736: Injection, clindamycin phosphate, 300 mg (Medicare: Carrier judgment) - J0737: Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg (Medicare: Carrier judgment) - J0738: Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) (Medicare: Special coverage instructions apply) - J0739: Injection, cabotegravir, 1mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) (Medicare: Special coverage instructions apply) - J0740: Injection, cidofovir, 375 mg (Medicare: Special coverage instructions apply) - J0741: Injection, cabotegravir and rilpivirine, 2mg/3mg (Medicare: Carrier judgment) - J0742: Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg (Medicare: Carrier judgment) - J0743: Injection, cilastatin sodium; imipenem, per 250 mg (Medicare: Special coverage instructions apply) - J0744: Injection, ciprofloxacin for intravenous infusion, 200 mg (Medicare: Carrier judgment) - J0745: Injection, codeine phosphate, per 30 mg (Medicare: Special coverage instructions apply) - J0750: 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) (Medicare: Special coverage instructions apply) - J0751: 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) (Medicare: Special coverage instructions apply) - J0752: Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) (Medicare: Special coverage instructions apply) - J0759: Injection, clevidipine butyrate, 1 mg (Medicare: Carrier judgment) - J0760: Injection, colchicine, per 1 mg (Medicare: Special coverage instructions apply) - J0770: Injection, colistimethate sodium, up to 150 mg (Medicare: Special coverage instructions apply) - J0775: Injection, collagenase, clostridium histolyticum, 0.01 mg (Medicare: Carrier judgment) - J0780: Injection, prochlorperazine, up to 10 mg (Medicare: Special coverage instructions apply) - J0791: Injection, crizanlizumab-tmca, 5 mg (Medicare: Carrier judgment) - J0795: Injection, corticorelin ovine triflutate, 1 microgram (Medicare: Special coverage instructions apply) - J0799: Fda approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified (Medicare: Special coverage instructions apply) - J0800: Injection, corticotropin, up to 40 units (Medicare: Special coverage instructions apply) - J0801: Injection, corticotropin (acthar gel), up to 40 units (Medicare: Carrier judgment) - J0802: Injection, corticotropin (ani), up to 40 units (Medicare: Carrier judgment) - J0833: Injection, cosyntropin, not otherwise specified, 0.25 mg (Medicare: Carrier judgment) - J0834: Injection, cosyntropin, 0.25 mg (Medicare: Carrier judgment) - J0840: Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram (Medicare: Carrier judgment) - J0841: Injection, crotalidae immune f(ab')2 (equine), 120 mg (Medicare: Carrier judgment) - J0850: Injection, cytomegalovirus immune globulin intravenous (human), per vial (Medicare: Special coverage instructions apply) - J0870: Injection, imetelstat, 1 mg (Medicare: Carrier judgment) - J0872: Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg (Medicare: Carrier judgment) - J0873: Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg (Medicare: Carrier judgment) - J0874: Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg (Medicare: Carrier judgment) - J0875: Injection, dalbavancin, 5 mg (Medicare: Carrier judgment) - J0877: Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg (Medicare: Carrier judgment) - J0878: Injection, daptomycin, 1 mg (Medicare: Carrier judgment) - J0879: Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis) (Medicare: Carrier judgment) - J0881: Injection, darbepoetin alfa, 1 microgram (non-esrd use) (Medicare: Special coverage instructions apply) - J0882: Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) (Medicare: Special coverage instructions apply) - J0883: Injection, argatroban, 1 mg (for non-esrd use) (Medicare: Special coverage instructions apply) - J0884: Injection, argatroban, 1 mg (for esrd on dialysis) (Medicare: Special coverage instructions apply) - J0885: Injection, epoetin alfa, (for non-esrd use), 1000 units (Medicare: Special coverage instructions apply) - J0886: Injection, epoetin alfa, 1000 units (for esrd on dialysis) (Medicare: Special coverage instructions apply) - J0887: Injection, epoetin beta, 1 microgram, (for esrd on dialysis) (Medicare: Special coverage instructions apply) - J0888: Injection, epoetin beta, 1 microgram, (for non esrd use) (Medicare: Special coverage instructions apply) - J0889: Daprodustat, oral, 1 mg, (for esrd on dialysis) (Medicare: Carrier judgment) - J0890: Injection, peginesatide, 0.1 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0891: Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) (Medicare: Special coverage instructions apply) - J0892: Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) (Medicare: Special coverage instructions apply) - J0893: Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mg (Medicare: Carrier judgment) - J0894: Injection, decitabine, 1 mg (Medicare: Carrier judgment) - J0895: Injection, deferoxamine mesylate, 500 mg (Medicare: Special coverage instructions apply) - J0896: Injection, luspatercept-aamt, 0.25 mg (Medicare: Carrier judgment) - J0897: Injection, denosumab, 1 mg (Medicare: Carrier judgment) - J0898: Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) (Medicare: Special coverage instructions apply) - J0899: Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) (Medicare: Special coverage instructions apply) - J0900: Injection, testosterone enanthate and estradiol valerate, up to 1 cc (Medicare: Special coverage instructions apply) - J0901: Vadadustat, oral, 1 mg (for esrd on dialysis) (Medicare: Carrier judgment) - J0911: Instillation, taurolidine 1.35 mg and heparin sodium 100 units (central venous catheter lock for adult patients receiving chronic hemodialysis) (Medicare: Carrier judgment) - J0945: Injection, brompheniramine maleate, per 10 mg (Medicare: Special coverage instructions apply) - J1000: Injection, depo-estradiol cypionate, up to 5 mg (Medicare: Special coverage instructions apply) - J1010: Injection, methylprednisolone acetate, 1 mg (Medicare: Special coverage instructions apply) - J1020: Injection, methylprednisolone acetate, 20 mg (Medicare: Special coverage instructions apply) - J1030: Injection, methylprednisolone acetate, 40 mg (Medicare: Special coverage instructions apply) - J1040: Injection, methylprednisolone acetate, 80 mg (Medicare: Special coverage instructions apply) - J1050: Injection, medroxyprogesterone acetate, 1 mg (Medicare: Carrier judgment) - J1060: Injection, testosterone cypionate and estradiol cypionate, up to 1 ml (Medicare: Special coverage instructions apply) - J1070: Injection, testosterone cypionate, up to 100 mg (Medicare: Special coverage instructions apply) - J1071: Injection, testosterone cypionate, 1 mg (Medicare: Special coverage instructions apply) - J1072: Injection, testosterone cypionate (azmiro), 1 mg (Medicare: Special coverage instructions apply) - J1073: Testosterone pellet, implant, 75 mg (Medicare: Special coverage instructions apply) - J1080: Injection, testosterone cypionate, 1 cc, 200 mg (Medicare: Special coverage instructions apply) - J1094: Injection, dexamethasone acetate, 1 mg (Medicare: Special coverage instructions apply) - J1095: Injection, dexamethasone 9 percent, intraocular, 1 microgram (Medicare: Special coverage instructions apply) - J1096: Dexamethasone, lacrimal ophthalmic insert, 0.1 mg (Medicare: Carrier judgment) - J1097: Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml (Medicare: Carrier judgment) - J1098: Articaine ophthalmic, 8% solution, 0.4 ml (Medicare: Carrier judgment) - J1100: Injection, dexamethasone sodium phosphate, 1 mg (Medicare: Special coverage instructions apply) - J1105: Dexmedetomidine, oral, 1 mcg (Medicare: Not payable by Medicare) - J1110: Injection, dihydroergotamine mesylate, per 1 mg (Medicare: Special coverage instructions apply) - J1120: Injection, acetazolamide sodium, up to 500 mg (Medicare: Special coverage instructions apply) - J1130: Injection, diclofenac sodium, 0.5 mg (Medicare: Carrier judgment) - J1160: Injection, digoxin, up to 0.5 mg (Medicare: Special coverage instructions apply) - J1162: Injection, digoxin immune fab (ovine), per vial (Medicare: Special coverage instructions apply) - J1163: Injection, diltiazem hydrochloride, 0.5 mg (Medicare: Carrier judgment) - J1164: Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg (Medicare: Carrier judgment) - J1165: Injection, phenytoin sodium, per 50 mg (Medicare: Special coverage instructions apply) - J1170: Injection, hydromorphone, up to 4 mg (Medicare: Special coverage instructions apply) - J1171: Injection, hydromorphone, 0.1 mg (Medicare: Special coverage instructions apply) - J1180: Injection, dyphylline, up to 500 mg (Medicare: Special coverage instructions apply) - J1190: Injection, dexrazoxane hydrochloride, per 250 mg (Medicare: Special coverage instructions apply) - J1200: Injection, diphenhydramine hcl, up to 50 mg (Medicare: Special coverage instructions apply) - J1201: Injection, cetirizine hydrochloride, 0.5 mg (Medicare: Carrier judgment) - J1202: Miglustat, oral, 65 mg (Medicare: Not payable by Medicare) - J1203: Injection, cipaglucosidase alfa-atga, 5 mg (Medicare: Carrier judgment) - J1205: Injection, chlorothiazide sodium, per 500 mg (Medicare: Special coverage instructions apply) - J1212: Injection, dmso, dimethyl sulfoxide, 50%, 50 ml (Medicare: Special coverage instructions apply) - J1230: Injection, methadone hcl, up to 10 mg (Medicare: Special coverage instructions apply) - J1240: Injection, dimenhydrinate, up to 50 mg (Medicare: Special coverage instructions apply) - J1245: Injection, dipyridamole, per 10 mg (Medicare: Special coverage instructions apply) - J1250: Injection, dobutamine hydrochloride, per 250 mg (Medicare: Special coverage instructions apply) - J1260: Injection, dolasetron mesylate, 10 mg (Medicare: Special coverage instructions apply) - J1265: Injection, dopamine hcl, 40 mg (Medicare: Carrier judgment) - J1267: Injection, doripenem, 10 mg (Medicare: Carrier judgment) - J1270: Injection, doxercalciferol, 1 mcg (Medicare: Carrier judgment) - J1271: Injection, doxycycline hyclate, 1 mg (Medicare: Carrier judgment) - J1290: Injection, ecallantide, 1 mg (Medicare: Carrier judgment) - J1299: Injection, eculizumab, 2 mg (Medicare: Carrier judgment) - J1300: Injection, eculizumab, 10 mg (Medicare: Carrier judgment) - J1301: Injection, edaravone, 1 mg (Medicare: Carrier judgment) - J1302: Injection, sutimlimab-jome, 10 mg (Medicare: Carrier judgment) - J1303: Injection, ravulizumab-cwvz, 10 mg (Medicare: Carrier judgment) - J1304: Injection, tofersen, 1 mg (Medicare: Carrier judgment) - J1305: Injection, evinacumab-dgnb, 5mg (Medicare: Carrier judgment) - J1306: Injection, inclisiran, 1 mg (Medicare: Carrier judgment) - J1307: Injection, crovalimab-akkz, 10 mg (Medicare: Carrier judgment) - J1308: Injection, famotidine, 0.25 mg (Medicare: Carrier judgment) - J1320: Injection, amitriptyline hcl, up to 20 mg (Medicare: Special coverage instructions apply) - J1322: Injection, elosulfase alfa, 1 mg (Medicare: Carrier judgment) - J1323: Injection, elranatamab-bcmm, 1 mg (Medicare: Carrier judgment) - J1324: Injection, enfuvirtide, 1 mg (Medicare: Carrier judgment) - J1325: Injection, epoprostenol, 0.5 mg (Medicare: Special coverage instructions apply) - J1326: Injection, zolbetuximab-clzb, 2 mg (Medicare: Carrier judgment) - J1327: Injection, eptifibatide, 5 mg (Medicare: Special coverage instructions apply) - J1330: Injection, ergonovine maleate, up to 0.2 mg (Medicare: Special coverage instructions apply) - J1335: Injection, ertapenem sodium, 500 mg (Medicare: Carrier judgment) - J1364: Injection, erythromycin lactobionate, per 500 mg (Medicare: Special coverage instructions apply) - J1370: Injection, esomeprazole sodium, 1 mg (Medicare: Carrier judgment) - J1380: Injection, estradiol valerate, up to 10 mg (Medicare: Special coverage instructions apply) - J1410: Injection, estrogen conjugated, per 25 mg (Medicare: Special coverage instructions apply) - J1411: Injection, etranacogene dezaparvovec-drlb, per therapeutic dose (Medicare: Carrier judgment) - J1412: Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes (Medicare: Carrier judgment) - J1413: Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose (Medicare: Carrier judgment) - J1414: Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose (Medicare: Carrier judgment) - J1426: Injection, casimersen, 10 mg (Medicare: Carrier judgment) - J1427: Injection, viltolarsen, 10 mg (Medicare: Carrier judgment) - J1428: Injection, eteplirsen, 10 mg (Medicare: Carrier judgment) - J1429: Injection, golodirsen, 10 mg (Medicare: Carrier judgment) - J1430: Injection, ethanolamine oleate, 100 mg (Medicare: Special coverage instructions apply) - J1434: Injection, fosaprepitant (focinvez), 1 mg (Medicare: Carrier judgment) - J1435: Injection, estrone, per 1 mg (Medicare: Special coverage instructions apply) - J1436: Injection, etidronate disodium, per 300 mg (Medicare: Special coverage instructions apply) - J1437: Injection, ferric derisomaltose, 10 mg (Medicare: Carrier judgment) - J1438: 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) (Medicare: Special coverage instructions apply) - J1439: Injection, ferric carboxymaltose, 1 mg (Medicare: Carrier judgment) - J1440: Fecal microbiota, live - jslm, 1 ml (Medicare: Carrier judgment) - J1442: Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram (Medicare: Special coverage instructions apply) - J1443: Injection, ferric pyrophosphate citrate solution (triferic), 0.1 mg of iron (Medicare: Carrier judgment) - J1444: Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron (Medicare: Carrier judgment) - J1445: Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron (Medicare: Carrier judgment) - J1446: Injection, tbo-filgrastim, 5 micrograms (Medicare: Special coverage instructions apply) - J1447: Injection, tbo-filgrastim, 1 microgram (Medicare: Special coverage instructions apply) - J1448: Injection, trilaciclib, 1mg (Medicare: Carrier judgment) - J1449: Injection, eflapegrastim-xnst, 0.1 mg (Medicare: Carrier judgment) - J1450: Injection fluconazole, 200 mg (Medicare: Special coverage instructions apply) - J1451: Injection, fomepizole, 15 mg (Medicare: Special coverage instructions apply) - J1452: Injection, fomivirsen sodium, intraocular, 1.65 mg (Medicare: Special coverage instructions apply) - J1453: Injection, fosaprepitant, 1 mg (Medicare: Carrier judgment) - J1454: Injection, fosnetupitant 235 mg and palonosetron 0.25 mg (Medicare: Special coverage instructions apply) - J1455: Injection, foscarnet sodium, per 1000 mg (Medicare: Special coverage instructions apply) - J1456: Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg (Medicare: Carrier judgment) - J1457: Injection, gallium nitrate, 1 mg (Medicare: Carrier judgment) - J1458: Injection, galsulfase, 1 mg (Medicare: Carrier judgment) - J1459: Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg (Medicare: Carrier judgment) - J1460: Injection, gamma globulin, intramuscular, 1 cc (Medicare: Special coverage instructions apply) - J1551: Injection, immune globulin (cutaquig), 100 mg (Medicare: Carrier judgment) - J1552: Injection, immune globulin (alyglo), 500 mg (Medicare: Carrier judgment) - J1553: Injection, immune globulin (yimmugo), 100 mg (Medicare: Carrier judgment) - J1554: Injection, immune globulin (asceniv), 500 mg (Medicare: Carrier judgment) - J1555: Injection, immune globulin (cuvitru), 100 mg (Medicare: Carrier judgment) - J1556: Injection, immune globulin (bivigam), 500 mg (Medicare: Carrier judgment) - J1557: Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg (Medicare: Carrier judgment) - J1558: Injection, immune globulin (xembify), 100 mg (Medicare: Carrier judgment) - J1559: Injection, immune globulin (hizentra), 100 mg (Medicare: Carrier judgment) - J1560: Injection, gamma globulin, intramuscular, over 10 cc (Medicare: Special coverage instructions apply) - J1561: Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg (Medicare: Special coverage instructions apply) - J1562: Injection, immune globulin (vivaglobin), 100 mg (Medicare: Carrier judgment) - J1566: Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg (Medicare: Special coverage instructions apply) - J1568: Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg (Medicare: Carrier judgment) - J1569: Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg (Medicare: Special coverage instructions apply) - J1570: Injection, ganciclovir sodium, 500 mg (Medicare: Special coverage instructions apply) - J1571: Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml (Medicare: Special coverage instructions apply) - J1572: Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg (Medicare: Special coverage instructions apply) - J1573: Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml (Medicare: Carrier judgment) - J1574: Injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg (Medicare: Special coverage instructions apply) - J1575: Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin (Medicare: Carrier judgment) - J1576: Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg (Medicare: Special coverage instructions apply) - J1580: Injection, garamycin, gentamicin, up to 80 mg (Medicare: Special coverage instructions apply) - J1590: Injection, gatifloxacin, 10 mg (Medicare: Carrier judgment) - J1595: Injection, glatiramer acetate, 20 mg (Medicare: Special coverage instructions apply) - J1596: Injection, glycopyrrolate, 0.1 mg (Medicare: Carrier judgment) - J1597: Injection, glycopyrrolate (glyrx-pf), 0.1 mg (Medicare: Carrier judgment) - J1598: Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg (Medicare: Carrier judgment) - J1599: Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg (Medicare: Carrier judgment) - J1600: Injection, gold sodium thiomalate, up to 50 mg (Medicare: Special coverage instructions apply) - J1602: Injection, golimumab, 1 mg, for intravenous use (Medicare: Carrier judgment) - J1610: Injection, glucagon hydrochloride, per 1 mg (Medicare: Special coverage instructions apply) - J1611: Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg (Medicare: Special coverage instructions apply) - J1612: Injection, glucagon (gvoke), 0.01 mg (Medicare: Carrier judgment) - J1620: Injection, gonadorelin hydrochloride, per 100 mcg (Medicare: Special coverage instructions apply) - J1626: Injection, granisetron hydrochloride, 100 mcg (Medicare: Special coverage instructions apply) - J1627: Injection, granisetron, extended-release, 0.1 mg (Medicare: Carrier judgment) - J1628: Injection, guselkumab, 1 mg (Medicare: Carrier judgment) - J1630: Injection, haloperidol, up to 5 mg (Medicare: Special coverage instructions apply) - J1631: Injection, haloperidol decanoate, per 50 mg (Medicare: Special coverage instructions apply) - J1632: Injection, brexanolone, 1 mg (Medicare: Carrier judgment) - J1640: Injection, hemin, 1 mg (Medicare: Special coverage instructions apply) - J1642: Injection, heparin sodium, (heparin lock flush), per 10 units (Medicare: Special coverage instructions apply) - J1643: Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units (Medicare: Special coverage instructions apply) - J1644: Injection, heparin sodium, per 1000 units (Medicare: Special coverage instructions apply) - J1645: Injection, dalteparin sodium, per 2500 iu (Medicare: Special coverage instructions apply) - J1650: Injection, enoxaparin sodium, 10 mg (Medicare: Carrier judgment) - J1652: Injection, fondaparinux sodium, 0.5 mg (Medicare: Special coverage instructions apply) - J1655: Injection, tinzaparin sodium, 1000 iu (Medicare: Carrier judgment) - J1670: Injection, tetanus immune globulin, human, up to 250 units (Medicare: Special coverage instructions apply) - J1675: Injection, histrelin acetate, 10 micrograms (Medicare: Special coverage instructions apply) - J1700: Injection, hydrocortisone acetate, up to 25 mg (Medicare: Special coverage instructions apply) - J1710: Injection, hydrocortisone sodium phosphate, up to 50 mg (Medicare: Special coverage instructions apply) - J1720: Injection, hydrocortisone sodium succinate, up to 100 mg (Medicare: Special coverage instructions apply) - J1725: Injection, hydroxyprogesterone caproate, 1 mg (Medicare: Not payable by Medicare) - J1726: Injection, hydroxyprogesterone caproate, (makena), 10 mg (Medicare: Carrier judgment) - J1729: Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg (Medicare: Carrier judgment) - J1730: Injection, diazoxide, up to 300 mg (Medicare: Special coverage instructions apply) - J1736: Injection, meloxicam (delova), 1 mg (Medicare: Carrier judgment) - J1737: Injection, meloxicam (azurity), 1 mg (Medicare: Carrier judgment) - J1738: Injection, meloxicam, 1 mg (Medicare: Carrier judgment) - J1740: Injection, ibandronate sodium, 1 mg (Medicare: Carrier judgment) - J1741: Injection, ibuprofen, 100 mg (Medicare: Carrier judgment) - J1742: Injection, ibutilide fumarate, 1 mg (Medicare: Special coverage instructions apply) - J1743: Injection, idursulfase, 1 mg (Medicare: Carrier judgment) - J1744: Injection, icatibant, 1 mg (Medicare: Carrier judgment) - J1745: Injection, infliximab, excludes biosimilar, 10 mg (Medicare: Special coverage instructions apply) - J1746: Injection, ibalizumab-uiyk, 10 mg (Medicare: Carrier judgment) - J1747: Injection, spesolimab-sbzo, 1 mg (Medicare: Carrier judgment) - J1748: Injection, infliximab-dyyb (zymfentra), 10 mg (Medicare: Carrier judgment) - J1749: Injection, iloprost, 0.1 mcg (Medicare: Carrier judgment) - J1750: Injection, iron dextran, 50 mg (Medicare: Special coverage instructions apply) - J1756: Injection, iron sucrose, 1 mg (Medicare: Carrier judgment) - J1786: Injection, imiglucerase, 10 units (Medicare: Special coverage instructions apply) - J1790: Injection, droperidol, up to 5 mg (Medicare: Special coverage instructions apply) - J1800: Injection, propranolol hcl, up to 1 mg (Medicare: Special coverage instructions apply) - J1805: Injection, esmolol hydrochloride, 10 mg (Medicare: Carrier judgment) - J1806: Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg (Medicare: Carrier judgment) - J1807: Injection, ethacrynate sodium, 1 mg (Medicare: Carrier judgment) - J1808: Injection, folic acid, 0.1 mg (Medicare: Special coverage instructions apply) - J1809: Injection, fosdenopterin, 0.1 mg (Medicare: Carrier judgment) - J1810: Injection, droperidol and fentanyl citrate, up to 2 ml ampule (Medicare: Special coverage instructions apply) - J1811: Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units (Medicare: Carrier judgment) - J1812: Insulin (fiasp), per 5 units (Medicare: Special coverage instructions apply) - J1813: Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units (Medicare: Carrier judgment) - J1814: Insulin (lyumjev), per 5 units (Medicare: Special coverage instructions apply) - J1815: Injection, insulin, per 5 units (Medicare: Special coverage instructions apply) - J1817: Insulin for administration through dme (i.e., insulin pump) per 50 units (Medicare: Carrier judgment) - J1823: Injection, inebilizumab-cdon, 1 mg (Medicare: Carrier judgment) - J1826: Injection, interferon beta-1a, 30 mcg (Medicare: Carrier judgment) - J1830: 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) (Medicare: Special coverage instructions apply) - J1833: Injection, isavuconazonium, 1 mg (Medicare: Carrier judgment) - J1834: Injection, isoniazid, 1 mg (Medicare: Carrier judgment) - J1835: Injection, itraconazole, 50 mg (Medicare: Carrier judgment) - J1836: Injection, metronidazole, 10 mg (Medicare: Carrier judgment) - J1837: Injection, posaconazole, 1 mg (Medicare: Carrier judgment) - J1840: Injection, kanamycin sulfate, up to 500 mg (Medicare: Special coverage instructions apply) - J1850: Injection, kanamycin sulfate, up to 75 mg (Medicare: Special coverage instructions apply) - J1885: Injection, ketorolac tromethamine, per 15 mg (Medicare: Special coverage instructions apply) - J1890: Injection, cephalothin sodium, up to 1 gram (Medicare: Special coverage instructions apply) - J1920: Injection, labetalol hydrochloride, 5 mg (Medicare: Carrier judgment) - J1921: Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg (Medicare: Carrier judgment) - J1930: Injection, lanreotide, 1 mg (Medicare: Carrier judgment) - J1931: Injection, laronidase, 0.1 mg (Medicare: Carrier judgment) - J1932: Injection, lanreotide, (cipla), 1 mg (Medicare: Carrier judgment) - J1938: Injection, furosemide, 1 mg (Medicare: Special coverage instructions apply) - J1939: Injection, bumetanide, 0.5 mg (Medicare: Special coverage instructions apply) - J1940: Injection, furosemide, up to 20 mg (Medicare: Special coverage instructions apply) - J1941: Injection, furosemide (furoscix), 20 mg (Medicare: Carrier judgment) - J1942: Injection, aripiprazole lauroxil, 1 mg (Medicare: Carrier judgment) - J1943: Injection, aripiprazole lauroxil, (aristada initio), 1 mg (Medicare: Carrier judgment) - J1944: Injection, aripiprazole lauroxil, (aristada), 1 mg (Medicare: Carrier judgment) - J1945: Injection, lepirudin, 50 mg (Medicare: Special coverage instructions apply) - J1950: Injection, leuprolide acetate (for depot suspension), per 3.75 mg (Medicare: Special coverage instructions apply) - J1951: Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg (Medicare: Carrier judgment) - J1952: Leuprolide injectable, camcevi, 1 mg (Medicare: Carrier judgment) - J1953: Injection, levetiracetam, 10 mg (Medicare: Carrier judgment) - J1954: Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg (Medicare: Carrier judgment) - J1955: Injection, levocarnitine, per 1 gm (Medicare: Special coverage instructions apply) - J1956: Injection, levofloxacin, 250 mg (Medicare: Special coverage instructions apply) - J1960: Injection, levorphanol tartrate, up to 2 mg (Medicare: Special coverage instructions apply) - J1961: Injection, lenacapavir (only for use as hiv treatment), 1 mg (Medicare: Carrier judgment) - J1980: Injection, hyoscyamine sulfate, up to 0.25 mg (Medicare: Special coverage instructions apply) - J1990: Injection, chlordiazepoxide hcl, up to 100 mg (Medicare: Special coverage instructions apply) - J2001: Injection, lidocaine hcl for intravenous infusion, 10 mg (Medicare: Special coverage instructions apply) - J2002: Injection, lidocaine hcl in 5% dextrose, 1 mg (Medicare: Special coverage instructions apply) - J2003: Injection, lidocaine hydrochloride, 1 mg (Medicare: Special coverage instructions apply) - J2004: Injection, lidocaine hcl with epinephrine, 1 mg (Medicare: Special coverage instructions apply) - J2010: Injection, lincomycin hcl, up to 300 mg (Medicare: Special coverage instructions apply) - J2020: Injection, linezolid, 200 mg (Medicare: Carrier judgment) - J2021: Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg (Medicare: Carrier judgment) - J2060: Injection, lorazepam, 2 mg (Medicare: Special coverage instructions apply) - J2062: Loxapine for inhalation, 1 mg (Medicare: Carrier judgment) - J2150: Injection, mannitol, 25% in 50 ml (Medicare: Special coverage instructions apply) - J2151: Injection, mannitol, 250 mg (Medicare: Special coverage instructions apply) - J2170: Injection, mecasermin, 1 mg (Medicare: Carrier judgment) - J2175: Injection, meperidine hydrochloride, per 100 mg (Medicare: Special coverage instructions apply) - J2180: Injection, meperidine and promethazine hcl, up to 50 mg (Medicare: Special coverage instructions apply) - J2182: Injection, mepolizumab, 1 mg (Medicare: Carrier judgment) - J2183: Injection, meropenem (wg critical care), not therapeutically equivalent to j2185, 100 mg (Medicare: Carrier judgment) - J2184: Injection, meropenem (b. braun), not therapeutically equivalent to j2185, 100 mg (Medicare: Carrier judgment) - J2185: Injection, meropenem, 100 mg (Medicare: Carrier judgment) - J2186: Injection, meropenem and vaborbactam, 10mg/10mg (20mg) (Medicare: Carrier judgment) - J2210: Injection, methylergonovine maleate, up to 0.2 mg (Medicare: Special coverage instructions apply) - J2212: Injection, methylnaltrexone, 0.1 mg (Medicare: Carrier judgment) - J2246: Injection, micafungin in sodium (baxter), not therapeutically equivalent to j2248, 1 mg (Medicare: Carrier judgment) - J2247: Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg (Medicare: Carrier judgment) - J2248: Injection, micafungin sodium, 1 mg (Medicare: Carrier judgment) - J2249: Injection, remimazolam, 1 mg (Medicare: Carrier judgment) - J2250: Injection, midazolam hydrochloride, per 1 mg (Medicare: Special coverage instructions apply) - J2251: Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg (Medicare: Special coverage instructions apply) - J2252: Injection, midazolam in 0.8% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg (Medicare: Special coverage instructions apply) - J2253: Injection, midazolam (seizalam), 1 mg (Medicare: Special coverage instructions apply) - J2260: Injection, milrinone lactate, 5 mg (Medicare: Special coverage instructions apply) - J2265: Injection, minocycline hydrochloride, 1 mg (Medicare: Carrier judgment) - J2267: Injection, mirikizumab-mrkz, 1 mg (Medicare: Carrier judgment) - J2270: Injection, morphine sulfate, up to 10 mg (Medicare: Special coverage instructions apply) - J2271: Injection, morphine sulfate, 100mg (Medicare: Not payable by Medicare) - J2272: Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg (Medicare: Special coverage instructions apply) - J2274: Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg (Medicare: Special coverage instructions apply) - J2275: Injection, morphine sulfate (preservative-free sterile solution), per 10 mg (Medicare: Not payable by Medicare) - J2277: Injection, motixafortide, 0.25 mg (Medicare: Carrier judgment) - J2278: Injection, ziconotide, 1 microgram (Medicare: Special coverage instructions apply) - J2280: Injection, moxifloxacin, 100 mg (Medicare: Carrier judgment) - J2281: Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg (Medicare: Carrier judgment) - J2290: Injection, nafcillin sodium, 20 mg (Medicare: Special coverage instructions apply) - J2291: Injection, nafcillin sodium (baxter), 20 mg (Medicare: Special coverage instructions apply) - J2300: Injection, nalbuphine hydrochloride, per 10 mg (Medicare: Special coverage instructions apply) - J2305: Injection, nitroglycerin, 5 mg (Medicare: Carrier judgment) - J2310: Injection, naloxone hydrochloride, per 1 mg (Medicare: Special coverage instructions apply) - J2311: Injection, naloxone hydrochloride (zimhi), 1 mg (Medicare: Special coverage instructions apply) - J2312: Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg (Medicare: Special coverage instructions apply) - J2313: Injection, naloxone hydrochloride (zimhi), 0.01 mg (Medicare: Special coverage instructions apply) - J2315: Injection, naltrexone, depot form, 1 mg (Medicare: Carrier judgment) - J2320: Injection, nandrolone decanoate, up to 50 mg (Medicare: Special coverage instructions apply) - J2323: Injection, natalizumab, 1 mg (Medicare: Carrier judgment) - J2325: Injection, nesiritide, 0.1 mg (Medicare: Special coverage instructions apply) - J2326: Injection, nusinersen, 0.1 mg (Medicare: Carrier judgment) - J2327: Injection, risankizumab-rzaa, intravenous, 1 mg (Medicare: Carrier judgment) - J2329: Injection, ublituximab-xiiy, 1mg (Medicare: Carrier judgment) - J2350: Injection, ocrelizumab, 1 mg (Medicare: Carrier judgment) - J2351: Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq (Medicare: Carrier judgment) - J2353: Injection, octreotide, depot form for intramuscular injection, 1 mg (Medicare: Carrier judgment) - J2354: Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg (Medicare: Carrier judgment) - J2355: Injection, oprelvekin, 5 mg (Medicare: Special coverage instructions apply) - J2356: Injection, tezepelumab-ekko, 1 mg (Medicare: Carrier judgment) - J2357: Injection, omalizumab, 5 mg (Medicare: Carrier judgment) - J2358: Injection, olanzapine, long-acting, 1 mg (Medicare: Carrier judgment) - J2359: Injection, olanzapine, 0.5 mg (Medicare: Carrier judgment) - J2360: Injection, orphenadrine citrate, up to 60 mg (Medicare: Special coverage instructions apply) - J2370: Injection, phenylephrine hcl, up to 1 ml (Medicare: Special coverage instructions apply) - J2371: Injection, phenylephrine hydrochloride, 20 micrograms (Medicare: Carrier judgment) - J2372: Injection, phenylephrine hydrochloride (biorphen), 20 micrograms (Medicare: Carrier judgment) - J2373: Injection, phenylephrine hydrochloride (immphentiv), 20 micrograms (Medicare: Carrier judgment) - J2400: Injection, chloroprocaine hydrochloride, per 30 ml (Medicare: Special coverage instructions apply) - J2401: Injection, chloroprocaine hydrochloride, per 1 mg (Medicare: Special coverage instructions apply) - J2402: Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg (Medicare: Special coverage instructions apply) - J2403: Chloroprocaine hcl ophthalmic, 3% gel, 1 mg (Medicare: Carrier judgment) - J2404: Injection, nicardipine, 0.1 mg (Medicare: Special coverage instructions apply) - J2405: Injection, ondansetron hydrochloride, per 1 mg (Medicare: Special coverage instructions apply) - J2406: Injection, oritavancin (kimyrsa), 10 mg (Medicare: Carrier judgment) - J2407: Injection, oritavancin (orbactiv), 10 mg (Medicare: Special coverage instructions apply) - J2410: Injection, oxymorphone hcl, up to 1 mg (Medicare: Special coverage instructions apply) - J2425: Injection, palifermin, 50 micrograms (Medicare: Carrier judgment) - J2426: Injection, paliperidone palmitate extended release (invega sustenna), 1 mg (Medicare: Carrier judgment) - J2427: Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg (Medicare: Carrier judgment) - J2428: Injection, paliperidone palmitate extended release (erzofri), 1 mg (Medicare: Carrier judgment) - J2430: Injection, pamidronate disodium, per 30 mg (Medicare: Special coverage instructions apply) - J2440: Injection, papaverine hcl, up to 60 mg (Medicare: Special coverage instructions apply) - J2460: Injection, oxytetracycline hcl, up to 50 mg (Medicare: Special coverage instructions apply) - J2468: Injection, palonosetron hydrochloride (posfrea), 25 micrograms (Medicare: Carrier judgment) - J2469: Injection, palonosetron hcl, 25 mcg (Medicare: Carrier judgment) - J2470: Injection, pantoprazole sodium, 40 mg (Medicare: Carrier judgment) - J2471: Injection, pantoprazole (hikma), not therapeutically equivalent to j2470, 40 mg (Medicare: Carrier judgment) - J2472: Injection, pantoprazole sodium in sodium chloride (baxter), 40 mg (Medicare: Carrier judgment) - J2501: Injection, paricalcitol, 1 mcg (Medicare: Special coverage instructions apply) - J2502: Injection, pasireotide long acting, 1 mg (Medicare: Carrier judgment) - J2503: Injection, pegaptanib sodium, 0.3 mg (Medicare: Carrier judgment) - J2504: Injection, pegademase bovine, 25 iu (Medicare: Special coverage instructions apply) - J2505: Injection, pegfilgrastim, 6 mg (Medicare: Carrier judgment) - J2506: Injection, pegfilgrastim, excludes biosimilar, 0.5 mg (Medicare: Carrier judgment) - J2507: Injection, pegloticase, 1 mg (Medicare: Carrier judgment) - J2508: Injection, pegunigalsidase alfa-iwxj, 1 mg (Medicare: Carrier judgment) - J2510: Injection, penicillin g procaine, aqueous, up to 600,000 units (Medicare: Special coverage instructions apply) - J2513: Injection, pentastarch, 10% solution, 100 ml (Medicare: Special coverage instructions apply) - J2515: Injection, pentobarbital sodium, per 50 mg (Medicare: Special coverage instructions apply) - J2516: Injection, pentamidine isethionate, 1 mg (Medicare: Carrier judgment) - J2540: Injection, penicillin g potassium, up to 600,000 units (Medicare: Special coverage instructions apply) - J2543: Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) (Medicare: Special coverage instructions apply) - J2545: Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg (Medicare: Special coverage instructions apply) - J2547: Injection, peramivir, 1 mg (Medicare: Carrier judgment) - J2550: Injection, promethazine hcl, up to 50 mg (Medicare: Special coverage instructions apply) - J2560: Injection, phenobarbital sodium, up to 120 mg (Medicare: Special coverage instructions apply) - J2561: Injection, phenobarbital sodium (sezaby), 1 mg (Medicare: Carrier judgment) - J2562: Injection, plerixafor, 1 mg (Medicare: Carrier judgment) - J2590: Injection, oxytocin, up to 10 units (Medicare: Special coverage instructions apply) - J2596: Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit (Medicare: Carrier judgment) - J2597: Injection, desmopressin acetate, per 1 mcg (Medicare: Special coverage instructions apply) - J2598: Injection, vasopressin, 1 unit (Medicare: Carrier judgment) - J2599: Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit (Medicare: Carrier judgment) - J2601: Injection, vasopressin (baxter), 1 unit (Medicare: Carrier judgment) - J2650: Injection, prednisolone acetate, up to 1 ml (Medicare: Special coverage instructions apply) - J2670: Injection, tolazoline hcl, up to 25 mg (Medicare: Special coverage instructions apply) - J2675: Injection, progesterone, per 50 mg (Medicare: Special coverage instructions apply) - J2679: Injection, fluphenazine hcl, 1.25 mg (Medicare: Special coverage instructions apply) - J2680: Injection, fluphenazine decanoate, up to 25 mg (Medicare: Special coverage instructions apply) - J2690: Injection, procainamide hcl, up to 1 gm (Medicare: Special coverage instructions apply) - J2700: Injection, oxacillin sodium, up to 250 mg (Medicare: Special coverage instructions apply) - J2704: Injection, propofol, 10 mg (Medicare: Carrier judgment) - J2710: Injection, neostigmine methylsulfate, up to 0.5 mg (Medicare: Special coverage instructions apply) - J2711: Injection, neostigmine methylsulfate 0.1 mg and glycopyrrolate 0.02 mg (Medicare: Carrier judgment) - J2720: Injection, protamine sulfate, per 10 mg (Medicare: Special coverage instructions apply) - J2724: Injection, protein c concentrate, intravenous, human, 10 iu (Medicare: Carrier judgment) - J2725: Injection, protirelin, per 250 mcg (Medicare: Special coverage instructions apply) - J2730: Injection, pralidoxime chloride, up to 1 gm (Medicare: Special coverage instructions apply) - J2760: Injection, phentolamine mesylate, up to 5 mg (Medicare: Special coverage instructions apply) - J2765: Injection, metoclopramide hcl, up to 10 mg (Medicare: Special coverage instructions apply) - J2770: Injection, quinupristin/dalfopristin, 500 mg (150/350) (Medicare: Special coverage instructions apply) - J2777: Injection, faricimab-svoa, 0.1 mg (Medicare: Carrier judgment) - J2778: Injection, ranibizumab, 0.1 mg (Medicare: Carrier judgment) - J2779: Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg (Medicare: Carrier judgment) - J2780: Injection, ranitidine hydrochloride, 25 mg (Medicare: Special coverage instructions apply) - J2781: Injection, pegcetacoplan, intravitreal, 1 mg (Medicare: Carrier judgment) - J2782: Injection, avacincaptad pegol, 0.1 mg (Medicare: Carrier judgment) - J2783: Injection, rasburicase, 0.5 mg (Medicare: Carrier judgment) - J2785: Injection, regadenoson, 0.1 mg (Medicare: Carrier judgment) - J2786: Injection, reslizumab, 1 mg (Medicare: Carrier judgment) - J2787: Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml (Medicare: Carrier judgment) - J2788: Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) (Medicare: Special coverage instructions apply) - J2790: Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) (Medicare: Special coverage instructions apply) - J2791: Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu (Medicare: Special coverage instructions apply) - J2792: Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu (Medicare: Special coverage instructions apply) - J2793: Injection, rilonacept, 1 mg (Medicare: Special coverage instructions apply) - J2794: Injection, risperidone (risperdal consta), 0.5 mg (Medicare: Carrier judgment) - J2795: Injection, ropivacaine hydrochloride, 1 mg (Medicare: Carrier judgment) - J2796: Injection, romiplostim, 10 micrograms (Medicare: Carrier judgment) - J2797: Injection, rolapitant, 0.5 mg (Medicare: Special coverage instructions apply) - J2798: Injection, risperidone, (perseris), 0.5 mg (Medicare: Carrier judgment) - J2799: Injection, risperidone (uzedy), 1 mg (Medicare: Carrier judgment) - J2800: Injection, methocarbamol, up to 10 ml (Medicare: Special coverage instructions apply) - J2801: Injection, risperidone (rykindo), 0.5 mg (Medicare: Carrier judgment) - J2802: Injection, romiplostim, 1 microgram (Medicare: Carrier judgment) - J2804: Injection, rifampin, 1 mg (Medicare: Special coverage instructions apply) - J2805: Injection, sincalide, 5 micrograms (Medicare: Carrier judgment) - J2806: Injection, sincalide (maia), not therapeutically equivalent to j2805, 5 micrograms (Medicare: Carrier judgment) - J2810: Injection, theophylline, per 40 mg (Medicare: Special coverage instructions apply) - J2820: Injection, sargramostim (gm-csf), 50 mcg (Medicare: Special coverage instructions apply) - J2840: Injection, sebelipase alfa, 1 mg (Medicare: Carrier judgment) - J2850: Injection, secretin, synthetic, human, 1 microgram (Medicare: Special coverage instructions apply) - J2860: Injection, siltuximab, 10 mg (Medicare: Carrier judgment) - J2865: Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg (Medicare: Special coverage instructions apply) - J2910: Injection, aurothioglucose, up to 50 mg (Medicare: Special coverage instructions apply) - J2916: Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg (Medicare: Special coverage instructions apply) - J2919: Injection, methylprednisolone sodium succinate, 5 mg (Medicare: Special coverage instructions apply) - J2920: Injection, methylprednisolone sodium succinate, up to 40 mg (Medicare: Special coverage instructions apply) - J2930: Injection, methylprednisolone sodium succinate, up to 125 mg (Medicare: Special coverage instructions apply) - J2940: Injection, somatrem, 1 mg (Medicare: Special coverage instructions apply) - J2941: Injection, somatropin, 1 mg (Medicare: Special coverage instructions apply) - J2950: Injection, promazine hcl, up to 25 mg (Medicare: Special coverage instructions apply) - J2993: Injection, reteplase, 18.1 mg (Medicare: Special coverage instructions apply) - J2995: Injection, streptokinase, per 250,000 iu (Medicare: Special coverage instructions apply) - J2997: Injection, alteplase recombinant, 1 mg (Medicare: Special coverage instructions apply) - J2998: Injection, plasminogen, human-tvmh, 1 mg (Medicare: Carrier judgment) - J3000: Injection, streptomycin, up to 1 gm (Medicare: Special coverage instructions apply) - J3010: Injection, fentanyl citrate, 0.1 mg (Medicare: Special coverage instructions apply) - J3030: 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) (Medicare: Special coverage instructions apply) - J3031: 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) (Medicare: Carrier judgment) - J3032: Injection, eptinezumab-jjmr, 1 mg (Medicare: Carrier judgment) - J3055: Injection, talquetamab-tgvs, 0.25 mg (Medicare: Carrier judgment) - J3060: Injection, taliglucerase alfa, 10 units (Medicare: Carrier judgment) - J3070: Injection, pentazocine, 30 mg (Medicare: Special coverage instructions apply) - J3090: Injection, tedizolid phosphate, 1 mg (Medicare: Carrier judgment) - J3095: Injection, telavancin, 10 mg (Medicare: Carrier judgment) - J3101: Injection, tenecteplase, 1 mg (Medicare: Carrier judgment) - J3105: Injection, terbutaline sulfate, up to 1 mg (Medicare: Special coverage instructions apply) - J3110: Injection, teriparatide, 10 mcg (Medicare: Special coverage instructions apply) - J3111: Injection, romosozumab-aqqg, 1 mg (Medicare: Carrier judgment) - J3120: Injection, testosterone enanthate, up to 100 mg (Medicare: Special coverage instructions apply) - J3121: Injection, testosterone enanthate, 1 mg (Medicare: Special coverage instructions apply) - J3130: Injection, testosterone enanthate, up to 200 mg (Medicare: Special coverage instructions apply) - J3140: Injection, testosterone suspension, up to 50 mg (Medicare: Special coverage instructions apply) - J3145: Injection, testosterone undecanoate, 1 mg (Medicare: Special coverage instructions apply) - J3150: Injection, testosterone propionate, up to 100 mg (Medicare: Special coverage instructions apply) - J3230: Injection, chlorpromazine hcl, up to 50 mg (Medicare: Special coverage instructions apply) - J3240: Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial (Medicare: Special coverage instructions apply) - J3241: Injection, teprotumumab-trbw, 10 mg (Medicare: Carrier judgment) - J3243: Injection, tigecycline, 1 mg (Medicare: Carrier judgment) - J3244: Injection, tigecycline (accord), not therapeutically equivalent to j3243, 1 mg (Medicare: Carrier judgment) - J3245: Injection, tildrakizumab, 1 mg (Medicare: Carrier judgment) - J3246: Injection, tirofiban hcl, 0.25 mg (Medicare: Carrier judgment) - J3247: Injection, secukinumab, intravenous, 1 mg (Medicare: Carrier judgment) - J3250: Injection, trimethobenzamide hcl, up to 200 mg (Medicare: Special coverage instructions apply) - J3260: Injection, tobramycin sulfate, up to 80 mg (Medicare: Special coverage instructions apply) - J3262: Injection, tocilizumab, 1 mg (Medicare: Carrier judgment) - J3263: Injection, toripalimab-tpzi, 1 mg (Medicare: Carrier judgment) - J3265: Injection, torsemide, 10 mg/ml (Medicare: Special coverage instructions apply) - J3280: Injection, thiethylperazine maleate, up to 10 mg (Medicare: Special coverage instructions apply) - J3285: Injection, treprostinil, 1 mg (Medicare: Carrier judgment) - J3290: Injection, tranexamic acid, 5 mg (Medicare: Not payable by Medicare) - J3291: Injection, tranexamic acid in sodium chloride, 5 mg (Medicare: Not payable by Medicare) - J3299: Injection, triamcinolone acetonide (xipere), 1 mg (Medicare: Carrier judgment) - J3300: Injection, triamcinolone acetonide, preservative free, 1 mg (Medicare: Special coverage instructions apply) - J3301: Injection, triamcinolone acetonide, not otherwise specified, 10 mg (Medicare: Special coverage instructions apply) - J3302: Injection, triamcinolone diacetate, per 5 mg (Medicare: Special coverage instructions apply) - J3303: Injection, triamcinolone hexacetonide, per 5 mg (Medicare: Special coverage instructions apply) - J3304: Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg (Medicare: Special coverage instructions apply) - J3305: Injection, trimetrexate glucuronate, per 25 mg (Medicare: Special coverage instructions apply) - J3310: Injection, perphenazine, up to 5 mg (Medicare: Special coverage instructions apply) - J3315: Injection, triptorelin pamoate, 3.75 mg (Medicare: Special coverage instructions apply) - J3316: Injection, triptorelin, extended-release, 3.75 mg (Medicare: Special coverage instructions apply) - J3320: Injection, spectinomycin dihydrochloride, up to 2 gm (Medicare: Special coverage instructions apply) - J3350: Injection, urea, up to 40 gm (Medicare: Special coverage instructions apply) - J3355: Injection, urofollitropin, 75 iu (Medicare: Special coverage instructions apply) - J3357: Ustekinumab, for subcutaneous injection, 1 mg (Medicare: Carrier judgment) - J3358: Ustekinumab, for intravenous injection, 1 mg (Medicare: Carrier judgment) - J3360: Injection, diazepam, up to 5 mg (Medicare: Special coverage instructions apply) - J3364: Injection, urokinase, 5000 iu vial (Medicare: Special coverage instructions apply) - J3365: Injection, iv, urokinase, 250,000 i.u. vial (Medicare: Special coverage instructions apply) - J3370: Injection, vancomycin hcl, 500 mg (Medicare: Special coverage instructions apply) - J3371: Injection, vancomycin hcl (mylan), not therapeutically equivalent to j3370, 500 mg (Medicare: Special coverage instructions apply) - J3372: Injection, vancomycin hcl (xellia), not therapeutically equivalent to j3370, 500 mg (Medicare: Special coverage instructions apply) - J3373: Injection, vancomycin hydrochloride, 10 mg (Medicare: Special coverage instructions apply) - J3374: Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg (Medicare: Special coverage instructions apply) - J3375: Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to j3373, 10 mg (Medicare: Special coverage instructions apply) - J3376: Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg (Medicare: Special coverage instructions apply) - J3379: Injection, valproate sodium, 5 mg (Medicare: Carrier judgment) - J3380: Injection, vedolizumab, intravenous, 1 mg (Medicare: Special coverage instructions apply) - J3385: Injection, velaglucerase alfa, 100 units (Medicare: Carrier judgment) - J3387: Injection, elivaldogene autotemcel, per treatment (Medicare: Carrier judgment) - J3389: Topical administration, prademagene zamikeracel, per treatment (Medicare: Carrier judgment) - J3391: Injection, atidarsagene autotemcel, per treatment (Medicare: Carrier judgment) - J3392: Injection, exagamglogene autotemcel, per treatment (Medicare: Carrier judgment) - J3393: Injection, betibeglogene autotemcel, per treatment (Medicare: Carrier judgment) - J3394: Injection, lovotibeglogene autotemcel, per treatment (Medicare: Carrier judgment) - J3396: Injection, verteporfin, 0.1 mg (Medicare: Special coverage instructions apply) - J3397: Injection, vestronidase alfa-vjbk, 1 mg (Medicare: Carrier judgment) - J3398: Injection, voretigene neparvovec-rzyl, 1 billion vector genomes (Medicare: Carrier judgment) - J3399: Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes (Medicare: Carrier judgment) - J3400: Injection, triflupromazine hcl, up to 20 mg (Medicare: Special coverage instructions apply) - J3401: Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml (Medicare: Carrier judgment) - J3402: Injection, remestemcel-l-rknd, per therapeutic dose (Medicare: Carrier judgment) - J3403: Revakinagene taroretcel-lwey, per implant (Medicare: Carrier judgment) - J3404: Injection, zopapogene imadenovec-drba suspension, per therapeutic dose (Medicare: Carrier judgment) - J3410: Injection, hydroxyzine hcl, up to 25 mg (Medicare: Special coverage instructions apply) - J3411: Injection, thiamine hcl, 100 mg (Medicare: Carrier judgment) - J3415: Injection, pyridoxine hcl, 100 mg (Medicare: Carrier judgment) - J3420: Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg (Medicare: Special coverage instructions apply) - J3424: Injection, hydroxocobalamin, intravenous, 25 mg (Medicare: Carrier judgment) - J3425: Injection, hydroxocobalamin, intramuscular, 10 mcg (Medicare: Special coverage instructions apply) - J3430: Injection, phytonadione (vitamin k), per 1 mg (Medicare: Special coverage instructions apply) - J3465: Injection, voriconazole, 10 mg (Medicare: Special coverage instructions apply) - J3470: Injection, hyaluronidase, up to 150 units (Medicare: Special coverage instructions apply) - J3471: Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) (Medicare: Special coverage instructions apply) - J3472: Injection, hyaluronidase, ovine, preservative free, per 1000 usp units (Medicare: Special coverage instructions apply) - J3473: Injection, hyaluronidase, recombinant, 1 usp unit (Medicare: Special coverage instructions apply) - J3475: Injection, magnesium sulfate, per 500 mg (Medicare: Special coverage instructions apply) - J3480: Injection, potassium chloride, per 2 meq (Medicare: Special coverage instructions apply) - J3485: Injection, zidovudine, 10 mg (Medicare: Special coverage instructions apply) - J3486: Injection, ziprasidone mesylate, 10 mg (Medicare: Carrier judgment) - J3489: Injection, zoledronic acid, 1 mg (Medicare: Carrier judgment) - J3490: Unclassified drugs (Medicare: Special coverage instructions apply) - J3520: Edetate disodium, per 150 mg (Medicare: Non-covered by Medicare) - J3530: Nasal vaccine inhalation (Medicare: Special coverage instructions apply) - J3535: Drug administered through a metered dose inhaler (Medicare: Non-covered by Medicare) - J3570: Laetrile, amygdalin, vitamin b17 (Medicare: Non-covered by Medicare) - J3590: Unclassified biologics (Medicare: Carrier judgment) - J3591: Unclassified drug or biological used for esrd on dialysis (Medicare: Carrier judgment) - J7030: Infusion, normal saline solution , 1000 cc (Medicare: Special coverage instructions apply) - J7040: Infusion, normal saline solution, sterile (500 ml = 1 unit) (Medicare: Special coverage instructions apply) - J7042: 5% dextrose/normal saline (500 ml = 1 unit) (Medicare: Special coverage instructions apply) - J7050: Infusion, normal saline solution, 250 cc (Medicare: Special coverage instructions apply) - J7060: 5% dextrose/water (500 ml = 1 unit) (Medicare: Special coverage instructions apply) - J7070: Infusion, d5w, 1000 cc (Medicare: Special coverage instructions apply) - J7100: Infusion, dextran 40, 500 ml (Medicare: Special coverage instructions apply) - J7110: Infusion, dextran 75, 500 ml (Medicare: Special coverage instructions apply) - J7120: Ringers lactate infusion, up to 1000 cc (Medicare: Special coverage instructions apply) - J7121: 5% dextrose in lactated ringers infusion, up to 1000 cc (Medicare: Special coverage instructions apply) - J7131: Hypertonic saline solution, 1 ml (Medicare: Special coverage instructions apply) - J7165: Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity (Medicare: Carrier judgment) - J7168: Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity (Medicare: Carrier judgment) - J7169: Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg (Medicare: Carrier judgment) - J7170: Injection, emicizumab-kxwh, 0.5 mg (Medicare: Carrier judgment) - J7171: Injection, adamts13, recombinant-krhn, 10 iu (Medicare: Carrier judgment) - J7172: Injection, marstacimab-hncq, 0.5 mg (Medicare: Carrier judgment) - J7173: Injection, concizumab-mtci, 0.5 mg (Medicare: Carrier judgment) - J7174: Injection, fitusiran, 0.04 mg (Medicare: Carrier judgment) - J7175: Injection, factor x, (human), 1 i.u. (Medicare: Carrier judgment) - J7177: Injection, human fibrinogen concentrate (fibryga), 1 mg (Medicare: Carrier judgment) - J7178: Injection, human fibrinogen concentrate, not otherwise specified, 1 mg (Medicare: Carrier judgment) - J7179: Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco (Medicare: Special coverage instructions apply) - J7180: Injection, factor xiii (antihemophilic factor, human), 1 i.u. (Medicare: Carrier judgment) - J7181: Injection, factor xiii a-subunit, (recombinant), per iu (Medicare: Carrier judgment) - J7182: Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu (Medicare: Carrier judgment) - J7183: Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco (Medicare: Special coverage instructions apply) - J7185: Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. (Medicare: Carrier judgment) - J7186: Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. (Medicare: Special coverage instructions apply) - J7187: Injection, von willebrand factor complex (humate-p), per iu vwf:rco (Medicare: Special coverage instructions apply) - J7188: Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. (Medicare: Special coverage instructions apply) - J7189: Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram (Medicare: Special coverage instructions apply) - J7190: Factor viii (antihemophilic factor, human) per i.u. (Medicare: Special coverage instructions apply) - J7191: Factor viii (antihemophilic factor (porcine)), per i.u. (Medicare: Special coverage instructions apply) - J7192: Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified (Medicare: Special coverage instructions apply) - J7193: Factor ix (antihemophilic factor, purified, non-recombinant) per i.u. (Medicare: Special coverage instructions apply) - J7194: Factor ix, complex, per i.u. (Medicare: Special coverage instructions apply) - J7195: Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified (Medicare: Special coverage instructions apply) - J7196: Injection, antithrombin recombinant, 50 i.u. (Medicare: Carrier judgment) - J7197: Antithrombin iii (human), per i.u. (Medicare: Special coverage instructions apply) - J7198: Anti-inhibitor, per i.u. (Medicare: Special coverage instructions apply) - J7199: Hemophilia clotting factor, not otherwise classified (Medicare: Special coverage instructions apply) - J7200: Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu (Medicare: Special coverage instructions apply) - J7201: Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u. (Medicare: Special coverage instructions apply) - J7202: Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. (Medicare: Special coverage instructions apply) - J7203: Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu (Medicare: Special coverage instructions apply) - J7204: Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu (Medicare: Carrier judgment) - J7205: Injection, factor viii fc fusion protein (recombinant), per iu (Medicare: Special coverage instructions apply) - J7207: Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. (Medicare: Special coverage instructions apply) - J7208: Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. (Medicare: Special coverage instructions apply) - J7209: Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. (Medicare: Carrier judgment) - J7210: Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. (Medicare: Carrier judgment) - J7211: Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. (Medicare: Carrier judgment) - J7212: Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram (Medicare: Carrier judgment) - J7213: Injection, coagulation factor ix (recombinant), ixinity, 1 i.u. (Medicare: Special coverage instructions apply) - J7214: Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u. (Medicare: Carrier judgment) - J7294: Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each (Medicare: Non-covered by Medicare statute) - J7295: Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each (Medicare: Non-covered by Medicare statute) - J7296: Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg (Medicare: Non-covered by Medicare statute) - J7297: Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg (Medicare: Non-covered by Medicare statute) - J7298: Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg (Medicare: Non-covered by Medicare statute) - J7299: Intrauterine copper contraceptive (miudella) (Medicare: Non-covered by Medicare statute) - J7300: Intrauterine copper contraceptive (paragard) (Medicare: Non-covered by Medicare statute) - J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg (Medicare: Non-covered by Medicare statute) - J7302: Levonorgestrel-releasing intrauterine contraceptive system, 52 mg (Medicare: Non-covered by Medicare statute) - J7303: Contraceptive supply, hormone containing vaginal ring, each (Medicare: Non-covered by Medicare statute) - J7304: Contraceptive supply, hormone containing patch, each (Medicare: Non-covered by Medicare statute) - J7306: Levonorgestrel (contraceptive) implant system, including implants and supplies (Medicare: Not payable by Medicare) - J7307: Etonogestrel (contraceptive) implant system, including implant and supplies (Medicare: Not payable by Medicare) - J7308: Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) (Medicare: Carrier judgment) - J7309: Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram (Medicare: Special coverage instructions apply) - J7310: Ganciclovir, 4.5 mg, long-acting implant (Medicare: Special coverage instructions apply) - J7311: Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg (Medicare: Carrier judgment) - J7312: Injection, dexamethasone, intravitreal implant, 0.1 mg (Medicare: Carrier judgment) - J7313: Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg (Medicare: Carrier judgment) - J7314: Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg (Medicare: Carrier judgment) - J7315: Mitomycin, ophthalmic, 0.2 mg (Medicare: Carrier judgment) - J7316: Injection, ocriplasmin, 0.125 mg (Medicare: Carrier judgment) - J7318: Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - J7320: Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - J7321: Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose (Medicare: Carrier judgment) - J7322: Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - J7323: Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose (Medicare: Carrier judgment) - J7324: Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose (Medicare: Carrier judgment) - J7325: Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - J7326: Hyaluronan or derivative, gel-one, for intra-articular injection, per dose (Medicare: Carrier judgment) - J7327: Hyaluronan or derivative, monovisc, for intra-articular injection, per dose (Medicare: Carrier judgment) - J7328: Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg (Medicare: Carrier judgment) - J7329: Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - J7330: Autologous cultured chondrocytes, implant (Medicare: Carrier judgment) - J7331: Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - J7332: Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - J7333: Hyaluronan or derivative, visco-3, for intra-articular injection, per dose (Medicare: Carrier judgment) - J7335: Capsaicin 8% patch, per 10 square centimeters (Medicare: Carrier judgment) - J7336: Capsaicin 8% patch, per square centimeter (Medicare: Carrier judgment) - J7340: Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml (Medicare: Carrier judgment) - J7342: Instillation, ciprofloxacin otic suspension, 6 mg (Medicare: Carrier judgment) - J7345: Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg (Medicare: Special coverage instructions apply) - J7351: Injection, bimatoprost, intracameral implant, 1 microgram (Medicare: Carrier judgment) - J7352: Afamelanotide implant, 1 mg (Medicare: Carrier judgment) - J7353: Anacaulase-bcdb, 8.8% gel, 1 gram (Medicare: Carrier judgment) - J7354: Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) (Medicare: Carrier judgment) - J7355: Injection, travoprost, intracameral implant, 1 microgram (Medicare: Carrier judgment) - J7356: Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg (Medicare: Carrier judgment) - J7401: Mometasone furoate sinus implant, 10 micrograms (Medicare: Carrier judgment) - J7402: Mometasone furoate sinus implant, (sinuva), 10 micrograms (Medicare: Carrier judgment) - J7500: Azathioprine, oral, 50 mg (Medicare: Special coverage instructions apply) - J7501: Azathioprine, parenteral, 100 mg (Medicare: Special coverage instructions apply) - J7502: Cyclosporine, oral, 100 mg (Medicare: Special coverage instructions apply) - J7503: Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg (Medicare: Special coverage instructions apply) - J7504: Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg (Medicare: Special coverage instructions apply) - J7505: Muromonab-cd3, parenteral, 5 mg (Medicare: Special coverage instructions apply) - J7506: Prednisone, oral, per 5 mg (Medicare: Special coverage instructions apply) - J7507: Tacrolimus, immediate release, oral, 1 mg (Medicare: Special coverage instructions apply) - J7508: Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg (Medicare: Special coverage instructions apply) - J7509: Methylprednisolone oral, per 4 mg (Medicare: Special coverage instructions apply) - J7510: Prednisolone oral, per 5 mg (Medicare: Special coverage instructions apply) - J7511: Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg (Medicare: Carrier judgment) - J7512: Prednisone, immediate release or delayed release, oral, 1 mg (Medicare: Special coverage instructions apply) - J7513: Daclizumab, parenteral, 25 mg (Medicare: Special coverage instructions apply) - J7514: Mycophenolate mofetil (myhibbin), oral suspension, 100 mg (Medicare: Carrier judgment) - J7515: Cyclosporine, oral, 25 mg (Medicare: Carrier judgment) - J7516: Injection, cyclosporine, 250 mg (Medicare: Carrier judgment) - J7517: Mycophenolate mofetil, oral, 250 mg (Medicare: Carrier judgment) - J7518: Mycophenolic acid, oral, 180 mg (Medicare: Special coverage instructions apply) - J7519: Injection, mycophenolate mofetil, 10 mg (Medicare: Carrier judgment) - J7520: Sirolimus, oral, 1 mg (Medicare: Special coverage instructions apply) - J7521: Tacrolimus, granules, oral suspension, 0.1 mg (Medicare: Special coverage instructions apply) - J7525: Tacrolimus, parenteral, 5 mg (Medicare: Special coverage instructions apply) - J7527: Everolimus, oral, 0.25 mg (Medicare: Special coverage instructions apply) - J7528: Mycophenolate mofetil, for suspension, oral, 100 mg (Medicare: Carrier judgment) - J7599: Immunosuppressive drug, not otherwise classified (Medicare: Special coverage instructions apply) - J7601: Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg (Medicare: Carrier judgment) - J7604: Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram (Medicare: Carrier judgment) - J7605: Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms (Medicare: Carrier judgment) - J7606: Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms (Medicare: Carrier judgment) - J7607: Levalbuterol, inhalation solution, compounded product, administered through dme, concentrated form, 0.5 mg (Medicare: Carrier judgment) - J7608: Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram (Medicare: Special coverage instructions apply) - J7609: Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg (Medicare: Carrier judgment) - J7610: Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg (Medicare: Carrier judgment) - J7611: Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg (Medicare: Special coverage instructions apply) - J7612: Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg (Medicare: Special coverage instructions apply) - J7613: Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg (Medicare: Special coverage instructions apply) - J7614: Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg (Medicare: Special coverage instructions apply) - J7615: Levalbuterol, inhalation solution, compounded product, administered through dme, unit dose, 0.5 mg (Medicare: Carrier judgment) - J7620: Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (Medicare: Special coverage instructions apply) - J7622: Beclomethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Carrier judgment) - J7624: Betamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Carrier judgment) - J7626: Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg (Medicare: Carrier judgment) - J7627: Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg (Medicare: Carrier judgment) - J7628: Bitolterol mesylate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7629: Bitolterol mesylate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7631: Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams (Medicare: Special coverage instructions apply) - J7632: Cromolyn sodium, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams (Medicare: Carrier judgment) - J7633: Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 0.25 milligram (Medicare: Carrier judgment) - J7634: Budesonide, inhalation solution, compounded product, administered through dme, concentrated form, per 0.25 milligram (Medicare: Carrier judgment) - J7635: Atropine, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7636: Atropine, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7637: Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7638: Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7639: Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7640: Formoterol, inhalation solution, compounded product, administered through dme, unit dose form, 12 micrograms (Medicare: Carrier judgment) - J7641: Flunisolide, inhalation solution, compounded product, administered through dme, unit dose, per milligram (Medicare: Carrier judgment) - J7642: Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7643: Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7644: Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7645: Ipratropium bromide, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Carrier judgment) - J7647: Isoetharine hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Carrier judgment) - J7648: Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7649: Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7650: Isoetharine hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Carrier judgment) - J7657: Isoproterenol hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Carrier judgment) - J7658: Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7659: Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7660: Isoproterenol hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Carrier judgment) - J7665: Mannitol, administered through an inhaler, 5 mg (Medicare: Carrier judgment) - J7667: Metaproterenol sulfate, inhalation solution, compounded product, concentrated form, per 10 milligrams (Medicare: Carrier judgment) - J7668: Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 10 milligrams (Medicare: Special coverage instructions apply) - J7669: Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams (Medicare: Special coverage instructions apply) - J7670: Metaproterenol sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams (Medicare: Carrier judgment) - J7674: Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg (Medicare: Carrier judgment) - J7676: Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg (Medicare: Carrier judgment) - J7677: Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram (Medicare: Carrier judgment) - J7680: Terbutaline sulfate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7681: Terbutaline sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7682: Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams (Medicare: Special coverage instructions apply) - J7683: Triamcinolone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram (Medicare: Special coverage instructions apply) - J7684: Triamcinolone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram (Medicare: Special coverage instructions apply) - J7685: Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams (Medicare: Carrier judgment) - J7686: Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg (Medicare: Carrier judgment) - J7699: Noc drugs, inhalation solution administered through dme (Medicare: Special coverage instructions apply) - J7799: Noc drugs, other than inhalation drugs, administered through dme (Medicare: Special coverage instructions apply) - J7999: Compounded drug, not otherwise classified (Medicare: Special coverage instructions apply) - J8498: Antiemetic drug, rectal/suppository, not otherwise specified (Medicare: Special coverage instructions apply) - J8499: Prescription drug, oral, non chemotherapeutic, nos (Medicare: Non-covered by Medicare) - J8501: Aprepitant, oral, 5 mg (Medicare: Special coverage instructions apply) - J8502: Injection, aprepitant (aponvie), 1 mg (Medicare: Carrier judgment) - J8510: Busulfan; oral, 2 mg (Medicare: Special coverage instructions apply) - J8515: Cabergoline, oral, 0.25 mg (Medicare: Non-covered by Medicare) - J8520: Capecitabine, oral, 150 mg (Medicare: Special coverage instructions apply) - J8521: Capecitabine, oral, 500 mg (Medicare: Special coverage instructions apply) - J8522: Capecitabine, oral, 50 mg (Medicare: Special coverage instructions apply) - J8530: Cyclophosphamide; oral, 25 mg (Medicare: Special coverage instructions apply) - J8540: Dexamethasone, oral, 0.25 mg (Medicare: Special coverage instructions apply) - J8541: Dexamethasone (hemady), oral, 0.25 mg (Medicare: Carrier judgment) - J8560: Etoposide; oral, 50 mg (Medicare: Special coverage instructions apply) - J8562: Fludarabine phosphate, oral, 10 mg (Medicare: Carrier judgment) - J8565: Gefitinib, oral, 250 mg (Medicare: Special coverage instructions apply) - J8597: Antiemetic drug, oral, not otherwise specified (Medicare: Special coverage instructions apply) - J8600: Melphalan; oral, 2 mg (Medicare: Special coverage instructions apply) - J8610: Methotrexate; oral, 2.5 mg (Medicare: Special coverage instructions apply) - J8611: Methotrexate (jylamvo), oral, 2.5 mg (Medicare: Special coverage instructions apply) - J8612: Methotrexate (xatmep), oral, 2.5 mg (Medicare: Special coverage instructions apply) - J8650: Nabilone, oral, 1 mg (Medicare: Carrier judgment) - J8655: Netupitant 300 mg and palonosetron 0.5 mg, oral (Medicare: Special coverage instructions apply) - J8670: Rolapitant, oral, 1 mg (Medicare: Special coverage instructions apply) - J8700: Temozolomide, oral, 5 mg (Medicare: Special coverage instructions apply) - J8705: Topotecan, oral, 0.25 mg (Medicare: Carrier judgment) - J8999: Prescription drug, oral, chemotherapeutic, nos (Medicare: Special coverage instructions apply) - J9000: Injection, doxorubicin hydrochloride, 10 mg (Medicare: Special coverage instructions apply) - J9003: Leuprolide injectable (camcevi etm), 1 mg (Medicare: Carrier judgment) - J9010: Injection, alemtuzumab, 10 mg (Medicare: Not payable by Medicare) - J9011: Injection, datopotamab deruxtecan-dlnk, 1 mg (Medicare: Carrier judgment) - J9015: Injection, aldesleukin, per single use vial (Medicare: Special coverage instructions apply) - J9017: Injection, arsenic trioxide, 1 mg (Medicare: Carrier judgment) - J9019: Injection, asparaginase (erwinaze), 1,000 iu (Medicare: Special coverage instructions apply) - J9020: Injection, asparaginase, not otherwise specified, 10,000 units (Medicare: Special coverage instructions apply) - J9021: Injection, asparaginase, recombinant, (rylaze), 0.1 mg (Medicare: Carrier judgment) - J9022: Injection, atezolizumab, 10 mg (Medicare: Carrier judgment) - J9023: Injection, avelumab, 10 mg (Medicare: Carrier judgment) - J9024: Injection, atezolizumab, 5 mg and hyaluronidase-tqjs (Medicare: Carrier judgment) - J9025: Injection, azacitidine, 1 mg (Medicare: Carrier judgment) - J9026: Injection, tarlatamab-dlle, 1 mg (Medicare: Carrier judgment) - J9027: Injection, clofarabine, 1 mg (Medicare: Carrier judgment) - J9028: Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram (Medicare: Carrier judgment) - J9029: Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose (Medicare: Carrier judgment) - J9030: Bcg live intravesical instillation, 1 mg (Medicare: Special coverage instructions apply) - J9031: Bcg (intravesical) per instillation (Medicare: Special coverage instructions apply) - J9032: Injection, belinostat, 10 mg (Medicare: Carrier judgment) - J9033: Injection, bendamustine hydrochloride, 1 mg (Medicare: Carrier judgment) - J9034: Injection, bendamustine hcl (bendeka), 1 mg (Medicare: Carrier judgment) - J9035: Injection, bevacizumab, 10 mg (Medicare: Carrier judgment) - J9036: Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg (Medicare: Carrier judgment) - J9037: Injection, belantamab mafodotin-blmf, 0.5 mg (Medicare: Carrier judgment) - J9038: Injection, axatilimab-csfr, 0.1 mg (Medicare: Carrier judgment) - J9039: Injection, blinatumomab, 1 microgram (Medicare: Carrier judgment) - J9040: Injection, bleomycin sulfate, 15 units (Medicare: Special coverage instructions apply) - J9041: Injection, bortezomib, 0.1 mg (Medicare: Carrier judgment) - J9042: Injection, brentuximab vedotin, 1 mg (Medicare: Carrier judgment) - J9043: Injection, cabazitaxel, 1 mg (Medicare: Carrier judgment) - J9044: Injection, bortezomib, not otherwise specified, 0.1 mg (Medicare: Carrier judgment) - J9045: Injection, carboplatin, 50 mg (Medicare: Special coverage instructions apply) - J9046: Injection, bortezomib (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg (Medicare: Carrier judgment) - J9047: Injection, carfilzomib, 1 mg (Medicare: Carrier judgment) - J9048: Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg (Medicare: Carrier judgment) - J9049: Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg (Medicare: Carrier judgment) - J9050: Injection, carmustine, 100 mg (Medicare: Special coverage instructions apply) - J9051: Injection, bortezomib (maia), not therapeutically equivalent to j9041, 0.1 mg (Medicare: Carrier judgment) - J9052: Injection, carmustine (accord), not therapeutically equivalent to j9050, 100 mg (Medicare: Special coverage instructions apply) - J9054: Injection, bortezomib (boruzu), 0.1 mg (Medicare: Carrier judgment) - J9055: Injection, cetuximab, 10 mg (Medicare: Carrier judgment) - J9056: Injection, bendamustine hydrochloride (vivimusta), 1 mg (Medicare: Carrier judgment) - J9057: Injection, copanlisib, 1 mg (Medicare: Carrier judgment) - J9058: Injection, bendamustine hydrochloride (apotex), 1 mg (Medicare: Carrier judgment) - J9059: Injection, bendamustine hydrochloride (baxter), 1 mg (Medicare: Carrier judgment) - J9060: Injection, cisplatin, powder or solution, 10 mg (Medicare: Special coverage instructions apply) - J9061: Injection, amivantamab-vmjw, 2 mg (Medicare: Carrier judgment) - J9063: Injection, mirvetuximab soravtansine-gynx, 1 mg (Medicare: Carrier judgment) - J9064: Injection, cabazitaxel (sandoz), not therapeutically equivalent to j9043, 1 mg (Medicare: Carrier judgment) - J9065: Injection, cladribine, per 1 mg (Medicare: Special coverage instructions apply) - J9070: Cyclophosphamide, 100 mg (Medicare: Special coverage instructions apply) - J9071: Injection, cyclophosphamide (auromedics), 5 mg (Medicare: Special coverage instructions apply) - J9072: Injection, cyclophosphamide (frindovyx), 5 mg (Medicare: Special coverage instructions apply) - J9073: Injection, cyclophosphamide (dr. reddy's), 5 mg (Medicare: Special coverage instructions apply) - J9074: Injection, cyclophosphamide (sandoz), 5 mg (Medicare: Special coverage instructions apply) - J9075: Injection, cyclophosphamide, not otherwise specified, 5 mg (Medicare: Special coverage instructions apply) - J9076: Injection, cyclophosphamide (baxter), 5 mg (Medicare: Special coverage instructions apply) - J9098: Injection, cytarabine liposome, 10 mg (Medicare: Carrier judgment) - J9100: Injection, cytarabine, 100 mg (Medicare: Special coverage instructions apply) - J9118: Injection, calaspargase pegol-mknl, 10 units (Medicare: Carrier judgment) - J9119: Injection, cemiplimab-rwlc, 1 mg (Medicare: Carrier judgment) - J9120: Injection, dactinomycin, 0.5 mg (Medicare: Special coverage instructions apply) - J9130: Dacarbazine, 100 mg (Medicare: Special coverage instructions apply) - J9144: Injection, daratumumab, 10 mg and hyaluronidase-fihj (Medicare: Carrier judgment) - J9145: Injection, daratumumab, 10 mg (Medicare: Special coverage instructions apply) - J9150: Injection, daunorubicin, 10 mg (Medicare: Special coverage instructions apply) - J9151: Injection, daunorubicin citrate, liposomal formulation, 10 mg (Medicare: Special coverage instructions apply) - J9153: Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine (Medicare: Carrier judgment) - J9155: Injection, degarelix, 1 mg (Medicare: Carrier judgment) - J9160: Injection, denileukin diftitox, 300 micrograms (Medicare: Carrier judgment) - J9161: Injection, denileukin diftitox-cxdl, 1 mcg (Medicare: Carrier judgment) - J9165: Injection, diethylstilbestrol diphosphate, 250 mg (Medicare: Special coverage instructions apply) - J9171: Injection, docetaxel, 1 mg (Medicare: Special coverage instructions apply) - J9172: Injection, docetaxel (docivyx), 1 mg (Medicare: Carrier judgment) - J9173: Injection, durvalumab, 10 mg (Medicare: Carrier judgment) - J9174: Injection, docetaxel (beizray), 1 mg (Medicare: Carrier judgment) - J9175: Injection, elliotts' b solution, 1 ml (Medicare: Special coverage instructions apply) - J9176: Injection, elotuzumab, 1 mg (Medicare: Carrier judgment) - J9177: Injection, enfortumab vedotin-ejfv, 0.25 mg (Medicare: Carrier judgment) - J9178: Injection, epirubicin hcl, 2 mg (Medicare: Carrier judgment) - J9179: Injection, eribulin mesylate, 0.1 mg (Medicare: Carrier judgment) - J9181: Injection, etoposide, 10 mg (Medicare: Special coverage instructions apply) - J9183: Gemcitabine intravesical system, 225 mg (Medicare: Carrier judgment) - J9184: Injection, gemcitabine hydrochloride (avyxa), 200 mg (Medicare: Special coverage instructions apply) - J9185: Injection, fludarabine phosphate, 50 mg (Medicare: Special coverage instructions apply) - J9190: Injection, fluorouracil, 500 mg (Medicare: Special coverage instructions apply) - J9196: Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg (Medicare: Special coverage instructions apply) - J9198: Injection, gemcitabine hydrochloride, (infugem), 100 mg (Medicare: Carrier judgment) - J9199: Injection, gemcitabine hydrochloride (infugem), 200 mg (Medicare: Carrier judgment) - J9200: Injection, floxuridine, 500 mg (Medicare: Special coverage instructions apply) - J9201: Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg (Medicare: Special coverage instructions apply) - J9202: Goserelin acetate implant, per 3.6 mg (Medicare: Special coverage instructions apply) - J9203: Injection, gemtuzumab ozogamicin, 0.1 mg (Medicare: Carrier judgment) - J9204: Injection, mogamulizumab-kpkc, 1 mg (Medicare: Carrier judgment) - J9205: Injection, irinotecan liposome, 1 mg (Medicare: Special coverage instructions apply) - J9206: Injection, irinotecan, 20 mg (Medicare: Special coverage instructions apply) - J9207: Injection, ixabepilone, 1 mg (Medicare: Carrier judgment) - J9208: Injection, ifosfamide, 1 gram (Medicare: Special coverage instructions apply) - J9209: Injection, mesna, 200 mg (Medicare: Special coverage instructions apply) - J9210: Injection, emapalumab-lzsg, 1 mg (Medicare: Carrier judgment) - J9211: Injection, idarubicin hydrochloride, 5 mg (Medicare: Special coverage instructions apply) - J9212: Injection, interferon alfacon-1, recombinant, 1 microgram (Medicare: Special coverage instructions apply) - J9213: Injection, interferon, alfa-2a, recombinant, 3 million units (Medicare: Special coverage instructions apply) - J9214: Injection, interferon, alfa-2b, recombinant, 1 million units (Medicare: Special coverage instructions apply) - J9215: Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu (Medicare: Special coverage instructions apply) - J9216: Injection, interferon, gamma 1-b, 3 million units (Medicare: Special coverage instructions apply) - J9217: Leuprolide acetate (for depot suspension), 7.5 mg (Medicare: Special coverage instructions apply) - J9218: Leuprolide acetate, per 1 mg (Medicare: Special coverage instructions apply) - J9219: Leuprolide acetate implant, 65 mg (Medicare: Special coverage instructions apply) - J9220: Injection, indigotindisulfonate sodium, 1 mg (Medicare: Carrier judgment) - J9223: Injection, lurbinectedin, 0.1 mg (Medicare: Carrier judgment) - J9225: Histrelin implant (vantas), 50 mg (Medicare: Special coverage instructions apply) - J9226: Histrelin implant (supprelin la), 50 mg (Medicare: Special coverage instructions apply) - J9227: Injection, isatuximab-irfc, 10 mg (Medicare: Carrier judgment) - J9228: Injection, ipilimumab, 1 mg (Medicare: Carrier judgment) - J9229: Injection, inotuzumab ozogamicin, 0.1 mg (Medicare: Carrier judgment) - J9230: Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg (Medicare: Special coverage instructions apply) - J9245: Injection, melphalan hydrochloride, not otherwise specified, 50 mg (Medicare: Special coverage instructions apply) - J9246: Injection, melphalan (evomela), 1 mg (Medicare: Carrier judgment) - J9247: Injection, melphalan flufenamide, 1mg (Medicare: Carrier judgment) - J9248: Injection, melphalan (hepzato), 1 mg (Medicare: Carrier judgment) - J9249: Injection, melphalan (apotex), 1 mg (Medicare: Carrier judgment) - J9250: Methotrexate sodium, 5 mg (Medicare: Special coverage instructions apply) - J9255: Injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg (Medicare: Special coverage instructions apply) - J9256: Injection, nipocalimab-aahu, 3 mg (Medicare: Carrier judgment) - J9258: Injection, paclitaxel protein-bound particles (teva), not therapeutically equivalent to j9264, 1 mg (Medicare: Carrier judgment) - J9259: Injection, paclitaxel protein-bound particles (american regent), not therapeutically equivalent to j9264, 1 mg (Medicare: Carrier judgment) - J9260: Injection, methotrexate sodium, 50 mg (Medicare: Special coverage instructions apply) - J9261: Injection, nelarabine, 50 mg (Medicare: Carrier judgment) - J9262: Injection, omacetaxine mepesuccinate, 0.01 mg (Medicare: Carrier judgment) - J9263: Injection, oxaliplatin, 0.5 mg (Medicare: Carrier judgment) - J9264: Injection, paclitaxel protein-bound particles, 1 mg (Medicare: Carrier judgment) - J9265: Injection, paclitaxel, 30 mg (Medicare: Special coverage instructions apply) - J9266: Injection, pegaspargase, per single dose vial (Medicare: Special coverage instructions apply) - J9267: Injection, paclitaxel, 1 mg (Medicare: Special coverage instructions apply) - J9268: Injection, pentostatin, 10 mg (Medicare: Special coverage instructions apply) - J9269: Injection, tagraxofusp-erzs, 10 micrograms (Medicare: Carrier judgment) - J9270: Injection, plicamycin, 2.5 mg (Medicare: Special coverage instructions apply) - J9271: Injection, pembrolizumab, 1 mg (Medicare: Carrier judgment) - J9272: Injection, dostarlimab-gxly, 10 mg (Medicare: Carrier judgment) - J9273: Injection, tisotumab vedotin-tftv, 1 mg (Medicare: Carrier judgment) - J9274: Injection, tebentafusp-tebn, 1 microgram (Medicare: Carrier judgment) - J9275: Injection, cosibelimab-ipdl, 2 mg (Medicare: Carrier judgment) - J9276: Injection, zanidatamab-hrii, 2 mg (Medicare: Carrier judgment) - J9277: Injection, pembrolizumab, 1 mg and berahyaluronidase alfa-pmph (Medicare: Carrier judgment) - J9278: Injection, carboplatin (avyxa), 1 mg (Medicare: Carrier judgment) - J9280: Injection, mitomycin, 5 mg (Medicare: Special coverage instructions apply) - J9281: Mitomycin pyelocalyceal instillation, 1 mg (Medicare: Carrier judgment) - J9282: Mitomycin, intravesical instillation, 1 mg (Medicare: Carrier judgment) - J9285: Injection, olaratumab, 10 mg (Medicare: Carrier judgment) - J9286: Injection, glofitamab-gxbm, 2.5 mg (Medicare: Carrier judgment) - J9289: Injection, nivolumab, 2 mg and hyaluronidase-nvhy (Medicare: Carrier judgment) - J9292: Injection, pemetrexed dipotassium, 10 mg (Medicare: Carrier judgment) - J9293: Injection, mitoxantrone hydrochloride, per 5 mg (Medicare: Special coverage instructions apply) - J9294: Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg (Medicare: Carrier judgment) - J9295: Injection, necitumumab, 1 mg (Medicare: Carrier judgment) - J9296: Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg (Medicare: Carrier judgment) - J9297: Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg (Medicare: Carrier judgment) - J9298: Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg (Medicare: Carrier judgment) - J9299: Injection, nivolumab, 1 mg (Medicare: Special coverage instructions apply) - J9300: Injection, gemtuzumab ozogamicin, 5 mg (Medicare: Carrier judgment) - J9301: Injection, obinutuzumab, 10 mg (Medicare: Carrier judgment) - J9302: Injection, ofatumumab, 10 mg (Medicare: Carrier judgment) - J9303: Injection, panitumumab, 10 mg (Medicare: Carrier judgment) - J9304: Injection, pemetrexed (pemfexy), 10 mg (Medicare: Carrier judgment) - J9305: Injection, pemetrexed, not otherwise specified, 10 mg (Medicare: Carrier judgment) - J9306: Injection, pertuzumab, 1 mg (Medicare: Carrier judgment) - J9307: Injection, pralatrexate, 1 mg (Medicare: Carrier judgment) - J9308: Injection, ramucirumab, 5 mg (Medicare: Carrier judgment) - J9309: Injection, polatuzumab vedotin-piiq, 1 mg (Medicare: Carrier judgment) - J9310: Injection, rituximab, 100 mg (Medicare: Special coverage instructions apply) - J9311: Injection, rituximab 10 mg and hyaluronidase (Medicare: Special coverage instructions apply) - J9312: Injection, rituximab, 10 mg (Medicare: Special coverage instructions apply) - J9313: Injection, moxetumomab pasudotox-tdfk, 0.01 mg (Medicare: Carrier judgment) - J9314: Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg (Medicare: Carrier judgment) - J9315: Injection, romidepsin, 1 mg (Medicare: Carrier judgment) - J9316: Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg (Medicare: Carrier judgment) - J9317: Injection, sacituzumab govitecan-hziy, 2.5 mg (Medicare: Carrier judgment) - J9318: Injection, romidepsin, non-lyophilized, 0.1 mg (Medicare: Carrier judgment) - J9319: Injection, romidepsin, lyophilized, 0.1 mg (Medicare: Carrier judgment) - J9320: Injection, streptozocin, 1 gram (Medicare: Special coverage instructions apply) - J9321: Injection, epcoritamab-bysp, 0.16 mg (Medicare: Carrier judgment) - J9322: Injection, pemetrexed (bluepoint), not therapeutically equivalent to j9305, 10 mg (Medicare: Carrier judgment) - J9323: Injection, pemetrexed ditromethamine, 10 mg (Medicare: Carrier judgment) - J9324: Injection, pemetrexed (pemrydi rtu), 10 mg (Medicare: Carrier judgment) - J9325: Injection, talimogene laherparepvec, per 1 million plaque forming units (Medicare: Carrier judgment) - J9326: Injection, telisotuzumab vedotin-tllv, 1 mg (Medicare: Carrier judgment) - J9328: Injection, temozolomide, 1 mg (Medicare: Carrier judgment) - J9329: Injection, tislelizumab-jsgr, 1mg (Medicare: Carrier judgment) - J9330: Injection, temsirolimus, 1 mg (Medicare: Carrier judgment) - J9331: Injection, sirolimus protein-bound particles, 1 mg (Medicare: Carrier judgment) - J9332: Injection, efgartigimod alfa-fcab, 2mg (Medicare: Carrier judgment) - J9333: Injection, rozanolixizumab-noli, 1 mg (Medicare: Carrier judgment) - J9334: Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc (Medicare: Carrier judgment) - J9340: Injection, thiotepa, 15 mg (Medicare: Special coverage instructions apply) - J9341: Injection, thiotepa (tepylute), 1 mg (Medicare: Special coverage instructions apply) - J9342: Injection, thiotepa, not otherwise specified, 1 mg (Medicare: Special coverage instructions apply) - J9345: Injection, retifanlimab-dlwr, 1 mg (Medicare: Carrier judgment) - J9347: Injection, tremelimumab-actl, 1 mg (Medicare: Carrier judgment) - J9348: Injection, naxitamab-gqgk, 1 mg (Medicare: Carrier judgment) - J9349: Injection, tafasitamab-cxix, 2 mg (Medicare: Carrier judgment) - J9350: Injection, mosunetuzumab-axgb, 1 mg (Medicare: Carrier judgment) - J9351: Injection, topotecan, 0.1 mg (Medicare: Carrier judgment) - J9352: Injection, trabectedin, 0.1 mg (Medicare: Carrier judgment) - J9353: Injection, margetuximab-cmkb, 5 mg (Medicare: Carrier judgment) - J9354: Injection, ado-trastuzumab emtansine, 1 mg (Medicare: Carrier judgment) - J9355: Injection, trastuzumab, excludes biosimilar, 10 mg (Medicare: Carrier judgment) - J9356: Injection, trastuzumab, 10 mg and hyaluronidase-oysk (Medicare: Carrier judgment) - J9357: Injection, valrubicin, intravesical, 200 mg (Medicare: Special coverage instructions apply) - J9358: Injection, fam-trastuzumab deruxtecan-nxki, 1 mg (Medicare: Carrier judgment) - J9359: Injection, loncastuximab tesirine-lpyl, 0.075 mg (Medicare: Carrier judgment) - J9360: Injection, vinblastine sulfate, 1 mg (Medicare: Special coverage instructions apply) - J9361: Injection, efbemalenograstim alfa-vuxw, 0.5 mg (Medicare: Carrier judgment) - J9370: Vincristine sulfate, 1 mg (Medicare: Special coverage instructions apply) - J9371: Injection, vincristine sulfate liposome, 1 mg (Medicare: Carrier judgment) - J9376: Injection, pozelimab-bbfg, 1 mg (Medicare: Carrier judgment) - J9380: Injection, teclistamab-cqyv, 0.5 mg (Medicare: Carrier judgment) - J9381: Injection, teplizumab-mzwv, 5 mcg (Medicare: Carrier judgment) - J9382: Injection, zenocutuzumab-zbco, 1 mg (Medicare: Carrier judgment) - J9390: Injection, vinorelbine tartrate, 10 mg (Medicare: Special coverage instructions apply) - J9393: Injection, fulvestrant (teva), not therapeutically equivalent to j9395, 25 mg (Medicare: Carrier judgment) - J9394: Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg (Medicare: Carrier judgment) - J9395: Injection, fulvestrant, 25 mg (Medicare: Carrier judgment) - J9400: Injection, ziv-aflibercept, 1 mg (Medicare: Carrier judgment) - J9600: Injection, porfimer sodium, 75 mg (Medicare: Special coverage instructions apply) - J9601: Injection, linvoseltamab-gcpt, 1 mg (Medicare: Carrier judgment) - J9999: Not otherwise classified, antineoplastic drugs (Medicare: Special coverage instructions apply) - K0001: Standard wheelchair (Medicare: Carrier judgment) - K0002: Standard hemi (low seat) wheelchair (Medicare: Carrier judgment) - K0003: Lightweight wheelchair (Medicare: Carrier judgment) - K0004: High strength, lightweight wheelchair (Medicare: Carrier judgment) - K0006: Heavy duty wheelchair (Medicare: Carrier judgment) - K0007: Extra heavy duty wheelchair (Medicare: Carrier judgment) - K0008: Custom manual wheelchair/base (Medicare: Special coverage instructions apply) - K0009: Other manual wheelchair/base (Medicare: Carrier judgment) - K0010: Standard - weight frame motorized/power wheelchair (Medicare: Carrier judgment) - K0011: Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (Medicare: Carrier judgment) - K0012: Lightweight portable motorized/power wheelchair (Medicare: Carrier judgment) - K0013: Custom motorized/power wheelchair base (Medicare: Special coverage instructions apply) - K0014: Other motorized/power wheelchair base (Medicare: Carrier judgment) - K0015: Detachable, non-adjustable height armrest, replacement only, each (Medicare: Carrier judgment) - K0017: Detachable, adjustable height armrest, base, replacement only, each (Medicare: Carrier judgment) - K0018: Detachable, adjustable height armrest, upper portion, replacement only, each (Medicare: Carrier judgment) - K0019: Arm pad, replacement only, each (Medicare: Carrier judgment) - K0020: Fixed, adjustable height armrest, pair (Medicare: Carrier judgment) - K0037: High mount flip-up footrest, each (Medicare: Carrier judgment) - K0038: Leg strap, each (Medicare: Carrier judgment) - K0039: Leg strap, h style, each (Medicare: Carrier judgment) - K0040: Adjustable angle footplate, each (Medicare: Carrier judgment) - K0041: Large size footplate, each (Medicare: Carrier judgment) - K0042: Standard size footplate, replacement only, each (Medicare: Carrier judgment) - K0043: Footrest, lower extension tube, replacement only, each (Medicare: Carrier judgment) - K0044: Footrest, upper hanger bracket, replacement only, each (Medicare: Carrier judgment) - K0045: Footrest, complete assembly, replacement only, each (Medicare: Carrier judgment) - K0046: Elevating legrest, lower extension tube, replacement only, each (Medicare: Carrier judgment) - K0047: Elevating legrest, upper hanger bracket, replacement only, each (Medicare: Carrier judgment) - K0050: Ratchet assembly, replacement only (Medicare: Carrier judgment) - K0051: Cam release assembly, footrest or legrest, replacement only, each (Medicare: Carrier judgment) - K0052: Swingaway, detachable footrests, replacement only, each (Medicare: Carrier judgment) - K0053: Elevating footrests, articulating (telescoping), each (Medicare: Carrier judgment) - K0056: Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair (Medicare: Carrier judgment) - K0065: Spoke protectors, each (Medicare: Carrier judgment) - K0069: Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each (Medicare: Carrier judgment) - K0070: Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (Medicare: Carrier judgment) - K0071: Front caster assembly, complete, with pneumatic tire, replacement only, each (Medicare: Carrier judgment) - K0072: Front caster assembly, complete, with semi-pneumatic tire, replacement only, each (Medicare: Carrier judgment) - K0073: Caster pin lock, each (Medicare: Carrier judgment) - K0077: Front caster assembly, complete, with solid tire, replacement only, each (Medicare: Carrier judgment) - K0098: Drive belt for power wheelchair, replacement only (Medicare: Carrier judgment) - K0105: Iv hanger, each (Medicare: Carrier judgment) - K0108: Wheelchair component or accessory, not otherwise specified (Medicare: Carrier judgment) - K0195: Elevating leg rests, pair (for use with capped rental wheelchair base) (Medicare: Special coverage instructions apply) - K0455: Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol) (Medicare: Special coverage instructions apply) - K0462: Temporary replacement for patient owned equipment being repaired, any type (Medicare: Special coverage instructions apply) - K0552: Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each (Medicare: Special coverage instructions apply) - K0553: Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (Medicare: Special coverage instructions apply) - K0554: Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system (Medicare: Special coverage instructions apply) - K0601: Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each (Medicare: Carrier judgment) - K0602: Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each (Medicare: Carrier judgment) - K0603: Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each (Medicare: Carrier judgment) - K0604: Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each (Medicare: Carrier judgment) - K0605: Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each (Medicare: Carrier judgment) - K0606: Automatic external defibrillator, with integrated electrocardiogram analysis, garment type (Medicare: Carrier judgment) - K0607: Replacement battery for automated external defibrillator, garment type only, each (Medicare: Carrier judgment) - K0608: Replacement garment for use with automated external defibrillator, each (Medicare: Carrier judgment) - K0609: Replacement electrodes for use with automated external defibrillator, garment type only, each (Medicare: Carrier judgment) - K0669: Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac (Medicare: Carrier judgment) - K0672: Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each (Medicare: Carrier judgment) - K0730: Controlled dose inhalation drug delivery system (Medicare: Carrier judgment) - K0733: Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) (Medicare: Carrier judgment) - K0738: Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing (Medicare: Carrier judgment) - K0739: Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes (Medicare: Carrier judgment) - K0740: Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes (Medicare: Non-covered by Medicare) - K0743: Suction pump, home model, portable, for use on wounds (Medicare: Carrier judgment) - K0744: Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less (Medicare: Carrier judgment) - K0745: 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 (Medicare: Carrier judgment) - K0746: Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches (Medicare: Carrier judgment) - K0800: Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0801: Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0802: Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0806: Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0807: Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0808: Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0812: Power operated vehicle, not otherwise classified (Medicare: Carrier judgment) - K0813: Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0814: Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0815: Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0816: Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0820: Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0821: Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0822: Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0823: Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0824: Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0825: Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0826: Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0827: Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0828: Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (Medicare: Carrier judgment) - K0829: Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more (Medicare: Carrier judgment) - K0830: Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0831: Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0835: Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0836: Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0837: Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0838: Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0839: Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0840: Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more (Medicare: Carrier judgment) - K0841: Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0842: Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0843: Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0848: Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0849: Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0850: Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0851: Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0852: Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0853: Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0854: Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (Medicare: Carrier judgment) - K0855: Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (Medicare: Carrier judgment) - K0856: Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0857: Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0858: Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds (Medicare: Carrier judgment) - K0859: Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0860: Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0861: Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0862: Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0863: Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0864: Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more (Medicare: Carrier judgment) - K0868: Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0869: Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0870: Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0871: Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (Medicare: Carrier judgment) - K0877: Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0878: Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0879: Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0880: Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds (Medicare: Carrier judgment) - K0884: Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0885: Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds (Medicare: Carrier judgment) - K0886: Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (Medicare: Carrier judgment) - K0890: Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds (Medicare: Carrier judgment) - K0891: Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds (Medicare: Carrier judgment) - K0898: Power wheelchair, not otherwise classified (Medicare: Carrier judgment) - K0899: Power mobility device, not coded by dme pdac or does not meet criteria (Medicare: Carrier judgment) - K0900: Customized durable medical equipment, other than wheelchair (Medicare: Special coverage instructions apply) - K0901: 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 (Medicare: Carrier judgment) - K0902: 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 (Medicare: Carrier judgment) - K0903: 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 (Medicare: Carrier judgment) - K1001: Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type (Medicare: Carrier judgment) - K1002: Cranial electrotherapy stimulation (ces) system, any type (Medicare: Carrier judgment) - K1003: Whirlpool tub, walk-in, portable (Medicare: Non-covered by Medicare) - K1004: Low frequency ultrasonic diathermy treatment device for home use (Medicare: Non-covered by Medicare statute) - K1005: Disposable collection and storage bag for breast milk, any size, any type, each (Medicare: Carrier judgment) - K1006: Suction pump, home model, portable or stationary, electric, any type, for use with external urine management system (Medicare: Carrier judgment) - K1007: 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 (Medicare: Carrier judgment) - K1009: Speech volume modulation system, any type, including all components and accessories (Medicare: Carrier judgment) - K1010: Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each (Medicare: Carrier judgment) - K1011: Activation device for intraurethral drainage device with valve, replacement only, each (Medicare: Carrier judgment) - K1012: Charger and base station for intraurethral activation device, replacement only (Medicare: Carrier judgment) - K1013: Enema tube, with or without adapter, any type, replacement only, each (Medicare: Non-covered by Medicare statute) - K1014: Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control (Medicare: Carrier judgment) - K1015: Foot, adductus positioning device, adjustable (Medicare: Carrier judgment) - K1016: Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve (Medicare: Carrier judgment) - K1017: Monthly supplies for use of device coded at k1016 (Medicare: Carrier judgment) - K1018: External upper limb tremor stimulator of the peripheral nerves of the wrist (Medicare: Carrier judgment) - K1019: Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist (Medicare: Carrier judgment) - K1020: Non-invasive vagus nerve stimulator (Medicare: Carrier judgment) - K1021: Exsufflation belt, includes all supplies and accessories (Medicare: Non-covered by Medicare statute) - K1022: Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type (Medicare: Carrier judgment) - K1023: Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm (Medicare: Non-covered by Medicare statute) - K1024: Non-pneumatic compression controller with sequential calibrated gradient pressure (Medicare: Carrier judgment) - K1025: Non-pneumatic sequential compression garment, full arm (Medicare: Carrier judgment) - K1026: Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical (Medicare: Non-covered by Medicare statute) - K1027: Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - K1028: Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application (Medicare: Non-covered by Medicare statute) - K1029: 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 (Medicare: Non-covered by Medicare statute) - K1030: External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only (Medicare: Carrier judgment) - K1031: Non-pneumatic compression controller without calibrated gradient pressure (Medicare: Carrier judgment) - K1032: Non-pneumatic sequential compression garment, full leg (Medicare: Carrier judgment) - K1033: Non-pneumatic sequential compression garment, half leg (Medicare: Carrier judgment) - K1034: Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count (Medicare: Carrier judgment) - K1035: Molecular diagnostic test reader, nonprescription self-administered and self-collected use, fda approved, authorized or cleared (Medicare: Carrier judgment) - K1036: Supplies and accessories (e.g., transducer) for low frequency ultrasonic diathermy treatment device, per month (Medicare: Non-covered by Medicare statute) - K1037: Docking station for use with oral device/appliance used to reduce upper airway collapsibility (Medicare: Carrier judgment) - L0112: Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated (Medicare: Carrier judgment) - L0113: Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L0120: Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) (Medicare: Carrier judgment) - L0130: Cervical, flexible, thermoplastic collar, molded to patient (Medicare: Carrier judgment) - L0140: Cervical, semi-rigid, adjustable (plastic collar) (Medicare: Carrier judgment) - L0150: Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) (Medicare: Carrier judgment) - L0160: Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L0170: Cervical, collar, molded to patient model (Medicare: Carrier judgment) - L0172: Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L0174: Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L0180: Cervical, multiple post collar, occipital/mandibular supports, adjustable (Medicare: Carrier judgment) - L0190: Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types) (Medicare: Carrier judgment) - L0200: Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension (Medicare: Carrier judgment) - L0220: Thoracic, rib belt, custom fabricated (Medicare: Carrier judgment) - L0450: 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 (Medicare: Carrier judgment) - L0452: 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 (Medicare: Carrier judgment) - L0454: 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 (Medicare: Carrier judgment) - L0455: 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 (Medicare: Carrier judgment) - L0456: 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 (Medicare: Carrier judgment) - L0457: 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 (Medicare: Carrier judgment) - L0458: 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 (Medicare: Carrier judgment) - L0460: 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 (Medicare: Carrier judgment) - L0462: 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 (Medicare: Carrier judgment) - L0464: 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 (Medicare: Carrier judgment) - L0466: 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 (Medicare: Carrier judgment) - L0467: 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 (Medicare: Carrier judgment) - L0468: 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 (Medicare: Carrier judgment) - L0469: 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 (Medicare: Carrier judgment) - L0470: 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 (Medicare: Carrier judgment) - L0472: 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 (Medicare: Carrier judgment) - L0480: 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 (Medicare: Carrier judgment) - L0482: 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 (Medicare: Carrier judgment) - L0484: 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 (Medicare: Carrier judgment) - L0486: 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 (Medicare: Carrier judgment) - L0488: 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 (Medicare: Carrier judgment) - L0490: 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 (Medicare: Carrier judgment) - L0491: 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 (Medicare: Carrier judgment) - L0492: 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 (Medicare: Carrier judgment) - L0621: 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 (Medicare: Carrier judgment) - L0622: Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated (Medicare: Carrier judgment) - L0623: 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 (Medicare: Carrier judgment) - L0624: 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 (Medicare: Carrier judgment) - L0625: 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 (Medicare: Carrier judgment) - L0626: 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 (Medicare: Carrier judgment) - L0627: 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 (Medicare: Carrier judgment) - L0628: 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 (Medicare: Carrier judgment) - L0629: 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 (Medicare: Carrier judgment) - L0630: 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 (Medicare: Carrier judgment) - L0631: 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 (Medicare: Carrier judgment) - L0632: 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 (Medicare: Carrier judgment) - L0633: 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 (Medicare: Carrier judgment) - L0634: 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 (Medicare: Carrier judgment) - L0635: 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 (Medicare: Carrier judgment) - L0636: 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 (Medicare: Carrier judgment) - L0637: 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 (Medicare: Carrier judgment) - L0638: 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 (Medicare: Carrier judgment) - L0639: 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 (Medicare: Carrier judgment) - L0640: 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 (Medicare: Carrier judgment) - L0641: 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 (Medicare: Carrier judgment) - L0642: 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 (Medicare: Carrier judgment) - L0643: 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 (Medicare: Carrier judgment) - L0648: 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 (Medicare: Carrier judgment) - L0649: 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 (Medicare: Carrier judgment) - L0650: 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 (Medicare: Carrier judgment) - L0651: 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 (Medicare: Carrier judgment) - L0700: Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type) (Medicare: Carrier judgment) - L0710: Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type) (Medicare: Carrier judgment) - L0720: 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 (Medicare: Carrier judgment) - L0810: Halo procedure, cervical halo incorporated into jacket vest (Medicare: Carrier judgment) - L0820: Halo procedure, cervical halo incorporated into plaster body jacket (Medicare: Carrier judgment) - L0830: Halo procedure, cervical halo incorporated into milwaukee type orthosis (Medicare: Carrier judgment) - L0859: Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material (Medicare: Carrier judgment) - L0861: Addition to halo procedure, replacement liner/interface material (Medicare: Carrier judgment) - L0970: Tlso, corset front (Medicare: Carrier judgment) - L0972: Lso, corset front (Medicare: Carrier judgment) - L0974: Tlso, full corset (Medicare: Carrier judgment) - L0976: Lso, full corset (Medicare: Carrier judgment) - L0978: Axillary crutch extension (Medicare: Carrier judgment) - L0980: Peroneal straps, prefabricated, off-the-shelf, pair (Medicare: Carrier judgment) - L0982: Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) (Medicare: Carrier judgment) - L0984: Protective body sock, prefabricated, off-the-shelf, each (Medicare: Carrier judgment) - L0999: Addition to spinal orthosis, not otherwise specified (Medicare: Carrier judgment) - L1000: Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model (Medicare: Carrier judgment) - L1001: Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1005: Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment (Medicare: Carrier judgment) - L1006: 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 (Medicare: Carrier judgment) - L1007: 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 (Medicare: Carrier judgment) - L1010: Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling (Medicare: Carrier judgment) - L1020: Addition to ctlso or scoliosis orthosis, kyphosis pad (Medicare: Carrier judgment) - L1025: Addition to ctlso or scoliosis orthosis, kyphosis pad, floating (Medicare: Carrier judgment) - L1030: Addition to ctlso or scoliosis orthosis, lumbar bolster pad (Medicare: Carrier judgment) - L1040: Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad (Medicare: Carrier judgment) - L1050: Addition to ctlso or scoliosis orthosis, sternal pad (Medicare: Carrier judgment) - L1060: Addition to ctlso or scoliosis orthosis, thoracic pad (Medicare: Carrier judgment) - L1070: Addition to ctlso or scoliosis orthosis, trapezius sling (Medicare: Carrier judgment) - L1080: Addition to ctlso or scoliosis orthosis, outrigger (Medicare: Carrier judgment) - L1085: Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions (Medicare: Carrier judgment) - L1090: Addition to ctlso or scoliosis orthosis, lumbar sling (Medicare: Carrier judgment) - L1100: Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather (Medicare: Carrier judgment) - L1110: Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model (Medicare: Carrier judgment) - L1120: Addition to ctlso, scoliosis orthosis, cover for upright, each (Medicare: Carrier judgment) - L1200: Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only (Medicare: Carrier judgment) - L1210: Addition to tlso, (low profile), lateral thoracic extension (Medicare: Carrier judgment) - L1220: Addition to tlso, (low profile), anterior thoracic extension (Medicare: Carrier judgment) - L1230: Addition to tlso, (low profile), milwaukee type superstructure (Medicare: Carrier judgment) - L1240: Addition to tlso, (low profile), lumbar derotation pad (Medicare: Carrier judgment) - L1250: Addition to tlso, (low profile), anterior asis pad (Medicare: Carrier judgment) - L1260: Addition to tlso, (low profile), anterior thoracic derotation pad (Medicare: Carrier judgment) - L1270: Addition to tlso, (low profile), abdominal pad (Medicare: Carrier judgment) - L1280: Addition to tlso, (low profile), rib gusset (elastic), each (Medicare: Carrier judgment) - L1290: Addition to tlso, (low profile), lateral trochanteric pad (Medicare: Carrier judgment) - L1300: Other scoliosis procedure, body jacket molded to patient model (Medicare: Carrier judgment) - L1310: Other scoliosis procedure, post-operative body jacket (Medicare: Carrier judgment) - L1320: Thoracic, pectus carinatum orthosis, sternal compression, rigid circumferential frame with anterior and posterior rigid pads, custom fabricated (Medicare: Carrier judgment) - L1499: Spinal orthosis, not otherwise specified (Medicare: Carrier judgment) - L1600: 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 (Medicare: Carrier judgment) - L1610: 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 (Medicare: Carrier judgment) - L1620: 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 (Medicare: Carrier judgment) - L1630: Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated (Medicare: Carrier judgment) - L1640: Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated (Medicare: Carrier judgment) - L1650: Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1652: 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 (Medicare: Carrier judgment) - L1653: Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf (Medicare: Carrier judgment) - L1660: Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1680: Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated (Medicare: Carrier judgment) - L1681: 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 (Medicare: Carrier judgment) - L1685: Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated (Medicare: Carrier judgment) - L1686: Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1690: Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1700: Legg perthes orthosis, (toronto type), custom fabricated (Medicare: Carrier judgment) - L1710: Legg perthes orthosis, (newington type), custom fabricated (Medicare: Carrier judgment) - L1720: Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated (Medicare: Carrier judgment) - L1730: Legg perthes orthosis, (scottish rite type), custom fabricated (Medicare: Carrier judgment) - L1755: Legg perthes orthosis, (patten bottom type), custom fabricated (Medicare: Carrier judgment) - L1810: 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 (Medicare: Carrier judgment) - L1812: Knee orthosis, elastic with joints, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1820: 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 (Medicare: Carrier judgment) - L1821: Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf (Medicare: Carrier judgment) - L1830: Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1831: Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1832: 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 (Medicare: Carrier judgment) - L1833: Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf (Medicare: Carrier judgment) - L1834: Knee orthosis, without knee joint, rigid, custom fabricated (Medicare: Carrier judgment) - L1836: Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1840: Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated (Medicare: Carrier judgment) - L1843: 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 (Medicare: Carrier judgment) - L1844: 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 (Medicare: Carrier judgment) - L1845: 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 (Medicare: Carrier judgment) - L1846: 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 (Medicare: Carrier judgment) - L1847: 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 (Medicare: Carrier judgment) - L1848: Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1850: Knee orthosis, swedish type, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1851: 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 (Medicare: Carrier judgment) - L1852: 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 (Medicare: Carrier judgment) - L1860: Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk) (Medicare: Carrier judgment) - L1900: Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated (Medicare: Carrier judgment) - L1902: Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1904: Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated (Medicare: Carrier judgment) - L1906: Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1907: Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated (Medicare: Carrier judgment) - L1910: Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1920: Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated (Medicare: Carrier judgment) - L1930: Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1932: 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 (Medicare: Carrier judgment) - L1933: Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1940: Ankle foot orthosis, plastic or other material, custom fabricated (Medicare: Carrier judgment) - L1945: Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated (Medicare: Carrier judgment) - L1950: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated (Medicare: Carrier judgment) - L1951: 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 (Medicare: Carrier judgment) - L1952: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L1960: Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated (Medicare: Carrier judgment) - L1970: Ankle foot orthosis, plastic with ankle joint, custom fabricated (Medicare: Carrier judgment) - L1971: Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L1980: Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated (Medicare: Carrier judgment) - L1990: Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated (Medicare: Carrier judgment) - L2000: Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated (Medicare: Carrier judgment) - L2005: 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 (Medicare: Carrier judgment) - L2006: 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 (Medicare: Carrier judgment) - L2010: Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated (Medicare: Carrier judgment) - L2020: Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated (Medicare: Carrier judgment) - L2030: Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated (Medicare: Carrier judgment) - L2034: 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 (Medicare: Carrier judgment) - L2035: Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L2036: Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated (Medicare: Carrier judgment) - L2037: Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated (Medicare: Carrier judgment) - L2038: Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated (Medicare: Carrier judgment) - L2040: Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated (Medicare: Carrier judgment) - L2050: Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated (Medicare: Carrier judgment) - L2060: Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated (Medicare: Carrier judgment) - L2070: Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated (Medicare: Carrier judgment) - L2080: Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated (Medicare: Carrier judgment) - L2090: Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated (Medicare: Carrier judgment) - L2106: Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated (Medicare: Carrier judgment) - L2108: Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated (Medicare: Carrier judgment) - L2112: Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L2114: Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L2116: Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L2126: Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated (Medicare: Carrier judgment) - L2128: Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated (Medicare: Carrier judgment) - L2132: Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L2134: Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L2136: Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L2180: Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints (Medicare: Carrier judgment) - L2182: Addition to lower extremity fracture orthosis, drop lock knee joint (Medicare: Carrier judgment) - L2184: Addition to lower extremity fracture orthosis, limited motion knee joint (Medicare: Carrier judgment) - L2186: Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type (Medicare: Carrier judgment) - L2188: Addition to lower extremity fracture orthosis, quadrilateral brim (Medicare: Carrier judgment) - L2190: Addition to lower extremity fracture orthosis, waist belt (Medicare: Carrier judgment) - L2192: Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt (Medicare: Carrier judgment) - L2200: Addition to lower extremity, limited ankle motion, each joint (Medicare: Carrier judgment) - L2210: Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint (Medicare: Carrier judgment) - L2220: Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint (Medicare: Carrier judgment) - L2221: Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power source (Medicare: Carrier judgment) - L2230: Addition to lower extremity, split flat caliper stirrups and plate attachment (Medicare: Carrier judgment) - L2232: Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only (Medicare: Carrier judgment) - L2240: Addition to lower extremity, round caliper and plate attachment (Medicare: Carrier judgment) - L2250: Addition to lower extremity, foot plate, molded to patient model, stirrup attachment (Medicare: Carrier judgment) - L2260: Addition to lower extremity, reinforced solid stirrup (scott-craig type) (Medicare: Carrier judgment) - L2265: Addition to lower extremity, long tongue stirrup (Medicare: Carrier judgment) - L2270: Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad (Medicare: Carrier judgment) - L2275: Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined (Medicare: Carrier judgment) - L2280: Addition to lower extremity, molded inner boot (Medicare: Carrier judgment) - L2300: Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable (Medicare: Carrier judgment) - L2310: Addition to lower extremity, abduction bar-straight (Medicare: Carrier judgment) - L2320: Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only (Medicare: Carrier judgment) - L2330: Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only (Medicare: Carrier judgment) - L2335: Addition to lower extremity, anterior swing band (Medicare: Carrier judgment) - L2340: Addition to lower extremity, pre-tibial shell, molded to patient model (Medicare: Carrier judgment) - L2350: Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses) (Medicare: Carrier judgment) - L2360: Addition to lower extremity, extended steel shank (Medicare: Carrier judgment) - L2370: Addition to lower extremity, patten bottom (Medicare: Carrier judgment) - L2375: Addition to lower extremity, torsion control, ankle joint and half solid stirrup (Medicare: Carrier judgment) - L2380: Addition to lower extremity, torsion control, straight knee joint, each joint (Medicare: Carrier judgment) - L2385: Addition to lower extremity, straight knee joint, heavy duty, each joint (Medicare: Carrier judgment) - L2387: Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint (Medicare: Carrier judgment) - L2390: Addition to lower extremity, offset knee joint, each joint (Medicare: Carrier judgment) - L2395: Addition to lower extremity, offset knee joint, heavy duty, each joint (Medicare: Carrier judgment) - L2397: Addition to lower extremity orthosis, suspension sleeve (Medicare: Carrier judgment) - L2405: Addition to knee joint, drop lock, each (Medicare: Carrier judgment) - L2415: Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint (Medicare: Carrier judgment) - L2425: Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint (Medicare: Carrier judgment) - L2430: Addition to knee joint, ratchet lock for active and progressive knee extension, each joint (Medicare: Carrier judgment) - L2492: Addition to knee joint, lift loop for drop lock ring (Medicare: Carrier judgment) - L2500: Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring (Medicare: Carrier judgment) - L2510: Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model (Medicare: Carrier judgment) - L2520: Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted (Medicare: Carrier judgment) - L2525: Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model (Medicare: Carrier judgment) - L2526: Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted (Medicare: Carrier judgment) - L2530: Addition to lower extremity, thigh-weight bearing, lacer, non-molded (Medicare: Carrier judgment) - L2540: Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model (Medicare: Carrier judgment) - L2550: Addition to lower extremity, thigh/weight bearing, high roll cuff (Medicare: Carrier judgment) - L2570: Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each (Medicare: Carrier judgment) - L2580: Addition to lower extremity, pelvic control, pelvic sling (Medicare: Carrier judgment) - L2600: Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each (Medicare: Carrier judgment) - L2610: Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each (Medicare: Carrier judgment) - L2620: Addition to lower extremity, pelvic control, hip joint, heavy duty, each (Medicare: Carrier judgment) - L2622: Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each (Medicare: Carrier judgment) - L2624: Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each (Medicare: Carrier judgment) - L2627: Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables (Medicare: Carrier judgment) - L2628: Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables (Medicare: Carrier judgment) - L2630: Addition to lower extremity, pelvic control, band and belt, unilateral (Medicare: Carrier judgment) - L2640: Addition to lower extremity, pelvic control, band and belt, bilateral (Medicare: Carrier judgment) - L2650: Addition to lower extremity, pelvic and thoracic control, gluteal pad, each (Medicare: Carrier judgment) - L2660: Addition to lower extremity, thoracic control, thoracic band (Medicare: Carrier judgment) - L2670: Addition to lower extremity, thoracic control, paraspinal uprights (Medicare: Carrier judgment) - L2680: Addition to lower extremity, thoracic control, lateral support uprights (Medicare: Carrier judgment) - L2750: Addition to lower extremity orthosis, plating chrome or nickel, per bar (Medicare: Carrier judgment) - L2755: Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only (Medicare: Carrier judgment) - L2760: Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth) (Medicare: Carrier judgment) - L2768: Orthotic side bar disconnect device, per bar (Medicare: Carrier judgment) - L2780: Addition to lower extremity orthosis, non-corrosive finish, per bar (Medicare: Carrier judgment) - L2785: Addition to lower extremity orthosis, drop lock retainer, each (Medicare: Carrier judgment) - L2795: Addition to lower extremity orthosis, knee control, full kneecap (Medicare: Carrier judgment) - L2800: Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only (Medicare: Carrier judgment) - L2810: Addition to lower extremity orthosis, knee control, condylar pad (Medicare: Carrier judgment) - L2820: Addition to lower extremity orthosis, soft interface for molded plastic, below knee section (Medicare: Carrier judgment) - L2830: Addition to lower extremity orthosis, soft interface for molded plastic, above knee section (Medicare: Carrier judgment) - L2840: Addition to lower extremity orthosis, tibial length sock, fracture or equal, each (Medicare: Carrier judgment) - L2850: Addition to lower extremity orthosis, femoral length sock, fracture or equal, each (Medicare: Carrier judgment) - L2861: Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each (Medicare: Not payable by Medicare) - L2999: Lower extremity orthoses, not otherwise specified (Medicare: Carrier judgment) - L3000: Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each (Medicare: Special coverage instructions apply) - L3001: Foot, insert, removable, molded to patient model, spenco, each (Medicare: Special coverage instructions apply) - L3002: Foot, insert, removable, molded to patient model, plastazote or equal, each (Medicare: Special coverage instructions apply) - L3003: Foot, insert, removable, molded to patient model, silicone gel, each (Medicare: Special coverage instructions apply) - L3010: Foot, insert, removable, molded to patient model, longitudinal arch support, each (Medicare: Special coverage instructions apply) - L3020: Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each (Medicare: Special coverage instructions apply) - L3030: Foot, insert, removable, formed to patient foot, each (Medicare: Special coverage instructions apply) - L3031: Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each (Medicare: Carrier judgment) - L3040: Foot, arch support, removable, premolded, longitudinal, each (Medicare: Special coverage instructions apply) - L3050: Foot, arch support, removable, premolded, metatarsal, each (Medicare: Special coverage instructions apply) - L3060: Foot, arch support, removable, premolded, longitudinal/ metatarsal, each (Medicare: Special coverage instructions apply) - L3070: Foot, arch support, non-removable attached to shoe, longitudinal, each (Medicare: Special coverage instructions apply) - L3080: Foot, arch support, non-removable attached to shoe, metatarsal, each (Medicare: Special coverage instructions apply) - L3090: Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each (Medicare: Special coverage instructions apply) - L3100: Hallus-valgus night dynamic splint, prefabricated, off-the-shelf (Medicare: Special coverage instructions apply) - L3140: Foot, abduction rotation bar, including shoes (Medicare: Special coverage instructions apply) - L3150: Foot, abduction rotation bar, without shoes (Medicare: Special coverage instructions apply) - L3160: Foot, adjustable shoe-styled positioning device (Medicare: Carrier judgment) - L3161: Foot, adductus positioning device, adjustable (Medicare: Carrier judgment) - L3170: Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each (Medicare: Special coverage instructions apply) - L3201: Orthopedic shoe, oxford with supinator or pronator, infant (Medicare: Special coverage instructions apply) - L3202: Orthopedic shoe, oxford with supinator or pronator, child (Medicare: Special coverage instructions apply) - L3203: Orthopedic shoe, oxford with supinator or pronator, junior (Medicare: Special coverage instructions apply) - L3204: Orthopedic shoe, hightop with supinator or pronator, infant (Medicare: Special coverage instructions apply) - L3206: Orthopedic shoe, hightop with supinator or pronator, child (Medicare: Special coverage instructions apply) - L3207: Orthopedic shoe, hightop with supinator or pronator, junior (Medicare: Special coverage instructions apply) - L3208: Surgical boot, each, infant (Medicare: Special coverage instructions apply) - L3209: Surgical boot, each, child (Medicare: Special coverage instructions apply) - L3211: Surgical boot, each, junior (Medicare: Special coverage instructions apply) - L3212: Benesch boot, pair, infant (Medicare: Special coverage instructions apply) - L3213: Benesch boot, pair, child (Medicare: Special coverage instructions apply) - L3214: Benesch boot, pair, junior (Medicare: Special coverage instructions apply) - L3215: Orthopedic footwear, ladies shoe, oxford, each (Medicare: Non-covered by Medicare statute) - L3216: Orthopedic footwear, ladies shoe, depth inlay, each (Medicare: Non-covered by Medicare statute) - L3217: Orthopedic footwear, ladies shoe, hightop, depth inlay, each (Medicare: Non-covered by Medicare statute) - L3219: Orthopedic footwear, mens shoe, oxford, each (Medicare: Non-covered by Medicare statute) - L3221: Orthopedic footwear, mens shoe, depth inlay, each (Medicare: Non-covered by Medicare statute) - L3222: Orthopedic footwear, mens shoe, hightop, depth inlay, each (Medicare: Non-covered by Medicare statute) - L3224: Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) (Medicare: Special coverage instructions apply) - L3225: Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) (Medicare: Special coverage instructions apply) - L3230: Orthopedic footwear, custom shoe, depth inlay, each (Medicare: Special coverage instructions apply) - L3250: Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each (Medicare: Special coverage instructions apply) - L3251: Foot, shoe molded to patient model, silicone shoe, each (Medicare: Special coverage instructions apply) - L3252: Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each (Medicare: Special coverage instructions apply) - L3253: Foot, molded shoe plastazote (or similar) custom fitted, each (Medicare: Special coverage instructions apply) - L3254: Non-standard size or width (Medicare: Special coverage instructions apply) - L3255: Non-standard size or length (Medicare: Special coverage instructions apply) - L3257: Orthopedic footwear, additional charge for split size (Medicare: Special coverage instructions apply) - L3260: Surgical boot/shoe, each (Medicare: Special coverage instructions apply) - L3265: Plastazote sandal, each (Medicare: Carrier judgment) - L3300: Lift, elevation, heel, tapered to metatarsals, per inch (Medicare: Special coverage instructions apply) - L3310: Lift, elevation, heel and sole, neoprene, per inch (Medicare: Special coverage instructions apply) - L3320: Lift, elevation, heel and sole, cork, per inch (Medicare: Special coverage instructions apply) - L3330: Lift, elevation, metal extension (skate) (Medicare: Special coverage instructions apply) - L3332: Lift, elevation, inside shoe, tapered, up to one-half inch (Medicare: Special coverage instructions apply) - L3334: Lift, elevation, heel, per inch (Medicare: Special coverage instructions apply) - L3340: Heel wedge, sach (Medicare: Special coverage instructions apply) - L3350: Heel wedge (Medicare: Special coverage instructions apply) - L3360: Sole wedge, outside sole (Medicare: Special coverage instructions apply) - L3370: Sole wedge, between sole (Medicare: Special coverage instructions apply) - L3380: Clubfoot wedge (Medicare: Special coverage instructions apply) - L3390: Outflare wedge (Medicare: Special coverage instructions apply) - L3400: Metatarsal bar wedge, rocker (Medicare: Special coverage instructions apply) - L3410: Metatarsal bar wedge, between sole (Medicare: Special coverage instructions apply) - L3420: Full sole and heel wedge, between sole (Medicare: Special coverage instructions apply) - L3430: Heel, counter, plastic reinforced (Medicare: Special coverage instructions apply) - L3440: Heel, counter, leather reinforced (Medicare: Special coverage instructions apply) - L3450: Heel, sach cushion type (Medicare: Special coverage instructions apply) - L3455: Heel, new leather, standard (Medicare: Special coverage instructions apply) - L3460: Heel, new rubber, standard (Medicare: Special coverage instructions apply) - L3465: Heel, thomas with wedge (Medicare: Special coverage instructions apply) - L3470: Heel, thomas extended to ball (Medicare: Special coverage instructions apply) - L3480: Heel, pad and depression for spur (Medicare: Special coverage instructions apply) - L3485: Heel, pad, removable for spur (Medicare: Special coverage instructions apply) - L3500: Orthopedic shoe addition, insole, leather (Medicare: Special coverage instructions apply) - L3510: Orthopedic shoe addition, insole, rubber (Medicare: Special coverage instructions apply) - L3520: Orthopedic shoe addition, insole, felt covered with leather (Medicare: Special coverage instructions apply) - L3530: Orthopedic shoe addition, sole, half (Medicare: Special coverage instructions apply) - L3540: Orthopedic shoe addition, sole, full (Medicare: Special coverage instructions apply) - L3550: Orthopedic shoe addition, toe tap standard (Medicare: Special coverage instructions apply) - L3560: Orthopedic shoe addition, toe tap, horseshoe (Medicare: Special coverage instructions apply) - L3570: Orthopedic shoe addition, special extension to instep (leather with eyelets) (Medicare: Special coverage instructions apply) - L3580: Orthopedic shoe addition, convert instep to velcro closure (Medicare: Special coverage instructions apply) - L3590: Orthopedic shoe addition, convert firm shoe counter to soft counter (Medicare: Special coverage instructions apply) - L3595: Orthopedic shoe addition, march bar (Medicare: Special coverage instructions apply) - L3600: Transfer of an orthosis from one shoe to another, caliper plate, existing (Medicare: Special coverage instructions apply) - L3610: Transfer of an orthosis from one shoe to another, caliper plate, new (Medicare: Special coverage instructions apply) - L3620: Transfer of an orthosis from one shoe to another, solid stirrup, existing (Medicare: Special coverage instructions apply) - L3630: Transfer of an orthosis from one shoe to another, solid stirrup, new (Medicare: Special coverage instructions apply) - L3640: Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes (Medicare: Special coverage instructions apply) - L3649: Orthopedic shoe, modification, addition or transfer, not otherwise specified (Medicare: Special coverage instructions apply) - L3650: Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3660: Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3670: Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3671: Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3674: 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 (Medicare: Carrier judgment) - L3675: Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3677: Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise (Medicare: Special coverage instructions apply) - L3678: Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3702: Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3710: Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3720: Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated (Medicare: Carrier judgment) - L3730: Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated (Medicare: Carrier judgment) - L3740: Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated (Medicare: Carrier judgment) - L3760: 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 (Medicare: Carrier judgment) - L3761: Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3762: Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3763: Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3764: Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3765: Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3766: 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 (Medicare: Carrier judgment) - L3806: 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 (Medicare: Carrier judgment) - L3807: 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 (Medicare: Carrier judgment) - L3808: Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3809: Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type (Medicare: Carrier judgment) - L3891: Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each (Medicare: Not payable by Medicare) - L3900: Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated (Medicare: Carrier judgment) - L3901: Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated (Medicare: Carrier judgment) - L3904: Wrist hand finger orthosis, external powered, electric, custom fabricated (Medicare: Carrier judgment) - L3905: Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3906: Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3908: Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3912: Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3913: Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3915: 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 (Medicare: Carrier judgment) - L3916: Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3917: 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 (Medicare: Carrier judgment) - L3918: Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3919: Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3921: Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3923: 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 (Medicare: Carrier judgment) - L3924: Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3925: Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3927: 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 (Medicare: Carrier judgment) - L3929: 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 (Medicare: Carrier judgment) - L3930: Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L3931: 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 (Medicare: Carrier judgment) - L3933: Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3935: Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3956: Addition of joint to upper extremity orthosis, any material; per joint (Medicare: Carrier judgment) - L3960: Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3961: Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3962: Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3967: Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3971: Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3973: Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3975: Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3976: Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3977: 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 (Medicare: Carrier judgment) - L3978: Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3980: Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3981: 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 (Medicare: Carrier judgment) - L3982: Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3984: Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L3995: Addition to upper extremity orthosis, sock, fracture or equal, each (Medicare: Carrier judgment) - L3999: Upper limb orthosis, not otherwise specified (Medicare: Carrier judgment) - L4000: Replace girdle for spinal orthosis (ctlso or so) (Medicare: Carrier judgment) - L4002: Replacement strap, any orthosis, includes all components, any length, any type (Medicare: Carrier judgment) - L4010: Replace trilateral socket brim (Medicare: Carrier judgment) - L4020: Replace quadrilateral socket brim, molded to patient model (Medicare: Carrier judgment) - L4030: Replace quadrilateral socket brim, custom fitted (Medicare: Carrier judgment) - L4040: Replace molded thigh lacer, for custom fabricated orthosis only (Medicare: Carrier judgment) - L4045: Replace non-molded thigh lacer, for custom fabricated orthosis only (Medicare: Carrier judgment) - L4050: Replace molded calf lacer, for custom fabricated orthosis only (Medicare: Carrier judgment) - L4055: Replace non-molded calf lacer, for custom fabricated orthosis only (Medicare: Carrier judgment) - L4060: Replace high roll cuff (Medicare: Carrier judgment) - L4070: Replace proximal and distal upright for kafo (Medicare: Carrier judgment) - L4080: Replace metal bands kafo, proximal thigh (Medicare: Carrier judgment) - L4090: Replace metal bands kafo-afo, calf or distal thigh (Medicare: Carrier judgment) - L4100: Replace leather cuff kafo, proximal thigh (Medicare: Carrier judgment) - L4110: Replace leather cuff kafo-afo, calf or distal thigh (Medicare: Carrier judgment) - L4130: Replace pretibial shell (Medicare: Carrier judgment) - L4205: Repair of orthotic device, labor component, per 15 minutes (Medicare: Special coverage instructions apply) - L4210: Repair of orthotic device, repair or replace minor parts (Medicare: Special coverage instructions apply) - L4350: Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf (Medicare: Carrier judgment) - L4360: 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 (Medicare: Carrier judgment) - L4361: Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L4370: Pneumatic full leg splint, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L4386: 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 (Medicare: Carrier judgment) - L4387: Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L4392: Replacement, soft interface material, static afo (Medicare: Carrier judgment) - L4394: Replace soft interface material, foot drop splint (Medicare: Carrier judgment) - L4396: 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 (Medicare: Carrier judgment) - L4397: 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 (Medicare: Carrier judgment) - L4398: Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf (Medicare: Carrier judgment) - L4631: 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 (Medicare: Carrier judgment) - L5000: Partial foot, shoe insert with longitudinal arch, toe filler (Medicare: Special coverage instructions apply) - L5010: Partial foot, molded socket, ankle height, with toe filler (Medicare: Special coverage instructions apply) - L5020: Partial foot, molded socket, tibial tubercle height, with toe filler (Medicare: Special coverage instructions apply) - L5050: Ankle, symes, molded socket, sach foot (Medicare: Carrier judgment) - L5060: Ankle, symes, metal frame, molded leather socket, articulated ankle/foot (Medicare: Carrier judgment) - L5100: Below knee, molded socket, shin, sach foot (Medicare: Carrier judgment) - L5105: Below knee, plastic socket, joints and thigh lacer, sach foot (Medicare: Carrier judgment) - L5150: Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot (Medicare: Carrier judgment) - L5160: Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot (Medicare: Carrier judgment) - L5200: Above knee, molded socket, single axis constant friction knee, shin, sach foot (Medicare: Carrier judgment) - L5210: Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each (Medicare: Carrier judgment) - L5220: Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each (Medicare: Carrier judgment) - L5230: Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot (Medicare: Carrier judgment) - L5250: Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot (Medicare: Carrier judgment) - L5270: Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot (Medicare: Carrier judgment) - L5280: Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot (Medicare: Carrier judgment) - L5301: Below knee, molded socket, shin, sach foot, endoskeletal system (Medicare: Carrier judgment) - L5312: Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system (Medicare: Carrier judgment) - L5321: Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee (Medicare: Carrier judgment) - L5331: Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot (Medicare: Carrier judgment) - L5341: Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot (Medicare: Carrier judgment) - L5400: Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee (Medicare: Carrier judgment) - L5410: Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment (Medicare: Carrier judgment) - L5420: Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation (Medicare: Carrier judgment) - L5430: 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 (Medicare: Carrier judgment) - L5450: Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee (Medicare: Carrier judgment) - L5460: Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee (Medicare: Carrier judgment) - L5500: Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed (Medicare: Carrier judgment) - L5505: Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed (Medicare: Carrier judgment) - L5510: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model (Medicare: Carrier judgment) - L5520: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed (Medicare: Carrier judgment) - L5530: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model (Medicare: Carrier judgment) - L5535: Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket (Medicare: Carrier judgment) - L5540: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model (Medicare: Carrier judgment) - L5560: Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model (Medicare: Carrier judgment) - L5570: Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed (Medicare: Carrier judgment) - L5580: Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model (Medicare: Carrier judgment) - L5585: Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket (Medicare: Carrier judgment) - L5590: Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model (Medicare: Carrier judgment) - L5595: Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model (Medicare: Carrier judgment) - L5600: Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model (Medicare: Carrier judgment) - L5610: Addition to lower extremity, endoskeletal system, above knee, hydracadence system (Medicare: Carrier judgment) - L5611: Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control (Medicare: Carrier judgment) - L5613: Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control (Medicare: Carrier judgment) - L5614: Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control (Medicare: Carrier judgment) - L5615: Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control (Medicare: Carrier judgment) - L5616: Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control (Medicare: Carrier judgment) - L5617: Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each (Medicare: Carrier judgment) - L5618: Addition to lower extremity, test socket, symes (Medicare: Carrier judgment) - L5620: Addition to lower extremity, test socket, below knee (Medicare: Carrier judgment) - L5622: Addition to lower extremity, test socket, knee disarticulation (Medicare: Carrier judgment) - L5624: Addition to lower extremity, test socket, above knee (Medicare: Carrier judgment) - L5626: Addition to lower extremity, test socket, hip disarticulation (Medicare: Carrier judgment) - L5628: Addition to lower extremity, test socket, hemipelvectomy (Medicare: Carrier judgment) - L5629: Addition to lower extremity, below knee, acrylic socket (Medicare: Carrier judgment) - L5630: Addition to lower extremity, symes type, expandable wall socket (Medicare: Carrier judgment) - L5631: Addition to lower extremity, above knee or knee disarticulation, acrylic socket (Medicare: Carrier judgment) - L5632: Addition to lower extremity, symes type, 'ptb' brim design socket (Medicare: Carrier judgment) - L5634: Addition to lower extremity, symes type, posterior opening (canadian) socket (Medicare: Carrier judgment) - L5636: Addition to lower extremity, symes type, medial opening socket (Medicare: Carrier judgment) - L5637: Addition to lower extremity, below knee, total contact (Medicare: Carrier judgment) - L5638: Addition to lower extremity, below knee, leather socket (Medicare: Carrier judgment) - L5639: Addition to lower extremity, below knee, wood socket (Medicare: Carrier judgment) - L5640: Addition to lower extremity, knee disarticulation, leather socket (Medicare: Carrier judgment) - L5642: Addition to lower extremity, above knee, leather socket (Medicare: Carrier judgment) - L5643: Addition to lower extremity, hip disarticulation, flexible inner socket, external frame (Medicare: Carrier judgment) - L5644: Addition to lower extremity, above knee, wood socket (Medicare: Carrier judgment) - L5645: Addition to lower extremity, below knee, flexible inner socket, external frame (Medicare: Carrier judgment) - L5646: Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket (Medicare: Carrier judgment) - L5647: Addition to lower extremity, below knee suction socket (Medicare: Carrier judgment) - L5648: Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket (Medicare: Carrier judgment) - L5649: Addition to lower extremity, ischial containment/narrow m-l socket (Medicare: Carrier judgment) - L5650: Additions to lower extremity, total contact, above knee or knee disarticulation socket (Medicare: Carrier judgment) - L5651: Addition to lower extremity, above knee, flexible inner socket, external frame (Medicare: Carrier judgment) - L5652: Addition to lower extremity, suction suspension, above knee or knee disarticulation socket (Medicare: Carrier judgment) - L5653: Addition to lower extremity, knee disarticulation, expandable wall socket (Medicare: Carrier judgment) - L5654: Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal) (Medicare: Carrier judgment) - L5655: Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal) (Medicare: Carrier judgment) - L5656: Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal) (Medicare: Carrier judgment) - L5657: Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials (Medicare: Carrier judgment) - L5658: Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal) (Medicare: Carrier judgment) - L5661: Addition to lower extremity, socket insert, multi-durometer symes (Medicare: Carrier judgment) - L5665: Addition to lower extremity, socket insert, multi-durometer, below knee (Medicare: Carrier judgment) - L5666: Addition to lower extremity, below knee, cuff suspension (Medicare: Carrier judgment) - L5668: Addition to lower extremity, below knee, molded distal cushion (Medicare: Carrier judgment) - L5670: Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar) (Medicare: Carrier judgment) - L5671: Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert (Medicare: Carrier judgment) - L5672: Addition to lower extremity, below knee, removable medial brim suspension (Medicare: Carrier judgment) - L5673: 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 (Medicare: Carrier judgment) - L5676: Additions to lower extremity, below knee, knee joints, single axis, pair (Medicare: Carrier judgment) - L5677: Additions to lower extremity, below knee, knee joints, polycentric, pair (Medicare: Carrier judgment) - L5678: Additions to lower extremity, below knee, joint covers, pair (Medicare: Carrier judgment) - L5679: 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 (Medicare: Carrier judgment) - L5680: Addition to lower extremity, below knee, thigh lacer, nonmolded (Medicare: Carrier judgment) - L5681: 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) (Medicare: Carrier judgment) - L5682: Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded (Medicare: Carrier judgment) - L5683: 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) (Medicare: Carrier judgment) - L5684: Addition to lower extremity, below knee, fork strap (Medicare: Carrier judgment) - L5685: Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each (Medicare: Carrier judgment) - L5686: Addition to lower extremity, below knee, back check (extension control) (Medicare: Carrier judgment) - L5688: Addition to lower extremity, below knee, waist belt, webbing (Medicare: Carrier judgment) - L5690: Addition to lower extremity, below knee, waist belt, padded and lined (Medicare: Carrier judgment) - L5692: Addition to lower extremity, above knee, pelvic control belt, light (Medicare: Carrier judgment) - L5694: Addition to lower extremity, above knee, pelvic control belt, padded and lined (Medicare: Carrier judgment) - L5695: Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each (Medicare: Carrier judgment) - L5696: Addition to lower extremity, above knee or knee disarticulation, pelvic joint (Medicare: Carrier judgment) - L5697: Addition to lower extremity, above knee or knee disarticulation, pelvic band (Medicare: Carrier judgment) - L5698: Addition to lower extremity, above knee or knee disarticulation, silesian bandage (Medicare: Carrier judgment) - L5699: All lower extremity prostheses, shoulder harness (Medicare: Carrier judgment) - L5700: Replacement, socket, below knee, molded to patient model (Medicare: Carrier judgment) - L5701: Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model (Medicare: Carrier judgment) - L5702: Replacement, socket, hip disarticulation, including hip joint, molded to patient model (Medicare: Carrier judgment) - L5703: Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only (Medicare: Carrier judgment) - L5704: Custom shaped protective cover, below knee (Medicare: Carrier judgment) - L5705: Custom shaped protective cover, above knee (Medicare: Carrier judgment) - L5706: Custom shaped protective cover, knee disarticulation (Medicare: Carrier judgment) - L5707: Custom shaped protective cover, hip disarticulation (Medicare: Carrier judgment) - L5710: Addition, exoskeletal knee-shin system, single axis, manual lock (Medicare: Carrier judgment) - L5711: Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material (Medicare: Carrier judgment) - L5712: Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) (Medicare: Carrier judgment) - L5714: Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control (Medicare: Carrier judgment) - L5716: Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock (Medicare: Carrier judgment) - L5718: Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control (Medicare: Carrier judgment) - L5722: Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control (Medicare: Carrier judgment) - L5724: Addition, exoskeletal knee-shin system, single axis, fluid swing phase control (Medicare: Carrier judgment) - L5726: Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control (Medicare: Carrier judgment) - L5728: Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control (Medicare: Carrier judgment) - L5780: Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control (Medicare: Carrier judgment) - L5781: Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system (Medicare: Carrier judgment) - L5782: Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty (Medicare: Carrier judgment) - L5783: Addition to lower extremity, user adjustable, mechanical, residual limb volume management system (with or without lamination kit) (Medicare: Carrier judgment) - L5785: Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L5790: Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L5795: Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L5810: Addition, endoskeletal knee-shin system, single axis, manual lock (Medicare: Carrier judgment) - L5811: Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material (Medicare: Carrier judgment) - L5812: Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) (Medicare: Carrier judgment) - L5814: Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock (Medicare: Carrier judgment) - L5816: Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock (Medicare: Carrier judgment) - L5818: Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control (Medicare: Carrier judgment) - L5822: Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control (Medicare: Carrier judgment) - L5824: Addition, endoskeletal knee-shin system, single axis, fluid swing phase control (Medicare: Carrier judgment) - L5826: Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame (Medicare: Carrier judgment) - L5827: Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping (Medicare: Carrier judgment) - L5828: Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control (Medicare: Carrier judgment) - L5830: Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control (Medicare: Carrier judgment) - L5840: Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control (Medicare: Carrier judgment) - L5841: Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control (Medicare: Carrier judgment) - L5845: Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable (Medicare: Carrier judgment) - L5848: Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability (Medicare: Carrier judgment) - L5850: Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist (Medicare: Carrier judgment) - L5855: Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist (Medicare: Carrier judgment) - L5856: Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type (Medicare: Carrier judgment) - L5857: Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type (Medicare: Carrier judgment) - L5858: Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type (Medicare: Carrier judgment) - L5859: Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s) (Medicare: Carrier judgment) - L5910: Addition, endoskeletal system, below knee, alignable system (Medicare: Carrier judgment) - L5920: Addition, endoskeletal system, above knee or hip disarticulation, alignable system (Medicare: Carrier judgment) - L5925: Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock (Medicare: Carrier judgment) - L5926: Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type (Medicare: Carrier judgment) - L5930: Addition, endoskeletal system, high activity knee control frame (Medicare: Carrier judgment) - L5940: Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L5950: Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L5960: Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L5961: Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control (Medicare: Carrier judgment) - L5962: Addition, endoskeletal system, below knee, flexible protective outer surface covering system (Medicare: Carrier judgment) - L5964: Addition, endoskeletal system, above knee, flexible protective outer surface covering system (Medicare: Carrier judgment) - L5966: Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system (Medicare: Carrier judgment) - L5968: Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature (Medicare: Carrier judgment) - L5969: Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) (Medicare: Carrier judgment) - L5970: All lower extremity prostheses, foot, external keel, sach foot (Medicare: Carrier judgment) - L5971: All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only (Medicare: Carrier judgment) - L5972: All lower extremity prostheses, foot, flexible keel (Medicare: Carrier judgment) - L5973: Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source (Medicare: Carrier judgment) - L5974: All lower extremity prostheses, foot, single axis ankle/foot (Medicare: Carrier judgment) - L5975: All lower extremity prosthesis, combination single axis ankle and flexible keel foot (Medicare: Carrier judgment) - L5976: All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal) (Medicare: Carrier judgment) - L5978: All lower extremity prostheses, foot, multiaxial ankle/foot (Medicare: Carrier judgment) - L5979: All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system (Medicare: Carrier judgment) - L5980: All lower extremity prostheses, flex foot system (Medicare: Carrier judgment) - L5981: All lower extremity prostheses, flex-walk system or equal (Medicare: Carrier judgment) - L5982: All exoskeletal lower extremity prostheses, axial rotation unit (Medicare: Carrier judgment) - L5984: All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability (Medicare: Carrier judgment) - L5985: All endoskeletal lower extremity prostheses, dynamic prosthetic pylon (Medicare: Carrier judgment) - L5986: All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) (Medicare: Carrier judgment) - L5987: All lower extremity prosthesis, shank foot system with vertical loading pylon (Medicare: Carrier judgment) - L5988: Addition to lower limb prosthesis, vertical shock reducing pylon feature (Medicare: Carrier judgment) - L5990: Addition to lower extremity prosthesis, user adjustable heel height (Medicare: Carrier judgment) - L5991: Addition to lower extremity prostheses, osseointegrated external prosthetic connector (Medicare: Carrier judgment) - L5992: All lower extremity prosthesis, foot shell for modular foot/non-solid ankle cushion heel (sach) replacement only (Medicare: Carrier judgment) - L5999: Lower extremity prosthesis, not otherwise specified (Medicare: Carrier judgment) - L6000: Partial hand, thumb remaining (Medicare: Carrier judgment) - L6010: Partial hand, little and/or ring finger remaining (Medicare: Carrier judgment) - L6020: Partial hand, no finger remaining (Medicare: Carrier judgment) - L6025: 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 (Medicare: Carrier judgment) - L6026: 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) (Medicare: Carrier judgment) - L6028: Partial hand, finger, and thumb prosthesis without prosthetic digit(s) /thumb, amputation at metacarpal level, including flexible or non-flexible interface, molded to patient model, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692 (Medicare: Carrier judgment) - L6029: Upper extremity addition, test socket/interface, partial hand including fingers (Medicare: Carrier judgment) - L6030: Upper extremity addition, external frame, partial hand including fingers (Medicare: Carrier judgment) - L6031: Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power (Medicare: Carrier judgment) - L6032: Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L6033: Addition to upper extremity prosthesis, partial hand including fingers, acrylic material (Medicare: Carrier judgment) - L6034: 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 (Medicare: Carrier judgment) - L6035: 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 (Medicare: Carrier judgment) - L6036: 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 (Medicare: Carrier judgment) - L6037: 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 (Medicare: Carrier judgment) - L6038: 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 (Medicare: Carrier judgment) - L6039: 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 (Medicare: Carrier judgment) - L6050: Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad (Medicare: Carrier judgment) - L6055: Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad (Medicare: Carrier judgment) - L6100: Below elbow, molded socket, flexible elbow hinge, triceps pad (Medicare: Carrier judgment) - L6110: Below elbow, molded socket, (muenster or northwestern suspension types) (Medicare: Carrier judgment) - L6120: Below elbow, molded double wall split socket, step-up hinges, half cuff (Medicare: Carrier judgment) - L6130: Below elbow, molded double wall split socket, stump activated locking hinge, half cuff (Medicare: Carrier judgment) - L6200: Elbow disarticulation, molded socket, outside locking hinge, forearm (Medicare: Carrier judgment) - L6205: Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm (Medicare: Carrier judgment) - L6250: Above elbow, molded double wall socket, internal locking elbow, forearm (Medicare: Carrier judgment) - L6300: Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm (Medicare: Carrier judgment) - L6310: Shoulder disarticulation, passive restoration (complete prosthesis) (Medicare: Carrier judgment) - L6320: Shoulder disarticulation, passive restoration (shoulder cap only) (Medicare: Carrier judgment) - L6350: Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm (Medicare: Carrier judgment) - L6360: Interscapular thoracic, passive restoration (complete prosthesis) (Medicare: Carrier judgment) - L6370: Interscapular thoracic, passive restoration (shoulder cap only) (Medicare: Carrier judgment) - L6380: 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 (Medicare: Carrier judgment) - L6382: 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 (Medicare: Carrier judgment) - L6384: 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 (Medicare: Carrier judgment) - L6386: Immediate post surgical or early fitting, each additional cast change and realignment (Medicare: Carrier judgment) - L6388: Immediate post surgical or early fitting, application of rigid dressing only (Medicare: Carrier judgment) - L6400: Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping (Medicare: Carrier judgment) - L6450: Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping (Medicare: Carrier judgment) - L6500: Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping (Medicare: Carrier judgment) - L6550: Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping (Medicare: Carrier judgment) - L6570: Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping (Medicare: Carrier judgment) - L6580: 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 (Medicare: Carrier judgment) - L6582: 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 (Medicare: Carrier judgment) - L6584: 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 (Medicare: Carrier judgment) - L6586: 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 (Medicare: Carrier judgment) - L6588: 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 (Medicare: Carrier judgment) - L6590: 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 (Medicare: Carrier judgment) - L6600: Upper extremity additions, polycentric hinge, pair (Medicare: Carrier judgment) - L6605: Upper extremity additions, single pivot hinge, pair (Medicare: Carrier judgment) - L6610: Upper extremity additions, flexible metal hinge, pair (Medicare: Carrier judgment) - L6611: Addition to upper extremity prosthesis, external powered, additional switch, any type (Medicare: Carrier judgment) - L6615: Upper extremity addition, disconnect locking wrist unit (Medicare: Carrier judgment) - L6616: Upper extremity addition, additional disconnect insert for locking wrist unit, each (Medicare: Carrier judgment) - L6620: Upper extremity addition, flexion/extension wrist unit, with or without friction (Medicare: Carrier judgment) - L6621: Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device (Medicare: Carrier judgment) - L6623: Upper extremity addition, spring assisted rotational wrist unit with latch release (Medicare: Carrier judgment) - L6624: Upper extremity addition, flexion/extension and rotation wrist unit (Medicare: Carrier judgment) - L6625: Upper extremity addition, rotation wrist unit with cable lock (Medicare: Carrier judgment) - L6628: Upper extremity addition, quick disconnect hook adapter, otto bock or equal (Medicare: Carrier judgment) - L6629: Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal (Medicare: Carrier judgment) - L6630: Upper extremity addition, stainless steel, any wrist (Medicare: Carrier judgment) - L6632: Upper extremity addition, latex suspension sleeve, each (Medicare: Carrier judgment) - L6635: Upper extremity addition, lift assist for elbow (Medicare: Carrier judgment) - L6637: Upper extremity addition, nudge control elbow lock (Medicare: Carrier judgment) - L6638: Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow (Medicare: Carrier judgment) - L6640: Upper extremity additions, shoulder abduction joint, pair (Medicare: Carrier judgment) - L6641: Upper extremity addition, excursion amplifier, pulley type (Medicare: Carrier judgment) - L6642: Upper extremity addition, excursion amplifier, lever type (Medicare: Carrier judgment) - L6645: Upper extremity addition, shoulder flexion-abduction joint, each (Medicare: Carrier judgment) - L6646: Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system (Medicare: Carrier judgment) - L6647: Upper extremity addition, shoulder lock mechanism, body powered actuator (Medicare: Carrier judgment) - L6648: Upper extremity addition, shoulder lock mechanism, external powered actuator (Medicare: Carrier judgment) - L6650: Upper extremity addition, shoulder universal joint, each (Medicare: Carrier judgment) - L6655: Upper extremity addition, standard control cable, extra (Medicare: Carrier judgment) - L6660: Upper extremity addition, heavy duty control cable (Medicare: Carrier judgment) - L6665: Upper extremity addition, teflon, or equal, cable lining (Medicare: Carrier judgment) - L6670: Upper extremity addition, hook to hand, cable adapter (Medicare: Carrier judgment) - L6672: Upper extremity addition, harness, chest or shoulder, saddle type (Medicare: Carrier judgment) - L6675: Upper extremity addition, harness, (e.g., figure of eight type), single cable design (Medicare: Carrier judgment) - L6676: Upper extremity addition, harness, (e.g., figure of eight type), dual cable design (Medicare: Carrier judgment) - L6677: Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow (Medicare: Carrier judgment) - L6680: Upper extremity addition, test socket, wrist disarticulation or below elbow (Medicare: Carrier judgment) - L6682: Upper extremity addition, test socket, elbow disarticulation or above elbow (Medicare: Carrier judgment) - L6684: Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic (Medicare: Carrier judgment) - L6686: Upper extremity addition, suction socket (Medicare: Carrier judgment) - L6687: Upper extremity addition, frame type socket, below elbow or wrist disarticulation (Medicare: Carrier judgment) - L6688: Upper extremity addition, frame type socket, above elbow or elbow disarticulation (Medicare: Carrier judgment) - L6689: Upper extremity addition, frame type socket, shoulder disarticulation (Medicare: Carrier judgment) - L6690: Upper extremity addition, frame type socket, interscapular-thoracic (Medicare: Carrier judgment) - L6691: Upper extremity addition, removable insert, each (Medicare: Carrier judgment) - L6692: Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each (Medicare: Carrier judgment) - L6693: Upper extremity addition, locking elbow, forearm counterbalance (Medicare: Carrier judgment) - L6694: 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 (Medicare: Carrier judgment) - L6695: 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 (Medicare: Carrier judgment) - L6696: Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) (Medicare: Carrier judgment) - L6697: Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) (Medicare: Carrier judgment) - L6698: Addition to upper extremity prosthesis, lock mechanism, excludes socket insert (Medicare: Carrier judgment) - L6700: Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement (Medicare: Carrier judgment) - L6703: Terminal device, passive hand/mitt, any material, any size (Medicare: Carrier judgment) - L6704: Terminal device, sport/recreational/work attachment, any material, any size (Medicare: Carrier judgment) - L6706: Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined (Medicare: Carrier judgment) - L6707: Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined (Medicare: Carrier judgment) - L6708: Terminal device, hand, mechanical, voluntary opening, any material, any size (Medicare: Carrier judgment) - L6709: Terminal device, hand, mechanical, voluntary closing, any material, any size (Medicare: Carrier judgment) - L6711: Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric (Medicare: Carrier judgment) - L6712: Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric (Medicare: Carrier judgment) - L6713: Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric (Medicare: Carrier judgment) - L6714: Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric (Medicare: Carrier judgment) - L6715: Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement (Medicare: Carrier judgment) - L6721: Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined (Medicare: Carrier judgment) - L6722: Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined (Medicare: Carrier judgment) - L6805: Addition to terminal device, modifier wrist unit (Medicare: Special coverage instructions apply) - L6810: Addition to terminal device, precision pinch device (Medicare: Special coverage instructions apply) - L6880: Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) (Medicare: Carrier judgment) - L6881: Automatic grasp feature, addition to upper limb electric prosthetic terminal device (Medicare: Carrier judgment) - L6882: Microprocessor control feature, addition to upper limb prosthetic terminal device (Medicare: Special coverage instructions apply) - L6883: Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power (Medicare: Carrier judgment) - L6884: Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power (Medicare: Carrier judgment) - L6885: Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power (Medicare: Carrier judgment) - L6890: Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment (Medicare: Carrier judgment) - L6895: Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated (Medicare: Carrier judgment) - L6900: Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining (Medicare: Carrier judgment) - L6905: Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining (Medicare: Carrier judgment) - L6910: Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining (Medicare: Carrier judgment) - L6915: Hand restoration (shading, and measurements included), replacement glove for above (Medicare: Carrier judgment) - L6920: Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device (Medicare: Carrier judgment) - L6925: Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device (Medicare: Carrier judgment) - L6930: Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device (Medicare: Carrier judgment) - L6935: Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device (Medicare: Carrier judgment) - L6940: Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device (Medicare: Carrier judgment) - L6945: Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device (Medicare: Carrier judgment) - L6950: Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device (Medicare: Carrier judgment) - L6955: Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device (Medicare: Carrier judgment) - L6960: Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device (Medicare: Carrier judgment) - L6965: Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device (Medicare: Carrier judgment) - L6970: Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device (Medicare: Carrier judgment) - L6975: Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device (Medicare: Carrier judgment) - L7007: Electric hand, switch or myoelectric controlled, adult (Medicare: Carrier judgment) - L7008: Electric hand, switch or myoelectric, controlled, pediatric (Medicare: Carrier judgment) - L7009: Electric hook, switch or myoelectric controlled, adult (Medicare: Carrier judgment) - L7040: Prehensile actuator, switch controlled (Medicare: Carrier judgment) - L7045: Electric hook, switch or myoelectric controlled, pediatric (Medicare: Carrier judgment) - L7170: Electronic elbow, hosmer or equal, switch controlled (Medicare: Carrier judgment) - L7180: Electronic elbow, microprocessor sequential control of elbow and terminal device (Medicare: Carrier judgment) - L7181: Electronic elbow, microprocessor simultaneous control of elbow and terminal device (Medicare: Carrier judgment) - L7185: Electronic elbow, adolescent, variety village or equal, switch controlled (Medicare: Carrier judgment) - L7186: Electronic elbow, child, variety village or equal, switch controlled (Medicare: Carrier judgment) - L7190: Electronic elbow, adolescent, variety village or equal, myoelectronically controlled (Medicare: Carrier judgment) - L7191: Electronic elbow, child, variety village or equal, myoelectronically controlled (Medicare: Carrier judgment) - L7259: Electronic wrist rotator, any type (Medicare: Carrier judgment) - L7260: Electronic wrist rotator, otto bock or equal (Medicare: Carrier judgment) - L7261: Electronic wrist rotator, for utah arm (Medicare: Carrier judgment) - L7360: Six volt battery, each (Medicare: Carrier judgment) - L7362: Battery charger, six volt, each (Medicare: Carrier judgment) - L7364: Twelve volt battery, each (Medicare: Carrier judgment) - L7366: Battery charger, twelve volt, each (Medicare: Carrier judgment) - L7367: Lithium ion battery, rechargeable, replacement (Medicare: Carrier judgment) - L7368: Lithium ion battery charger, replacement only (Medicare: Carrier judgment) - L7400: Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L7401: Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L7402: Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) (Medicare: Carrier judgment) - L7403: Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material (Medicare: Carrier judgment) - L7404: Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material (Medicare: Carrier judgment) - L7405: Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material (Medicare: Carrier judgment) - L7406: Addition to upper extremity prosthesis, user adjustable, mechanical, residual limb volume management system (with or without lamination kit) (Medicare: Carrier judgment) - L7499: Upper extremity prosthesis, not otherwise specified (Medicare: Carrier judgment) - L7510: Repair of prosthetic device, repair or replace minor parts (Medicare: Special coverage instructions apply) - L7520: Repair prosthetic device, labor component, per 15 minutes (Medicare: Carrier judgment) - L7600: Prosthetic donning sleeve, any material, each (Medicare: Non-covered by Medicare statute) - L7700: Gasket or seal, for use with prosthetic socket insert, any type, each (Medicare: Carrier judgment) - L7900: Male vacuum erection system (Medicare: Non-covered by Medicare statute) - L7902: Tension ring, for vacuum erection device, any type, replacement only, each (Medicare: Non-covered by Medicare statute) - L8000: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type (Medicare: Special coverage instructions apply) - L8001: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type (Medicare: Special coverage instructions apply) - L8002: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type (Medicare: Special coverage instructions apply) - L8010: Breast prosthesis, mastectomy sleeve (Medicare: Special coverage instructions apply) - L8015: External breast prosthesis garment, with mastectomy form, post mastectomy (Medicare: Special coverage instructions apply) - L8020: Breast prosthesis, mastectomy form (Medicare: Special coverage instructions apply) - L8030: Breast prosthesis, silicone or equal, without integral adhesive (Medicare: Special coverage instructions apply) - L8031: Breast prosthesis, silicone or equal, with integral adhesive (Medicare: Special coverage instructions apply) - L8032: Nipple prosthesis, prefabricated, reusable, any type, each (Medicare: Carrier judgment) - L8033: Nipple prosthesis, custom fabricated, reusable, any material, any type, each (Medicare: Carrier judgment) - L8035: Custom breast prosthesis, post mastectomy, molded to patient model (Medicare: Special coverage instructions apply) - L8039: Breast prosthesis, not otherwise specified (Medicare: Carrier judgment) - L8040: Nasal prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8041: Midfacial prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8042: Orbital prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8043: Upper facial prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8044: Hemi-facial prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8045: Auricular prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8046: Partial facial prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8047: Nasal septal prosthesis, provided by a non-physician (Medicare: Carrier judgment) - L8048: Unspecified maxillofacial prosthesis, by report, provided by a non-physician (Medicare: Carrier judgment) - L8049: Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician (Medicare: Carrier judgment) - L8300: Truss, single with standard pad (Medicare: Special coverage instructions apply) - L8310: Truss, double with standard pads (Medicare: Special coverage instructions apply) - L8320: Truss, addition to standard pad, water pad (Medicare: Special coverage instructions apply) - L8330: Truss, addition to standard pad, scrotal pad (Medicare: Special coverage instructions apply) - L8400: Prosthetic sheath, below knee, each (Medicare: Special coverage instructions apply) - L8410: Prosthetic sheath, above knee, each (Medicare: Special coverage instructions apply) - L8415: Prosthetic sheath, upper limb, each (Medicare: Special coverage instructions apply) - L8417: Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each (Medicare: Carrier judgment) - L8420: Prosthetic sock, multiple ply, below knee, each (Medicare: Special coverage instructions apply) - L8430: Prosthetic sock, multiple ply, above knee, each (Medicare: Special coverage instructions apply) - L8435: Prosthetic sock, multiple ply, upper limb, each (Medicare: Special coverage instructions apply) - L8440: Prosthetic shrinker, below knee, each (Medicare: Special coverage instructions apply) - L8460: Prosthetic shrinker, above knee, each (Medicare: Special coverage instructions apply) - L8465: Prosthetic shrinker, upper limb, each (Medicare: Special coverage instructions apply) - L8470: Prosthetic sock, single ply, fitting, below knee, each (Medicare: Special coverage instructions apply) - L8480: Prosthetic sock, single ply, fitting, above knee, each (Medicare: Special coverage instructions apply) - L8485: Prosthetic sock, single ply, fitting, upper limb, each (Medicare: Special coverage instructions apply) - L8499: Unlisted procedure for miscellaneous prosthetic services (Medicare: Carrier judgment) - L8500: Artificial larynx, any type (Medicare: Special coverage instructions apply) - L8501: Tracheostomy speaking valve (Medicare: Special coverage instructions apply) - L8505: Artificial larynx replacement battery / accessory, any type (Medicare: Carrier judgment) - L8507: Tracheo-esophageal voice prosthesis, patient inserted, any type, each (Medicare: Carrier judgment) - L8509: Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type (Medicare: Carrier judgment) - L8510: Voice amplifier (Medicare: Special coverage instructions apply) - L8511: Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each (Medicare: Carrier judgment) - L8512: Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 (Medicare: Carrier judgment) - L8513: Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each (Medicare: Carrier judgment) - L8514: Tracheoesophageal puncture dilator, replacement only, each (Medicare: Carrier judgment) - L8515: Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each (Medicare: Carrier judgment) - L8600: Implantable breast prosthesis, silicone or equal (Medicare: Special coverage instructions apply) - L8603: Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies (Medicare: Special coverage instructions apply) - L8604: Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies (Medicare: Carrier judgment) - L8605: Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies (Medicare: Carrier judgment) - L8606: Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies (Medicare: Special coverage instructions apply) - L8607: Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies (Medicare: Special coverage instructions apply) - L8608: Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system (Medicare: Carrier judgment) - L8609: Artificial cornea (Medicare: Carrier judgment) - L8610: Ocular implant (Medicare: Special coverage instructions apply) - L8612: Aqueous shunt (Medicare: Special coverage instructions apply) - L8613: Ossicula implant (Medicare: Special coverage instructions apply) - L8614: Cochlear device, includes all internal and external components (Medicare: Special coverage instructions apply) - L8615: Headset/headpiece for use with cochlear implant device, replacement (Medicare: Special coverage instructions apply) - L8616: Microphone for use with cochlear implant device, replacement (Medicare: Special coverage instructions apply) - L8617: Transmitting coil for use with cochlear implant device, replacement (Medicare: Special coverage instructions apply) - L8618: Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement (Medicare: Special coverage instructions apply) - L8619: Cochlear implant, external speech processor and controller, integrated system, replacement (Medicare: Special coverage instructions apply) - L8621: Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each (Medicare: Carrier judgment) - L8622: Alkaline battery for use with cochlear implant device, any size, replacement, each (Medicare: Carrier judgment) - L8623: Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each (Medicare: Carrier judgment) - L8624: Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each (Medicare: Carrier judgment) - L8625: External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each (Medicare: Special coverage instructions apply) - L8627: Cochlear implant, external speech processor, component, replacement (Medicare: Special coverage instructions apply) - L8628: Cochlear implant, external controller component, replacement (Medicare: Special coverage instructions apply) - L8629: Transmitting coil and cable, integrated, for use with cochlear implant device, replacement (Medicare: Special coverage instructions apply) - L8630: Metacarpophalangeal joint implant (Medicare: Special coverage instructions apply) - L8631: 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) (Medicare: Special coverage instructions apply) - L8641: Metatarsal joint implant (Medicare: Special coverage instructions apply) - L8642: Hallux implant (Medicare: Special coverage instructions apply) - L8658: Interphalangeal joint spacer, silicone or equal, each (Medicare: Special coverage instructions apply) - L8659: 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 (Medicare: Special coverage instructions apply) - L8670: Vascular graft material, synthetic, implant (Medicare: Special coverage instructions apply) - L8678: Electrical stimulator supplies (external) for use with implantable neurostimulator, per month (Medicare: Carrier judgment) - L8679: Implantable neurostimulator, pulse generator, any type (Medicare: Special coverage instructions apply) - L8680: Implantable neurostimulator electrode, each (Medicare: Not payable by Medicare) - L8681: Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only (Medicare: Special coverage instructions apply) - L8682: Implantable neurostimulator radiofrequency receiver (Medicare: Special coverage instructions apply) - L8683: Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver (Medicare: Special coverage instructions apply) - L8684: Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement (Medicare: Special coverage instructions apply) - L8685: Implantable neurostimulator pulse generator, single array, rechargeable, includes extension (Medicare: Not payable by Medicare) - L8686: Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension (Medicare: Not payable by Medicare) - L8687: Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension (Medicare: Not payable by Medicare) - L8688: Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension (Medicare: Not payable by Medicare) - L8689: External recharging system for battery (internal) for use with implantable neurostimulator, replacement only (Medicare: Special coverage instructions apply) - L8690: Auditory osseointegrated device, includes all internal and external components (Medicare: Carrier judgment) - L8691: Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each (Medicare: Carrier judgment) - L8692: Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment (Medicare: Non-covered by Medicare statute) - L8693: Auditory osseointegrated device abutment, any length, replacement only (Medicare: Carrier judgment) - L8694: Auditory osseointegrated device, transducer/actuator, replacement only, each (Medicare: Carrier judgment) - L8695: External recharging system for battery (external) for use with implantable neurostimulator, replacement only (Medicare: Special coverage instructions apply) - L8696: Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each (Medicare: Special coverage instructions apply) - L8698: Miscellaneous component, supply or accessory for use with total artificial heart system (Medicare: Special coverage instructions apply) - L8699: Prosthetic implant, not otherwise specified (Medicare: Carrier judgment) - L8701: 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 (Medicare: Carrier judgment) - L8702: 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 (Medicare: Carrier judgment) - L8720: External lower extremity sensory prosthetic device, cutaneous stimulation of mechanoreceptors proximal to the ankle, per leg (Medicare: Carrier judgment) - L8721: Receptor sole for use with l8720, replacement, each (Medicare: Carrier judgment) - L9900: Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code (Medicare: Carrier judgment) - M0001: Advancing cancer care mips value pathways (Medicare: Carrier judgment) - M0002: Optimal care for kidney health mips value pathways (Medicare: Carrier judgment) - M0003: Optimal care for patients with episodic neurological conditions mips value pathways (Medicare: Carrier judgment) - M0004: Quality care for patients with neurological conditions mips value pathway (Medicare: Carrier judgment) - M0005: Value in primary care mips value pathway (Medicare: Carrier judgment) - M0010: Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services (Medicare: Carrier judgment) - M0064: Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders (Medicare: Special coverage instructions apply) - M0075: Cellular therapy (Medicare: Non-covered by Medicare) - M0076: Prolotherapy (Medicare: Non-covered by Medicare) - M0100: Intragastric hypothermia using gastric freezing (Medicare: Non-covered by Medicare) - M0201: 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 (Medicare: Carrier judgment) - M0220: 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 (Medicare: Carrier judgment) - M0221: 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 (Medicare: Carrier judgment) - M0222: Intravenous injection, bebtelovimab, includes injection and post administration monitoring (Medicare: Carrier judgment) - M0223: 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 (Medicare: Carrier judgment) - M0224: 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 (Medicare: Carrier judgment) - M0233: 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 (Medicare: Carrier judgment) - M0234: 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 (Medicare: Carrier judgment) - M0235: 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 (Medicare: Carrier judgment) - M0236: 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 (Medicare: Carrier judgment) - M0237: 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 (Medicare: Carrier judgment) - M0238: 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 (Medicare: Carrier judgment) - M0239: Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring (Medicare: Carrier judgment) - M0240: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses (Medicare: Carrier judgment) - M0241: 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 (Medicare: Carrier judgment) - M0243: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring (Medicare: Carrier judgment) - M0244: 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 (Medicare: Carrier judgment) - M0245: Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring (Medicare: Carrier judgment) - M0246: 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 (Medicare: Carrier judgment) - M0247: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring (Medicare: Carrier judgment) - M0248: 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 (Medicare: Carrier judgment) - M0249: 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 (Medicare: Carrier judgment) - M0250: 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 (Medicare: Carrier judgment) - M0300: Iv chelation therapy (chemical endarterectomy) (Medicare: Non-covered by Medicare) - M0301: Fabric wrapping of abdominal aneurysm (Medicare: Non-covered by Medicare) - M1000: Pain screened as moderate to severe (Medicare: Carrier judgment) - M1001: Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician (Medicare: Carrier judgment) - M1002: 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 (Medicare: Carrier judgment) - M1003: Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy (Medicare: Carrier judgment) - M1004: 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) (Medicare: Carrier judgment) - M1005: Tb screening not performed or results not interpreted, reason not given (Medicare: Carrier judgment) - M1006: Disease activity not assessed, reason not given (Medicare: Carrier judgment) - M1007: >=50% of total number of a patient's outpatient ra encounters assessed (Medicare: Carrier judgment) - M1008: <50% of total number of a patient's outpatient ra encounters assessed (Medicare: Carrier judgment) - M1009: Discharge/discontinuation of the episode of care documented in the medical record (Medicare: Carrier judgment) - M1010: Discharge/discontinuation of the episode of care documented in the medical record (Medicare: Carrier judgment) - M1011: Discharge/discontinuation of the episode of care documented in the medical record (Medicare: Carrier judgment) - M1012: Discharge/discontinuation of the episode of care documented in the medical record (Medicare: Carrier judgment) - M1013: Discharge/discontinuation of the episode of care documented in the medical record (Medicare: Carrier judgment) - M1014: Discharge/discontinuation of the episode of care documented in the medical record (Medicare: Carrier judgment) - M1015: Discharge/discontinuation of the episode of care documented in the medical record (Medicare: Carrier judgment) - M1016: Female patients unable to bear children (Medicare: Carrier judgment) - M1017: Patient admitted to palliative care services (Medicare: Carrier judgment) - M1018: 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 (Medicare: Carrier judgment) - M1019: 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 (Medicare: Carrier judgment) - M1020: 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 (Medicare: Carrier judgment) - M1021: Patient had only urgent care visits during the performance period (Medicare: Carrier judgment) - M1022: Patients who were in hospice at any time during the performance period (Medicare: Carrier judgment) - M1023: 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 (Medicare: Carrier judgment) - M1024: 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 (Medicare: Carrier judgment) - M1025: Patients who were in hospice at any time during the performance period (Medicare: Carrier judgment) - M1026: Patients who were in hospice at any time during the performance period (Medicare: Carrier judgment) - M1027: Imaging of the head (ct or mri) was obtained (Medicare: Carrier judgment) - M1028: Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained (Medicare: Carrier judgment) - M1029: Imaging of the head (ct or mri) was not obtained, reason not given (Medicare: Carrier judgment) - M1030: Patients with clinical indications for imaging of the head (Medicare: Carrier judgment) - M1031: Patients with no clinical indications for imaging of the head (Medicare: Carrier judgment) - M1032: Adults currently taking pharmacotherapy for oud (Medicare: Carrier judgment) - M1033: Pharmacotherapy for oud initiated after june 30th of performance period (Medicare: Carrier judgment) - M1034: Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days (Medicare: Carrier judgment) - M1035: Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment (Medicare: Carrier judgment) - M1036: 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 (Medicare: Carrier judgment) - M1037: Patients with a diagnosis of lumbar spine region cancer at the time of the procedure (Medicare: Carrier judgment) - M1038: Patients with a diagnosis of lumbar spine region fracture at the time of the procedure (Medicare: Carrier judgment) - M1039: Patients with a diagnosis of lumbar spine region infection at the time of the procedure (Medicare: Carrier judgment) - M1040: Patients with a diagnosis of lumbar idiopathic or congenital scoliosis (Medicare: Carrier judgment) - M1041: Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis (Medicare: Carrier judgment) - M1042: 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 (Medicare: Carrier judgment) - M1043: Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively (Medicare: Carrier judgment) - M1044: 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 (Medicare: Carrier judgment) - M1045: 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 (Medicare: Carrier judgment) - M1046: 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 (Medicare: Carrier judgment) - M1047: 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 (Medicare: Carrier judgment) - M1048: 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 (Medicare: Carrier judgment) - M1049: Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively (Medicare: Carrier judgment) - M1050: 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 (Medicare: Carrier judgment) - M1051: Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis (Medicare: Carrier judgment) - M1052: Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively (Medicare: Carrier judgment) - M1053: Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively (Medicare: Carrier judgment) - M1054: Patient had only urgent care visits during the performance period (Medicare: Carrier judgment) - M1055: Aspirin or another antiplatelet therapy used (Medicare: Carrier judgment) - M1056: 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 (Medicare: Carrier judgment) - M1057: Aspirin or another antiplatelet therapy not used, reason not given (Medicare: Carrier judgment) - M1058: Patient was a permanent nursing home resident at any time during the performance period (Medicare: Carrier judgment) - M1059: Patient was in hospice or receiving palliative care at any time during the performance period (Medicare: Carrier judgment) - M1060: Patient died prior to the end of the performance period (Medicare: Carrier judgment) - M1061: Patient pregnancy (Medicare: Carrier judgment) - M1062: Patient immunocompromised (Medicare: Carrier judgment) - M1063: Patients receiving high doses of immunosuppressive therapy (Medicare: Carrier judgment) - M1064: Shingrix vaccine documented as administered or previously received (Medicare: Carrier judgment) - M1065: 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) (Medicare: Carrier judgment) - M1066: Shingrix vaccine not documented as administered, reason not given (Medicare: Carrier judgment) - M1067: Hospice services for patient provided any time during the measurement period (Medicare: Carrier judgment) - M1068: Adults who are not ambulatory (Medicare: Carrier judgment) - M1069: Patient screened for future fall risk (Medicare: Carrier judgment) - M1070: Patient not screened for future fall risk, reason not given (Medicare: Carrier judgment) - M1071: Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy (Medicare: Carrier judgment) - M1106: The start of an episode of care documented in the medical record (Medicare: Carrier judgment) - M1107: 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 (Medicare: Carrier judgment) - M1108: 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 (Medicare: Carrier judgment) - M1109: 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 (Medicare: Carrier judgment) - M1110: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) (Medicare: Carrier judgment) - M1111: The start of an episode of care documented in the medical record (Medicare: Carrier judgment) - M1112: 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 (Medicare: Carrier judgment) - M1113: 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 (Medicare: Carrier judgment) - M1114: 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 (Medicare: Carrier judgment) - M1115: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) (Medicare: Carrier judgment) - M1116: The start of an episode of care documented in the medical record (Medicare: Carrier judgment) - M1117: 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 (Medicare: Carrier judgment) - M1118: 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 (Medicare: Carrier judgment) - M1119: 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 (Medicare: Carrier judgment) - M1120: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) (Medicare: Carrier judgment) - M1121: The start of an episode of care documented in the medical record (Medicare: Carrier judgment) - M1122: 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 (Medicare: Carrier judgment) - M1123: 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 (Medicare: Carrier judgment) - M1124: 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 (Medicare: Carrier judgment) - M1125: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) (Medicare: Carrier judgment) - M1126: The start of an episode of care documented in the medical record (Medicare: Carrier judgment) - M1127: 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 (Medicare: Carrier judgment) - M1128: 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 (Medicare: Carrier judgment) - M1129: 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 (Medicare: Carrier judgment) - M1130: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) (Medicare: Carrier judgment) - M1131: 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 (Medicare: Carrier judgment) - M1132: 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 (Medicare: Carrier judgment) - M1133: 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 (Medicare: Carrier judgment) - M1134: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) (Medicare: Carrier judgment) - M1135: The start of an episode of care documented in the medical record (Medicare: Carrier judgment) - M1136: The start of an episode of care documented in the medical record (Medicare: Carrier judgment) - M1137: 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 (Medicare: Carrier judgment) - M1138: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) (Medicare: Carrier judgment) - M1139: 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) (Medicare: Carrier judgment) - M1140: 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 (Medicare: Carrier judgment) - M1141: 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 (Medicare: Carrier judgment) - M1142: Emergent cases (Medicare: Carrier judgment) - M1143: Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment (Medicare: Carrier judgment) - M1144: Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only (Medicare: Carrier judgment) - M1145: Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier) (Medicare: Carrier judgment) - M1146: 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 (Medicare: Carrier judgment) - M1147: 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 (Medicare: Carrier judgment) - M1148: Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) (Medicare: Carrier judgment) - M1149: 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 (Medicare: Carrier judgment) - M1150: 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 (Medicare: Carrier judgment) - M1151: Patients with a history of heart transplant or with a left ventricular assist device (lvad) (Medicare: Carrier judgment) - M1152: Patients with a history of heart transplant or with a left ventricular assist device (lvad) (Medicare: Carrier judgment) - M1153: Patient with diagnosis of osteoporosis on date of encounter (Medicare: Carrier judgment) - M1154: Hospice services provided to patient any time during the measurement period (Medicare: Carrier judgment) - M1155: Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period (Medicare: Carrier judgment) - M1156: Patient received active chemotherapy any time during the measurement period (Medicare: Carrier judgment) - M1157: Patient received bone marrow transplant any time during the measurement period (Medicare: Carrier judgment) - M1158: Patient had history of immunocompromising conditions prior to or during the measurement period (Medicare: Carrier judgment) - M1159: Hospice services provided to patient any time during the measurement period (Medicare: Carrier judgment) - M1160: Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday (Medicare: Carrier judgment) - M1161: Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday (Medicare: Carrier judgment) - M1162: Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday (Medicare: Carrier judgment) - M1163: Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday (Medicare: Carrier judgment) - M1164: Patients with dementia any time during the patient's history through the end of the measurement period (Medicare: Carrier judgment) - M1165: Patients who use hospice services any time during the measurement period (Medicare: Carrier judgment) - M1166: Pathology report for tissue specimens produced from wide local excisions or re-excisions (Medicare: Carrier judgment) - M1167: In hospice or using hospice services during the measurement period (Medicare: Carrier judgment) - M1168: 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 (Medicare: Carrier judgment) - M1169: Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine) (Medicare: Carrier judgment) - M1170: 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 (Medicare: Carrier judgment) - M1171: 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 (Medicare: Carrier judgment) - M1172: 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) (Medicare: Carrier judgment) - M1173: 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 (Medicare: Carrier judgment) - M1174: 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 (Medicare: Carrier judgment) - M1175: Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine) (Medicare: Carrier judgment) - M1176: 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 (Medicare: Carrier judgment) - M1177: Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period (Medicare: Carrier judgment) - M1178: Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine) (Medicare: Carrier judgment) - M1179: Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period (Medicare: Carrier judgment) - M1180: Patients on immune checkpoint inhibitor therapy (Medicare: Carrier judgment) - M1181: Grade 2 or above diarrhea and/or grade 2 or above colitis (Medicare: Carrier judgment) - M1182: Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease) (Medicare: Carrier judgment) - M1183: Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered (Medicare: Carrier judgment) - M1184: 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) (Medicare: Carrier judgment) - M1185: Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given (Medicare: Carrier judgment) - M1186: Patients who have an order for or are receiving hospice or palliative care (Medicare: Carrier judgment) - M1187: Patients with a diagnosis of end stage renal disease (esrd) (Medicare: Carrier judgment) - M1188: Patients with a diagnosis of chronic kidney disease (ckd) stage 5 (Medicare: Carrier judgment) - M1189: Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed (Medicare: Carrier judgment) - M1190: Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) (Medicare: Carrier judgment) - M1191: Hospice services provided to patient any time during the measurement period (Medicare: Carrier judgment) - M1192: Patients with an existing diagnosis of squamous cell carcinoma of the esophagus (Medicare: Carrier judgment) - M1193: 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 (Medicare: Carrier judgment) - M1194: 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) (Medicare: Carrier judgment) - M1195: 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 (Medicare: Carrier judgment) - M1196: Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 (Medicare: Carrier judgment) - M1197: Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score (Medicare: Carrier judgment) - M1198: 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 (Medicare: Carrier judgment) - M1199: Patients receiving rrt (Medicare: Carrier judgment) - M1200: Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period (Medicare: Carrier judgment) - M1201: 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) (Medicare: Carrier judgment) - M1202: Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons) (Medicare: Carrier judgment) - M1203: Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given (Medicare: Carrier judgment) - M1204: Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 (Medicare: Carrier judgment) - M1205: Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score (Medicare: Carrier judgment) - M1206: 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 (Medicare: Carrier judgment) - M1207: Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (Medicare: Carrier judgment) - M1208: Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (Medicare: Carrier judgment) - M1209: At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses (Medicare: Carrier judgment) - M1210: At least two orders for high-risk medications from the same drug class, (table 4), not ordered (Medicare: Carrier judgment) - M1211: Most recent glycemic status assessment (hba1c or gmi) level > 9.0% (Medicare: Carrier judgment) - M1212: Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period (Medicare: Carrier judgment) - M1213: No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70% (Medicare: Carrier judgment) - M1214: Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed (Medicare: Carrier judgment) - M1215: Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy) (Medicare: Carrier judgment) - M1216: No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter (Medicare: Carrier judgment) - M1217: Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter) (Medicare: Carrier judgment) - M1218: Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) (Medicare: Carrier judgment) - M1219: Anaphylaxis due to the vaccine on or before the date of the encounter (Medicare: Carrier judgment) - M1220: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy (Medicare: Carrier judgment) - M1221: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy (Medicare: Carrier judgment) - M1222: Glaucoma plan of care not documented, reason not otherwise specified (Medicare: Carrier judgment) - M1223: Glaucoma plan of care documented (Medicare: Carrier judgment) - M1224: Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level (Medicare: Carrier judgment) - M1225: Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level (Medicare: Carrier judgment) - M1226: Iop measurement not documented, reason not otherwise specified (Medicare: Carrier judgment) - M1227: Evidence-based therapy was prescribed (Medicare: Carrier judgment) - M1228: 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 (Medicare: Carrier judgment) - M1229: 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 (Medicare: Carrier judgment) - M1230: 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 (Medicare: Carrier judgment) - M1231: Patient receives hcv antibody test with nonreactive result (Medicare: Carrier judgment) - M1232: Patient receives hcv antibody test with reactive result (Medicare: Carrier judgment) - M1233: Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given (Medicare: Carrier judgment) - M1234: Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia (Medicare: Carrier judgment) - M1235: Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period (Medicare: Carrier judgment) - M1236: Baseline mrs > 2 (Medicare: Carrier judgment) - M1237: 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) (Medicare: Carrier judgment) - M1238: 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) (Medicare: Carrier judgment) - M1239: Patient did not respond to the question of patient felt heard and understood by this provider and team (Medicare: Carrier judgment) - M1240: 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 (Medicare: Carrier judgment) - M1241: 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 (Medicare: Carrier judgment) - M1242: Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life (Medicare: Carrier judgment) - M1243: Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team (Medicare: Carrier judgment) - M1244: 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 (Medicare: Carrier judgment) - M1245: 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 (Medicare: Carrier judgment) - M1246: 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 (Medicare: Carrier judgment) - M1247: 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 (Medicare: Carrier judgment) - M1248: 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 (Medicare: Carrier judgment) - M1249: Patient responded "completely true" for the question of patient felt this provider and team understood what is important to me in my life (Medicare: Carrier judgment) - M1250: Patient responded as "completely true" for the question of patient felt heard and understood by this provider and team (Medicare: Carrier judgment) - M1251: Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement) (Medicare: Carrier judgment) - M1252: 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 (Medicare: Carrier judgment) - M1253: 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) (Medicare: Carrier judgment) - M1254: Patients who were deceased when the hu survey reached them (Medicare: Carrier judgment) - M1255: 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) (Medicare: Carrier judgment) - M1256: Prior history of known cvd (Medicare: Carrier judgment) - M1257: Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified (Medicare: Carrier judgment) - M1258: Cvd risk assessment performed, have a documented calculated risk score (Medicare: Carrier judgment) - M1259: Patient status documented within the first year of initiating dialysis (Medicare: Carrier judgment) - M1260: Patient status not documented within the first year of initiating dialysis (Medicare: Carrier judgment) - M1261: Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis (Medicare: Carrier judgment) - M1262: Patients who had a transplant prior to initiation of dialysis (Medicare: Carrier judgment) - M1263: Patients in hospice on their initiation of dialysis date or during the month of evaluation (Medicare: Carrier judgment) - M1264: Patients age 75 or older on their initiation of dialysis date (Medicare: Carrier judgment) - M1265: Cms medical evidence form 2728 for dialysis patients: initial form completed (Medicare: Carrier judgment) - M1266: Patients admitted to a skilled nursing facility (snf) (Medicare: Carrier judgment) - M1267: 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 (Medicare: Carrier judgment) - M1268: 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 (Medicare: Carrier judgment) - M1269: Receiving esrd mcp dialysis services by the provider on the last day of the reporting month (Medicare: Carrier judgment) - M1270: Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period (Medicare: Carrier judgment) - M1271: Patients with dementia at any time prior to or during the month (Medicare: Carrier judgment) - M1272: Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period (Medicare: Carrier judgment) - M1273: Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form (Medicare: Carrier judgment) - M1274: Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month (Medicare: Carrier judgment) - M1275: Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period (Medicare: Carrier judgment) - M1276: Bmi documented outside normal parameters, no follow-up plan documented, no reason given (Medicare: Carrier judgment) - M1277: Colorectal cancer screening results documented and reviewed (Medicare: Carrier judgment) - M1278: Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented (Medicare: Carrier judgment) - M1279: Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given (Medicare: Carrier judgment) - M1280: 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 (Medicare: Carrier judgment) - M1281: Blood pressure reading not documented, reason not given (Medicare: Carrier judgment) - M1282: Patient screened for tobacco use and identified as a tobacco non-user (Medicare: Carrier judgment) - M1283: Patient screened for tobacco use and identified as a tobacco user (Medicare: Carrier judgment) - M1284: 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 (Medicare: Carrier judgment) - M1285: Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified (Medicare: Carrier judgment) - M1286: Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason (Medicare: Carrier judgment) - M1287: Bmi is documented below normal parameters and a follow-up plan is documented (Medicare: Carrier judgment) - M1288: Documented reason for not screening or recommending a follow-up for high blood pressure (Medicare: Carrier judgment) - M1289: 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) (Medicare: Carrier judgment) - M1290: Patient not eligible due to active diagnosis of hypertension (Medicare: Carrier judgment) - M1291: 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 (Medicare: Carrier judgment) - M1292: 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 (Medicare: Carrier judgment) - M1293: Bmi is documented above normal parameters and a follow-up plan is documented (Medicare: Carrier judgment) - M1294: Normal blood pressure reading documented, follow-up not required (Medicare: Carrier judgment) - M1295: Patients with a diagnosis or past history of total colectomy or colorectal cancer (Medicare: Carrier judgment) - M1296: Bmi is documented within normal parameters and no follow-up plan is required (Medicare: Carrier judgment) - M1297: Bmi not documented due to medical reason or patient refusal of height or weight measurement (Medicare: Carrier judgment) - M1298: Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter (Medicare: Carrier judgment) - M1299: Influenza immunization administered or previously received (Medicare: Carrier judgment) - M1300: 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) (Medicare: Carrier judgment) - M1301: 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) (Medicare: Carrier judgment) - M1302: Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed (Medicare: Carrier judgment) - M1303: Hospice services provided to patient any time during the measurement period (Medicare: Carrier judgment) - M1304: Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period (Medicare: Carrier judgment) - M1305: Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period (Medicare: Carrier judgment) - M1306: Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period (Medicare: Carrier judgment) - M1307: Documentation stating the patient has received or is currently receiving palliative or hospice care (Medicare: Carrier judgment) - M1308: Influenza immunization was not administered, reason not given (Medicare: Carrier judgment) - M1309: Palliative care services provided to patient any time during the measurement period (Medicare: Carrier judgment) - M1310: 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 (Medicare: Carrier judgment) - M1311: Anaphylaxis due to the vaccine on or before the date of the encounter (Medicare: Carrier judgment) - M1312: Patient not screened for tobacco use (Medicare: Carrier judgment) - M1313: Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period (Medicare: Carrier judgment) - M1314: Bmi not documented and no reason is given (Medicare: Carrier judgment) - M1315: Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified (Medicare: Carrier judgment) - M1316: Current tobacco non-user (Medicare: Carrier judgment) - M1317: Patients who are counseled on connection with a csp and explicitly opt out (Medicare: Carrier judgment) - M1318: 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 (Medicare: Carrier judgment) - M1319: Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening (Medicare: Carrier judgment) - M1320: Patients who screened positive for at least 1 of the 5 hrsns (Medicare: Carrier judgment) - M1321: 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 (Medicare: Carrier judgment) - M1322: 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 (Medicare: Carrier judgment) - M1323: 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 (Medicare: Carrier judgment) - M1324: Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) (Medicare: Carrier judgment) - M1325: 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) (Medicare: Carrier judgment) - M1326: Patients with a diagnosis of hypotony (Medicare: Carrier judgment) - M1327: Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks (Medicare: Carrier judgment) - M1328: Patients with a diagnosis of acute vitreous hemorrhage (Medicare: Carrier judgment) - M1329: 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 (Medicare: Carrier judgment) - M1330: Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) (Medicare: Carrier judgment) - M1331: Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam (Medicare: Carrier judgment) - M1332: Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks (Medicare: Carrier judgment) - M1333: Acute vitreous hemorrhage (Medicare: Carrier judgment) - M1334: 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 (Medicare: Carrier judgment) - M1335: Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) (Medicare: Carrier judgment) - M1336: Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks (Medicare: Carrier judgment) - M1337: Acute pvd (Medicare: Carrier judgment) - M1338: 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 (Medicare: Carrier judgment) - M1339: 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 (Medicare: Carrier judgment) - M1340: Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period (Medicare: Carrier judgment) - M1341: 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 (Medicare: Carrier judgment) - M1342: Patients who died during the performance period (Medicare: Carrier judgment) - M1343: 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 (Medicare: Carrier judgment) - M1344: Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score (Medicare: Carrier judgment) - M1345: Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score (Medicare: Carrier judgment) - M1346: Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period (Medicare: Carrier judgment) - M1347: Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing) (Medicare: Carrier judgment) - M1348: Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent) (Medicare: Carrier judgment) - M1349: Patients who did not have a net increase in pam score of at least 3 points within a 4 to 12 month period (Medicare: Carrier judgment) - M1350: 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 (Medicare: Carrier judgment) - M1351: 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 (Medicare: Carrier judgment) - M1352: Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment (Medicare: Carrier judgment) - M1353: 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 (Medicare: Carrier judgment) - M1354: 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 (Medicare: Carrier judgment) - M1355: Suicide risk based on their clinician's evaluation or a clinician-rated tool (Medicare: Carrier judgment) - M1356: Patients who died during the measurement period (Medicare: Carrier judgment) - M1357: Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment (Medicare: Carrier judgment) - M1358: Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment (Medicare: Carrier judgment) - M1359: Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained (Medicare: Carrier judgment) - M1360: Suicidal ideation and/or behavior symptoms based on the c-ssrs (Medicare: Carrier judgment) - M1361: Suicide risk based on their clinician's evaluation or a clinician-rated tool (Medicare: Carrier judgment) - M1362: Patients who died during the measurement period (Medicare: Carrier judgment) - M1363: Patients who did not have a follow-up assessment within 120 days of the index assessment (Medicare: Carrier judgment) - M1364: Calculated 10-year ascvd risk score of >= 20 percent during the performance period (Medicare: Carrier judgment) - M1365: Patient encounter during the performance period with hospice and palliative care specialty code 17 (Medicare: Carrier judgment) - M1366: Focusing on women's health mips value pathway (Medicare: Carrier judgment) - M1367: Quality care for the treatment of ear, nose, and throat disorders mips value pathway (Medicare: Carrier judgment) - M1368: Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway (Medicare: Carrier judgment) - M1369: Quality care in mental health and substance use disorders mips value pathway (Medicare: Carrier judgment) - M1370: Rehabilitative support for musculoskeletal care mips value pathway (Medicare: Carrier judgment) - M1371: Most recent glycemic status assessment (hba1c or gmi) level < 7.0% (Medicare: Carrier judgment) - M1372: Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0% (Medicare: Carrier judgment) - M1373: Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0% (Medicare: Carrier judgment) - M1374: 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 (Medicare: Carrier judgment) - M1375: 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 (Medicare: Carrier judgment) - M1376: 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 (Medicare: Carrier judgment) - M1377: Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient (Medicare: Carrier judgment) - M1378: 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) (Medicare: Carrier judgment) - M1379: A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified (Medicare: Carrier judgment) - M1380: 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" (Medicare: Carrier judgment) - M1381: 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 (Medicare: Carrier judgment) - M1382: Patient encounter during the performance period with place of service code 11 (Medicare: Carrier judgment) - M1383: Acute pvd (Medicare: Carrier judgment) - M1384: Patients who died during the performance period (Medicare: Carrier judgment) - M1385: 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 (Medicare: Carrier judgment) - M1386: 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 (Medicare: Carrier judgment) - M1387: Patients who died during the performance period (Medicare: Carrier judgment) - M1388: Patients with documentation of an exam performed for recurrence of melanoma (Medicare: Carrier judgment) - M1390: Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period (Medicare: Carrier judgment) - M1391: All patients who were diagnosed with recurrent melanoma during the current performance period (Medicare: Carrier judgment) - M1392: 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) (Medicare: Carrier judgment) - M1393: Patients who were not diagnosed with recurrent melanoma during the current performance period (Medicare: Carrier judgment) - M1394: Stages i-iii breast cancer (Medicare: Carrier judgment) - M1395: Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group (Medicare: Carrier judgment) - M1396: Patients on a therapeutic clinical trial (Medicare: Carrier judgment) - M1397: Patients with recurrence/disease progression (Medicare: Carrier judgment) - M1398: Patients with baseline and follow-up promis surveys documented in the medical record (Medicare: Carrier judgment) - M1399: Patients who leave the practice during the follow-up period (Medicare: Carrier judgment) - M1400: Patients who died during the follow-up period (Medicare: Carrier judgment) - M1401: Stages i-iii breast cancer (Medicare: Carrier judgment) - M1402: Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group (Medicare: Carrier judgment) - M1403: Patients with baseline and follow-up promis surveys documented in the medical record (Medicare: Carrier judgment) - M1404: Patients on a therapeutic clinical trial (Medicare: Carrier judgment) - M1405: Patients with recurrence/disease progression (Medicare: Carrier judgment) - M1406: Patients who leave the practice during the follow-up period (Medicare: Carrier judgment) - M1407: Patients who died during the follow-up period (Medicare: Carrier judgment) - M1408: Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer (Medicare: Carrier judgment) - M1409: Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis (Medicare: Carrier judgment) - M1410: Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis (Medicare: Carrier judgment) - M1411: Currently on first-line immune checkpoint inhibitors without chemotherapy (Medicare: Carrier judgment) - M1412: 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 (Medicare: Carrier judgment) - M1413: Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy (Medicare: Carrier judgment) - M1414: 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) (Medicare: Carrier judgment) - M1415: Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy (Medicare: Carrier judgment) - M1416: Patient received hospice services any time during the performance period (Medicare: Carrier judgment) - M1417: Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination (Medicare: Carrier judgment) - M1418: 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 (Medicare: Carrier judgment) - M1419: Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination (Medicare: Carrier judgment) - M1420: Complete ophthalmologic care mips value pathway (Medicare: Carrier judgment) - M1421: Dermatological care mips value pathway (Medicare: Carrier judgment) - M1422: Gastroenterology care mips value pathway (Medicare: Carrier judgment) - M1423: Optimal care for patients with urologic conditions mips value pathway (Medicare: Carrier judgment) - M1424: Pulmonology care mips value pathway (Medicare: Carrier judgment) - M1425: Surgical care mips value pathway (Medicare: Carrier judgment) - M1426: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1427: Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons) (Medicare: Carrier judgment) - M1428: Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period (Medicare: Carrier judgment) - M1429: Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented (Medicare: Carrier judgment) - M1430: Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year) (Medicare: Carrier judgment) - M1431: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1432: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1433: Patient on oral chemotherapy on or within 30 days before denominator eligible encounter (Medicare: Carrier judgment) - M1434: Patient on oral chemotherapy on or within 30 days after denominator eligible encounter (Medicare: Carrier judgment) - M1435: Patient on oral chemotherapy during the performance period (Medicare: Carrier judgment) - M1436: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1437: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1438: Time last known well to hospital arrival less than or equal to 3.5 hours (<= 210 minutes) (Medicare: Carrier judgment) - M1439: Significant ocular conditions that impact the visual outcome of surgery (Medicare: Carrier judgment) - M1440: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1441: Encounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient (Medicare: Carrier judgment) - M1442: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1443: Encounters conducted via telehealth (Medicare: Carrier judgment) - M1444: Delivery at < 39 weeks of gestation (Medicare: Carrier judgment) - M1445: Postpartum care visit before or at 12 weeks of giving birth (Medicare: Carrier judgment) - M1446: Patients who died any time prior to the end of the measure assessment period (Medicare: Carrier judgment) - M1447: Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period (Medicare: Carrier judgment) - M1448: Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period (Medicare: Carrier judgment) - M1449: Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period (Medicare: Carrier judgment) - M1450: Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period (Medicare: Carrier judgment) - M1451: Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period (Medicare: Carrier judgment) - M1452: Patient ever had a diagnosis of dementia (Medicare: Carrier judgment) - M1453: Patients with a pre-operative visual acuity better than 20/40 (Medicare: Carrier judgment) - M1454: New cied (Medicare: Carrier judgment) - M1455: Replaced or revised cied (Medicare: Carrier judgment) - M1456: Patient had a heart transplant (Medicare: Carrier judgment) - M1457: 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 (Medicare: Carrier judgment) - M1458: Patient died prior to the end of the performance period (Medicare: Carrier judgment) - M1459: Patient was in hospice or receiving palliative care services at any time during the performance period (Medicare: Carrier judgment) - M1460: Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure (Medicare: Carrier judgment) - M1461: Patient diagnosis for chronic hepatitis c (Medicare: Carrier judgment) - M1462: Patients with clinical indications for imaging of the head (Medicare: Carrier judgment) - M1463: Documentation of at least two attempts to follow up with patient within 180 days of treatment (Medicare: Carrier judgment) - M1464: No documentation of at least two attempts to follow up with patient within 180 days of treatment (Medicare: Carrier judgment) - M1465: Patient follow up more than 180 days after treatment (Medicare: Carrier judgment) - M1466: Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure (Medicare: Carrier judgment) - M1467: Patients with an existing diagnosis of lynch syndrome (Medicare: Carrier judgment) - M1468: Patient received recommended doses of hepatitis b vaccination based on age (Medicare: Carrier judgment) - M1469: 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 (Medicare: Carrier judgment) - M1470: Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine) (Medicare: Carrier judgment) - M1471: 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 (Medicare: Carrier judgment) - M1472: Patient did not receive recommended doses of hepatitis b vaccination based on age (Medicare: Carrier judgment) - M1473: 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 (Medicare: Carrier judgment) - M1474: Patients with diagnosis of dementia (Medicare: Carrier judgment) - M1475: Patients with diagnosis of huntington's disease (Medicare: Carrier judgment) - M1476: Patients with diagnosis of cognitive impairment or alzheimer's disease (Medicare: Carrier judgment) - M1477: Diagnosis of delirium (Medicare: Carrier judgment) - M1478: Psychoactive substance abuse (Medicare: Carrier judgment) - M1479: 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 (Medicare: Carrier judgment) - M1480: 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 (Medicare: Carrier judgment) - M1481: Patients receiving hospice or palliative care or who died during the measurement period (Medicare: Carrier judgment) - M1482: Positive/detectable hepatitis c virus quantitative or qualitative rna test result during the denominator identification period (Medicare: Carrier judgment) - M1483: 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 (Medicare: Carrier judgment) - M1484: 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) (Medicare: Carrier judgment) - M1485: 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 (Medicare: Carrier judgment) - M1486: Patients admitted to a skilled nursing facility (snf) during the period of evaluation (Medicare: Carrier judgment) - M1487: Patients in hospice in the year before or during the period of evaluation (Medicare: Carrier judgment) - M1488: Patients with a diagnosis for dementia in the year before or during the period of evaluation (Medicare: Carrier judgment) - M1489: Patient status documented (Medicare: Carrier judgment) - M1490: Patient status not documented (Medicare: Carrier judgment) - M1491: Receiving esrd mcp dialysis services by the provider during the performance period (Medicare: Carrier judgment) - M1492: Patients who did not report a fall (Medicare: Carrier judgment) - M1493: 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) (Medicare: Carrier judgment) - M1494: Patients that reported a fall since the last visit (Medicare: Carrier judgment) - M1495: Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall (Medicare: Carrier judgment) - M1496: 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 (Medicare: Carrier judgment) - M1497: 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) (Medicare: Carrier judgment) - M1498: Diagnostic radiology mips value pathway (Medicare: Carrier judgment) - M1499: Interventional radiology mips value pathway (Medicare: Carrier judgment) - M1500: Neuropsychology mips value pathway (Medicare: Carrier judgment) - M1501: Pathology mips value pathway (Medicare: Carrier judgment) - M1502: Podiatry mips value pathway (Medicare: Carrier judgment) - M1503: Vascular surgery mips value pathway (Medicare: Carrier judgment) - P2028: Cephalin floculation, blood (Medicare: Special coverage instructions apply) - P2029: Congo red, blood (Medicare: Special coverage instructions apply) - P2031: Hair analysis (excluding arsenic) (Medicare: Non-covered by Medicare) - P2033: Thymol turbidity, blood (Medicare: Special coverage instructions apply) - P2038: Mucoprotein, blood (seromucoid) (medical necessity procedure) (Medicare: Special coverage instructions apply) - P3000: Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision (Medicare: Special coverage instructions apply) - P3001: Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician (Medicare: Special coverage instructions apply) - P7001: Culture, bacterial, urine; quantitative, sensitivity study (Medicare: Not payable by Medicare) - P9010: Blood (whole), for transfusion, per unit (Medicare: Special coverage instructions apply) - P9011: Blood, split unit (Medicare: Special coverage instructions apply) - P9012: Cryoprecipitate, each unit (Medicare: Special coverage instructions apply) - P9016: Red blood cells, leukocytes reduced, each unit (Medicare: Special coverage instructions apply) - P9017: Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit (Medicare: Special coverage instructions apply) - P9019: Platelets, each unit (Medicare: Special coverage instructions apply) - P9020: Platelet rich plasma, each unit (Medicare: Special coverage instructions apply) - P9021: Red blood cells, each unit (Medicare: Special coverage instructions apply) - P9022: Red blood cells, washed, each unit (Medicare: Special coverage instructions apply) - P9023: Plasma, pooled multiple donor, solvent/detergent treated, frozen, each unit (Medicare: Special coverage instructions apply) - P9025: Plasma, cryoprecipitate reduced, pathogen reduced, each unit (Medicare: Carrier judgment) - P9026: Cryoprecipitated fibrinogen complex, pathogen reduced, each unit (Medicare: Carrier judgment) - P9027: Red blood cells, leukocytes reduced, oxygen/ carbon dioxide reduced, each unit (Medicare: Carrier judgment) - P9031: Platelets, leukocytes reduced, each unit (Medicare: Special coverage instructions apply) - P9032: Platelets, irradiated, each unit (Medicare: Special coverage instructions apply) - P9033: Platelets, leukocytes reduced, irradiated, each unit (Medicare: Special coverage instructions apply) - P9034: Platelets, pheresis, each unit (Medicare: Special coverage instructions apply) - P9035: Platelets, pheresis, leukocytes reduced, each unit (Medicare: Special coverage instructions apply) - P9036: Platelets, pheresis, irradiated, each unit (Medicare: Special coverage instructions apply) - P9037: Platelets, pheresis, leukocytes reduced, irradiated, each unit (Medicare: Special coverage instructions apply) - P9038: Red blood cells, irradiated, each unit (Medicare: Special coverage instructions apply) - P9039: Red blood cells, deglycerolized, each unit (Medicare: Special coverage instructions apply) - P9040: Red blood cells, leukocytes reduced, irradiated, each unit (Medicare: Special coverage instructions apply) - P9041: Infusion, albumin (human), 5%, 50 ml (Medicare: Carrier judgment) - P9043: Infusion, plasma protein fraction (human), 5%, 50 ml (Medicare: Special coverage instructions apply) - P9044: Plasma, cryoprecipitate reduced, each unit (Medicare: Special coverage instructions apply) - P9045: Infusion, albumin (human), 5%, 250 ml (Medicare: Carrier judgment) - P9046: Infusion, albumin (human), 25%, 20 ml (Medicare: Carrier judgment) - P9047: Infusion, albumin (human), 25%, 50 ml (Medicare: Carrier judgment) - P9048: Infusion, plasma protein fraction (human), 5%, 250 ml (Medicare: Carrier judgment) - P9050: Granulocytes, pheresis, each unit (Medicare: Carrier judgment) - P9051: Whole blood or red blood cells, leukocytes reduced, cmv-negative, each unit (Medicare: Special coverage instructions apply) - P9052: Platelets, hla-matched leukocytes reduced, apheresis/pheresis, each unit (Medicare: Special coverage instructions apply) - P9053: Platelets, pheresis, leukocytes reduced, cmv-negative, irradiated, each unit (Medicare: Special coverage instructions apply) - P9054: Whole blood or red blood cells, leukocytes reduced, frozen, deglycerol, washed, each unit (Medicare: Special coverage instructions apply) - P9055: Platelets, leukocytes reduced, cmv-negative, apheresis/pheresis, each unit (Medicare: Special coverage instructions apply) - P9056: Whole blood, leukocytes reduced, irradiated, each unit (Medicare: Special coverage instructions apply) - P9057: Red blood cells, frozen/deglycerolized/washed, leukocytes reduced, irradiated, each unit (Medicare: Special coverage instructions apply) - P9058: Red blood cells, leukocytes reduced, cmv-negative, irradiated, each unit (Medicare: Special coverage instructions apply) - P9059: Fresh frozen plasma between 8-24 hours of collection, each unit (Medicare: Special coverage instructions apply) - P9060: Fresh frozen plasma, donor retested, each unit (Medicare: Special coverage instructions apply) - P9070: Plasma, pooled multiple donor, pathogen reduced, frozen, each unit (Medicare: Special coverage instructions apply) - P9071: Plasma (single donor), pathogen reduced, frozen, each unit (Medicare: Special coverage instructions apply) - P9072: Platelets, pheresis, pathogen reduced or rapid bacterial tested, each unit (Medicare: Not payable by Medicare) - P9073: Platelets, pheresis, pathogen-reduced, each unit (Medicare: Special coverage instructions apply) - P9099: Blood component or product not otherwise classified (Medicare: Carrier judgment) - P9100: Pathogen(s) test for platelets (Medicare: Special coverage instructions apply) - P9603: 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 (Medicare: Special coverage instructions apply) - P9604: Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge (Medicare: Special coverage instructions apply) - P9612: Catheterization for collection of specimen, single patient, all places of service (Medicare: Special coverage instructions apply) - P9615: Catheterization for collection of specimen(s) (multiple patients) (Medicare: Special coverage instructions apply) - Q0035: Cardiokymography (Medicare: Special coverage instructions apply) - Q0081: Infusion therapy, using other than chemotherapeutic drugs, per visit (Medicare: Special coverage instructions apply) - Q0083: Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit (Medicare: Carrier judgment) - Q0084: Chemotherapy administration by infusion technique only, per visit (Medicare: Special coverage instructions apply) - Q0085: Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit (Medicare: Carrier judgment) - Q0091: Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory (Medicare: Special coverage instructions apply) - Q0092: Set-up portable x-ray equipment (Medicare: Special coverage instructions apply) - Q0111: Wet mounts, including preparations of vaginal, cervical or skin specimens (Medicare: Carrier judgment) - Q0112: All potassium hydroxide (koh) preparations (Medicare: Carrier judgment) - Q0113: Pinworm examinations (Medicare: Carrier judgment) - Q0114: Fern test (Medicare: Carrier judgment) - Q0115: Post-coital direct, qualitative examinations of vaginal or cervical mucous (Medicare: Carrier judgment) - Q0138: Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) (Medicare: Carrier judgment) - Q0139: Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis) (Medicare: Carrier judgment) - Q0144: Azithromycin dihydrate, oral, capsules/powder, 1 gram (Medicare: Non-covered by Medicare) - Q0155: 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 (Medicare: Special coverage instructions apply) - Q0161: 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 (Medicare: Carrier judgment) - Q0162: 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 (Medicare: Special coverage instructions apply) - Q0163: 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 (Medicare: Special coverage instructions apply) - Q0164: 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 (Medicare: Special coverage instructions apply) - Q0166: 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 (Medicare: Special coverage instructions apply) - Q0167: 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 (Medicare: Special coverage instructions apply) - Q0169: 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 (Medicare: Special coverage instructions apply) - Q0173: 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 (Medicare: Special coverage instructions apply) - Q0174: 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 (Medicare: Special coverage instructions apply) - Q0175: 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 (Medicare: Special coverage instructions apply) - Q0177: 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 (Medicare: Special coverage instructions apply) - Q0180: 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 (Medicare: Special coverage instructions apply) - Q0181: 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 (Medicare: Special coverage instructions apply) - Q0220: 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 (Medicare: Carrier judgment) - Q0221: 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 (Medicare: Carrier judgment) - Q0222: Injection, bebtelovimab, 175 mg (Medicare: Carrier judgment) - Q0224: 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 (Medicare: Carrier judgment) - Q0235: 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 (Medicare: Carrier judgment) - Q0237: 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 (Medicare: Carrier judgment) - Q0238: 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 (Medicare: Carrier judgment) - Q0239: Injection, bamlanivimab-xxxx, 700 mg (Medicare: Carrier judgment) - Q0240: Injection, casirivimab and imdevimab, 600 mg (Medicare: Carrier judgment) - Q0243: Injection, casirivimab and imdevimab, 2400 mg (Medicare: Carrier judgment) - Q0244: Injection, casirivimab and imdevimab, 1200 mg (Medicare: Carrier judgment) - Q0245: Injection, bamlanivimab and etesevimab, 2100 mg (Medicare: Carrier judgment) - Q0247: Injection, sotrovimab, 500 mg (Medicare: Carrier judgment) - Q0249: 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 (Medicare: Carrier judgment) - Q0477: Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0478: Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type (Medicare: Special coverage instructions apply) - Q0479: Power module for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0480: Driver for use with pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0481: Microprocessor control unit for use with electric ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0482: Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0483: Monitor/display module for use with electric ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0484: Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0485: Monitor control cable for use with electric ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0486: Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0487: Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0488: Power pack base for use with electric ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0489: Power pack base for use with electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0490: Emergency power source for use with electric ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0491: Emergency power source for use with electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0492: Emergency power supply cable for use with electric ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0493: Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0494: Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0495: Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0496: Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0497: Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0498: Holster for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0499: Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0500: Filters for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0501: Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0502: Mobility cart for pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0503: Battery for pneumatic ventricular assist device, replacement only, each (Medicare: Special coverage instructions apply) - Q0504: Power adapter for pneumatic ventricular assist device, replacement only, vehicle type (Medicare: Special coverage instructions apply) - Q0506: Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only (Medicare: Special coverage instructions apply) - Q0507: Miscellaneous supply or accessory for use with an external ventricular assist device (Medicare: Special coverage instructions apply) - Q0508: Miscellaneous supply or accessory for use with an implanted ventricular assist device (Medicare: Special coverage instructions apply) - Q0509: Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a (Medicare: Special coverage instructions apply) - Q0510: Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant (Medicare: Special coverage instructions apply) - Q0511: Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period (Medicare: Special coverage instructions apply) - Q0512: Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period (Medicare: Special coverage instructions apply) - Q0513: Pharmacy dispensing fee for inhalation drug(s); per 30 days (Medicare: Special coverage instructions apply) - Q0514: Pharmacy dispensing fee for inhalation drug(s); per 90 days (Medicare: Special coverage instructions apply) - Q0515: Injection, sermorelin acetate, 1 microgram (Medicare: Special coverage instructions apply) - Q0516: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 30-days (Medicare: Special coverage instructions apply) - Q0517: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 60-days (Medicare: Special coverage instructions apply) - Q0518: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription oral drug, per 90-days (Medicare: Special coverage instructions apply) - Q0519: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 30-days (Medicare: Special coverage instructions apply) - Q0520: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 60-days (Medicare: Special coverage instructions apply) - Q0521: Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription (Medicare: Special coverage instructions apply) - Q1004: New technology intraocular lens category 4 as defined in federal register notice (Medicare: Special coverage instructions apply) - Q1005: New technology intraocular lens category 5 as defined in federal register notice (Medicare: Special coverage instructions apply) - Q2004: Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml (Medicare: Special coverage instructions apply) - Q2009: Injection, fosphenytoin, 50 mg phenytoin equivalent (Medicare: Special coverage instructions apply) - Q2017: Injection, teniposide, 50 mg (Medicare: Special coverage instructions apply) - Q2026: Injection, radiesse, 0.1 ml (Medicare: Special coverage instructions apply) - Q2028: Injection, sculptra, 0.5 mg (Medicare: Special coverage instructions apply) - Q2034: Influenza virus vaccine, split virus, for intramuscular use (agriflu) (Medicare: Special coverage instructions apply) - Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) (Medicare: Special coverage instructions apply) - Q2036: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) (Medicare: Special coverage instructions apply) - Q2037: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) (Medicare: Special coverage instructions apply) - Q2038: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) (Medicare: Special coverage instructions apply) - Q2039: Influenza virus vaccine, not otherwise specified (Medicare: Special coverage instructions apply) - Q2040: Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion (Medicare: Carrier judgment) - Q2041: Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Carrier judgment) - Q2042: Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Carrier judgment) - Q2043: Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion (Medicare: Special coverage instructions apply) - Q2049: Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg (Medicare: Carrier judgment) - Q2050: Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg (Medicare: Special coverage instructions apply) - Q2052: Services, supplies and accessories used in the home for the administration of intravenous immune globulin (ivig) (Medicare: Special coverage instructions apply) - Q2053: Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Carrier judgment) - Q2054: Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Carrier judgment) - Q2055: 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 (Medicare: Carrier judgment) - Q2056: 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 (Medicare: Carrier judgment) - Q2057: Afamitresgene autoleucel, including leukapheresis and dose preparation procedures, per therapeutic dose (Medicare: Carrier judgment) - Q2058: Obecabtagene autoleucel, 10 up to 400 million cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion (Medicare: Carrier judgment) - Q3001: Radioelements for brachytherapy, any type, each (Medicare: Special coverage instructions apply) - Q3014: Telehealth originating site facility fee (Medicare: Carrier judgment) - Q3027: Injection, interferon beta-1a, 1 mcg for intramuscular use (Medicare: Special coverage instructions apply) - Q3028: Injection, interferon beta-1a, 1 mcg for subcutaneous use (Medicare: Not payable by Medicare) - Q3031: Collagen skin test (Medicare: Special coverage instructions apply) - Q4001: Casting supplies, body cast adult, with or without head, plaster (Medicare: Carrier judgment) - Q4002: Cast supplies, body cast adult, with or without head, fiberglass (Medicare: Carrier judgment) - Q4003: Cast supplies, shoulder cast, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4004: Cast supplies, shoulder cast, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4005: Cast supplies, long arm cast, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4006: Cast supplies, long arm cast, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4007: Cast supplies, long arm cast, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4008: Cast supplies, long arm cast, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4009: Cast supplies, short arm cast, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4010: Cast supplies, short arm cast, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4011: Cast supplies, short arm cast, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4012: Cast supplies, short arm cast, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4013: Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster (Medicare: Carrier judgment) - Q4014: Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4015: Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4016: Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4017: Cast supplies, long arm splint, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4018: Cast supplies, long arm splint, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4019: Cast supplies, long arm splint, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4020: Cast supplies, long arm splint, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4021: Cast supplies, short arm splint, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4022: Cast supplies, short arm splint, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4023: Cast supplies, short arm splint, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4024: Cast supplies, short arm splint, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4025: Cast supplies, hip spica (one or both legs), adult (11 years +), plaster (Medicare: Carrier judgment) - Q4026: Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4027: Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4028: Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4029: Cast supplies, long leg cast, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4030: Cast supplies, long leg cast, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4031: Cast supplies, long leg cast, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4032: Cast supplies, long leg cast, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4033: Cast supplies, long leg cylinder cast, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4034: Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4035: Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4036: Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4037: Cast supplies, short leg cast, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4038: Cast supplies, short leg cast, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4039: Cast supplies, short leg cast, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4040: Cast supplies, short leg cast, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4041: Cast supplies, long leg splint, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4042: Cast supplies, long leg splint, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4043: Cast supplies, long leg splint, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4044: Cast supplies, long leg splint, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4045: Cast supplies, short leg splint, adult (11 years +), plaster (Medicare: Carrier judgment) - Q4046: Cast supplies, short leg splint, adult (11 years +), fiberglass (Medicare: Carrier judgment) - Q4047: Cast supplies, short leg splint, pediatric (0-10 years), plaster (Medicare: Carrier judgment) - Q4048: Cast supplies, short leg splint, pediatric (0-10 years), fiberglass (Medicare: Carrier judgment) - Q4049: Finger splint, static (Medicare: Carrier judgment) - Q4050: Cast supplies, for unlisted types and materials of casts (Medicare: Carrier judgment) - Q4051: Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies) (Medicare: Carrier judgment) - Q4074: Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms (Medicare: Carrier judgment) - Q4081: Injection, epoetin alfa, 100 units (for esrd on dialysis) (Medicare: Special coverage instructions apply) - Q4082: Drug or biological, not otherwise classified, part b drug competitive acquisition program (cap) (Medicare: Carrier judgment) - Q4100: Skin substitute, not otherwise specified (Medicare: Carrier judgment) - Q4101: Apligraf, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4102: Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4103: Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4104: Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4105: Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4106: Dermagraft, per square centimeter (Medicare: Carrier judgment) - Q4107: Graftjacket, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4108: Integra matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4110: Primatrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4111: Gammagraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4112: Cymetra, injectable, 1 cc (Medicare: Carrier judgment) - Q4113: Graftjacket xpress, injectable, 1 cc (Medicare: Carrier judgment) - Q4114: Integra flowable wound matrix, injectable, 1 cc (Medicare: Carrier judgment) - Q4115: Alloskin, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4116: Alloderm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4117: Hyalomatrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4118: Matristem micromatrix, 1 mg (Medicare: Carrier judgment) - Q4119: Matristem wound matrix, per square centimeter (Medicare: Carrier judgment) - Q4120: Matristem burn matrix, per square centimeter (Medicare: Carrier judgment) - Q4121: Theraskin, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4122: Dermacell, dermacell awm or dermacell awm porous, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4123: Alloskin rt, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4124: Oasis ultra tri-layer wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4125: Arthroflex, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4126: Memoderm, dermaspan, tranzgraft or integuply, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4127: Talymed, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4128: Flex hd, or allopatch hd, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4129: Unite biomatrix, per square centimeter (Medicare: Carrier judgment) - Q4130: Strattice tm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4131: Epifix or epicord, per square centimeter (Medicare: Carrier judgment) - Q4132: Grafix core and grafixpl core, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4133: Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4134: Hmatrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4135: Mediskin, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4136: Ez-derm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4137: Amnioexcel, amnioexcel plus or biodexcel, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4138: Biodfence dryflex, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4139: Amniomatrix or biodmatrix, injectable, 1 cc (Medicare: Carrier judgment) - Q4140: Biodfence, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4141: Alloskin ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4142: Xcm biologic tissue matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4143: Repriza, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4145: Epifix, injectable, 1 mg (Medicare: Carrier judgment) - Q4146: Tensix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4147: Architect, architect px, or architect fx, extracellular matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4148: Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4149: Excellagen, 0.1 cc (Medicare: Carrier judgment) - Q4150: Allowrap ds or dry, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4151: Amnioband or guardian, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4152: Dermapure, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4153: Dermavest and plurivest, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4154: Biovance, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4155: Neoxflo or clarixflo, 1 mg (Medicare: Carrier judgment) - Q4156: Neox 100 or clarix 100, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4157: Revitalon, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4158: Kerecis omega3, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4159: Affinity, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4160: Nushield, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4161: Bio-connekt wound matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4162: Woundex flow, bioskin flow, 0.5 cc (Medicare: Carrier judgment) - Q4163: Woundex, bioskin, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4164: Helicoll, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4165: Keramatrix or kerasorb, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4166: Cytal, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4167: Truskin, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4168: Amnioband, 1 mg (Medicare: Carrier judgment) - Q4169: Artacent wound, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4170: Cygnus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4171: Interfyl, 1 mg (Medicare: Carrier judgment) - Q4172: Puraply or puraply am, per square centimeter (Medicare: Carrier judgment) - Q4173: Palingen or palingen xplus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4174: Palingen or promatrx, 0.36 mg per 0.25 cc (Medicare: Carrier judgment) - Q4175: Miroderm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4176: Neopatch or therion, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4177: Floweramnioflo, 0.1 cc (Medicare: Carrier judgment) - Q4178: Floweramniopatch, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4179: Flowerderm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4180: Revita, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4181: Amnio wound, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4182: Transcyte, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4183: Surgigraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4184: Cellesta or cellesta duo, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4185: Cellesta flowable amnion (25 mg per cc); per 0.5 cc (Medicare: Carrier judgment) - Q4186: Epifix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4187: Epicord, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4188: Amnioarmor, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4189: Artacent ac, 1 mg (Medicare: Carrier judgment) - Q4190: Artacent ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4191: Restorigin, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4192: Restorigin, 1 cc (Medicare: Carrier judgment) - Q4193: Coll-e-derm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4194: Novachor, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4195: Puraply, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4196: Puraply am, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4197: Puraply xt, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4198: Genesis amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4199: Cygnus matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4200: Skin te, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4201: Matrion, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4202: Keroxx (2.5g/cc), 1cc (Medicare: Carrier judgment) - Q4203: Derma-gide, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4204: Xwrap, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4205: Membrane graft or membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4206: Fluid flow or fluid gf, 1 cc (Medicare: Carrier judgment) - Q4208: Novafix, per square cenitmeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4209: Surgraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4210: Axolotl graft or axolotl dualgraft, per square centimeter (Medicare: Carrier judgment) - Q4211: Amnion bio or axobiomembrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4212: Allogen, per cc (Medicare: Carrier judgment) - Q4213: Ascent, 0.5 mg (Medicare: Carrier judgment) - Q4214: Cellesta cord, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4215: Axolotl ambient or axolotl cryo, 0.1 mg (Medicare: Carrier judgment) - Q4216: Artacent cord, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4217: Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4218: Surgicord, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4219: Surgigraft-dual, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4220: Bellacell hd or surederm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4221: Amniowrap2, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4222: Progenamatrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4224: Human health factor 10 amniotic patch (hhf10-p), per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4225: Amniobind or dermabind tl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4226: Myown skin, includes harvesting and preparation procedures, per square centimeter (Medicare: Carrier judgment) - Q4227: Amniocore, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4228: Bionextpatch, per square centimeter (Medicare: Carrier judgment) - Q4229: Cogenex amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4230: Cogenex flowable amnion, per 0.5 cc (Medicare: Carrier judgment) - Q4231: Corplex p, per cc (Medicare: Carrier judgment) - Q4232: Corplex, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4233: Surfactor or nudyn, per 0.5 cc (Medicare: Carrier judgment) - Q4234: Xcellerate, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4235: Amniorepair or altiply, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4236: Carepatch, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4237: Cryo-cord, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4238: Derm-maxx, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4239: Amnio-maxx or amnio-maxx lite, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4240: Corecyte, for topical use only, per 0.5 cc (Medicare: Carrier judgment) - Q4241: Polycyte, for topical use only, per 0.5 cc (Medicare: Carrier judgment) - Q4242: Amniocyte plus, per 0.5 cc (Medicare: Carrier judgment) - Q4244: Procenta, per 200 mg (Medicare: Carrier judgment) - Q4245: Amniotext, per cc (Medicare: Carrier judgment) - Q4246: Coretext or protext, per cc (Medicare: Carrier judgment) - Q4247: Amniotext patch, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4248: Dermacyte amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4249: Amniply, for topical use only, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4250: Amnioamp-mp, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4251: Vim, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4252: Vendaje, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4253: Zenith amniotic membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4254: Novafix dl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4255: Reguard, for topical use only, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4256: Mlg-complete, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4257: Relese, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4258: Enverse, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4259: Celera dual layer or celera dual membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4260: Signature apatch, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4261: Tag, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4262: Dual layer impax membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4263: Surgraft tl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4264: Cocoon membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4265: Neostim tl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4266: Neostim membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4267: Neostim dl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4268: Surgraft ft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4269: Surgraft xt, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4270: Complete sl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4271: Complete ft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4272: Esano a, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4273: Esano aaa, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4274: Esano ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4275: Esano aca, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4276: Orion, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4277: Woundplus membrane or e-graft, per square centimeter (Medicare: Carrier judgment) - Q4278: Epieffect, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4279: Vendaje ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4280: Xcell amnio matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4281: Barrera sl or barrera dl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4282: Cygnus dual, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4283: Biovance tri-layer or biovance 3l, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4284: Dermabind sl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4285: Nudyn dl or nudyn dl mesh, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4286: Nudyn sl or nudyn slw, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4287: Dermabind dl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4288: Dermabind ch, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4289: Revoshield + amniotic barrier, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4290: Membrane wrap-hydro, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4291: Lamellas xt, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4292: Lamellas, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4293: Acesso dl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4294: Amnio quad-core, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4295: Amnio tri-core amniotic, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4296: Rebound matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4297: Emerge matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4298: Amniocore pro, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4299: Amniocore pro+, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4300: Acesso tl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4301: Activate matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4302: Complete aca, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4303: Complete aa, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4304: Grafix plus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4305: American amnion ac tri-layer, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4306: American amnion ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4307: American amnion, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4308: Sanopellis, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4309: Via matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4310: Procenta, per 100 mg (Medicare: Carrier judgment) - Q4311: Acesso, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4312: Acesso ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4313: Dermabind fm, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4314: Reeva ft, per square cenitmeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4315: Regenelink amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4316: Amchoplast, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4317: Vitograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4318: E-graft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4319: Sanograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4320: Pellograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4321: Renograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4322: Caregraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4323: Alloply, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4324: Amniotx, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4325: Acapatch, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4326: Woundplus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4327: Duoamnion, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4328: Most, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4329: Singlay, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4330: Total, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4331: Axolotl graft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4332: Axolotl dualgraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4333: Ardeograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4334: Amnioplast 1, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4335: Amnioplast 2, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4336: Artacent c, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4337: Artacent trident, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4338: Artacent velos, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4339: Artacent vericlen, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4340: Simpligraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4341: Simplimax, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4342: Theramend, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4343: Dermacyte ac matrix amniotic membrane allograft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4344: Tri-membrane wrap, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4345: Matrix hd allograft dermis, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4346: Shelter dm matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4347: Rampart dl matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4348: Sentry sl matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4349: Mantle dl matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4350: Palisade dm matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4351: Enclose tl matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4352: Overlay sl matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4353: Xceed tl matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4354: Palingen dual-layer membrane and dual-layer palingen x-membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4355: Abiomend xplus membrane and abiomend xplus hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4356: Abiomend membrane and abiomend hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4357: Xwrap plus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4358: Xwrap dual, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4359: Choriply, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4360: Amchoplast fd, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4361: Epixpress, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4362: Cygnus disk, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4363: Amnio burgeon membrane and hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4364: Amnio burgeon xplus membrane and xplus hydromembrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4365: Amnio burgeon dual-layer membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4366: Dual layer amnio burgeon x-membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4367: Amniocore sl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4368: Amchothick, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4369: Amnioplast 3, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4370: Aeroguard, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4371: Neoguard, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4372: Amchoplast excel, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4373: Membrane wrap lite, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4375: Duograft ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4376: Duograft aa, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4377: Trigraft ft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4378: Renew ft matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4379: Amniodefend ft matrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4380: Advograft one, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4382: Advograft dual, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4383: Axolotl graft ultra, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4384: Axolotl dualgraft ultra, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4385: Apollo ft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4386: Acesso trifaca, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4387: Neothelium ft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4388: Neothelium 4l, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4389: Neothelium 4l+, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4390: Ascendion, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4391: Amnioplast double, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4392: Grafix duo, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4393: Surgraft ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4394: Surgraft aca, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4395: Acelagraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4396: Natalin, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4397: Summit aaa, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4398: Summit ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4399: Summit fx, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4400: Polygon3 membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4401: Absolv3 membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4402: Xwrap 2.0, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4403: Xwrap dual plus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4404: Xwrap hydro plus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4405: Xwrap fenestra plus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4406: Xwrap fenestra, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4407: Xwrap tribus, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4408: Xwrap hydro, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4409: Amniomatrixf3x, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4410: Amchomatrixdl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4411: Amniomatrixf4x, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4412: Choriofix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4413: Cygnus solo, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4414: Simplichor, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4415: Alexiguard sl-t, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4416: Alexiguard tl-t, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4417: Alexiguard dl-t, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4418: Biolab membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4419: Biolab membrane wrap lite flow, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4420: Nuform, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4421: Biolab membrane wrap solo, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4422: A/c wrap, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4423: Biolab tri-membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4424: Revive ft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4425: Revive tl, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4426: Dermabind tl + or dermabind tl x, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4427: Dermabind dl n or dermabind dl + or dermabind dl x, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4428: Dermabind sl n or dermabind sl + or dermabind sl x, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4429: Dermabind ch n or dermabind ch x, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4431: Pma skin substitute product, not otherwise specified (list in addition to primary procedure) (Medicare: Carrier judgment) - Q4432: 510(k) skin substitute product, not otherwise specified (list in addition to primary procedure) (Medicare: Carrier judgment) - Q4433: 361 hct/p skin substitute product, not otherwise specified (list in addition to primary procedure) (Medicare: Carrier judgment) - Q4435: Renati membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4436: Renati ac membrane, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4437: Revival ac, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4438: Pretect, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4439: Instagraft, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q4440: Curamatrix, per square centimeter (add-on, list separately in addition to primary procedure) (Medicare: Carrier judgment) - Q5001: Hospice or home health care provided in patient's home/residence (Medicare: Special coverage instructions apply) - Q5002: Hospice or home health care provided in assisted living facility (Medicare: Special coverage instructions apply) - Q5003: Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) (Medicare: Special coverage instructions apply) - Q5004: Hospice care provided in skilled nursing facility (snf) (Medicare: Special coverage instructions apply) - Q5005: Hospice care provided in inpatient hospital (Medicare: Special coverage instructions apply) - Q5006: Hospice care provided in inpatient hospice facility (Medicare: Special coverage instructions apply) - Q5007: Hospice care provided in long term care facility (Medicare: Special coverage instructions apply) - Q5008: Hospice care provided in inpatient psychiatric facility (Medicare: Special coverage instructions apply) - Q5009: Hospice or home health care provided in place not otherwise specified (nos) (Medicare: Special coverage instructions apply) - Q5010: Hospice home care provided in a hospice facility (Medicare: Special coverage instructions apply) - Q5098: Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5099: Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5100: Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5101: Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram (Medicare: Special coverage instructions apply) - Q5102: Injection, infliximab, biosimilar, 10 mg (Medicare: Special coverage instructions apply) - Q5103: Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg (Medicare: Special coverage instructions apply) - Q5104: Injection, infliximab-abda, biosimilar, (renflexis), 10 mg (Medicare: Special coverage instructions apply) - Q5105: Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units (Medicare: Special coverage instructions apply) - Q5106: Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units (Medicare: Special coverage instructions apply) - Q5107: Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg (Medicare: Special coverage instructions apply) - Q5108: Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg (Medicare: Carrier judgment) - Q5109: Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg (Medicare: Special coverage instructions apply) - Q5110: Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram (Medicare: Special coverage instructions apply) - Q5111: Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg (Medicare: Carrier judgment) - Q5112: Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg (Medicare: Carrier judgment) - Q5113: Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg (Medicare: Carrier judgment) - Q5114: Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg (Medicare: Carrier judgment) - Q5115: Injection, rituximab-abbs, biosimilar, (truxima), 10 mg (Medicare: Special coverage instructions apply) - Q5116: Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg (Medicare: Carrier judgment) - Q5117: Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg (Medicare: Carrier judgment) - Q5118: Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg (Medicare: Carrier judgment) - Q5119: Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg (Medicare: Carrier judgment) - Q5120: Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg (Medicare: Carrier judgment) - Q5121: Injection, infliximab-axxq, biosimilar, (avsola), 10 mg (Medicare: Carrier judgment) - Q5122: Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg (Medicare: Carrier judgment) - Q5123: Injection, rituximab-arrx, biosimilar, (riabni), 10 mg (Medicare: Carrier judgment) - Q5124: Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg (Medicare: Carrier judgment) - Q5125: Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram (Medicare: Carrier judgment) - Q5126: Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg (Medicare: Carrier judgment) - Q5127: Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg (Medicare: Carrier judgment) - Q5128: Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg (Medicare: Carrier judgment) - Q5129: Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg (Medicare: Carrier judgment) - Q5130: Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg (Medicare: Carrier judgment) - Q5131: Injection, adalimumab-aacf (idacio), biosimilar, 20 mg (Medicare: Carrier judgment) - Q5132: Injection, adalimumab-afzb (abrilada), biosimilar, 10 mg (Medicare: Carrier judgment) - Q5133: Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5134: Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5135: Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5136: Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5137: Injection, ustekinumab-auub (wezlana), biosimilar, subcutaneous, 1 mg (Medicare: Carrier judgment) - Q5138: Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg (Medicare: Carrier judgment) - Q5139: Injection, eculizumab-aeeb (bkemv), biosimilar, 10 mg (Medicare: Carrier judgment) - Q5140: Injection, adalimumab-fkjp, biosimilar, 1 mg (Medicare: Carrier judgment) - Q5141: Injection, adalimumab-aaty, biosimilar, 1 mg (Medicare: Carrier judgment) - Q5142: Injection, adalimumab-ryvk biosimilar, 1 mg (Medicare: Carrier judgment) - Q5143: Injection, adalimumab-adbm, biosimilar, 1 mg (Medicare: Carrier judgment) - Q5144: Injection, adalimumab-aacf (idacio), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5145: Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5146: Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg (Medicare: Carrier judgment) - Q5147: Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5148: Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram (Medicare: Special coverage instructions apply) - Q5149: Injection, aflibercept-abzv (enzeevu), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5150: Injection, aflibercept-mrbb (ahzantive), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5151: Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg (Medicare: Carrier judgment) - Q5152: Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg (Medicare: Carrier judgment) - Q5153: Injection, aflibercept-yszy (opuviz), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5154: Injection, omalizumab-igec (omlyclo), biosimilar, 5 mg (Medicare: Carrier judgment) - Q5155: Injection, aflibercept-jbvf (yesafili), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5156: Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5157: Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5158: Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5159: Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5160: Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg (Medicare: Carrier judgment) - Q5161: Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg (Medicare: Carrier judgment) - Q5162: Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg (Medicare: Carrier judgment) - Q9001: Assessment by chaplain services (Medicare: Carrier judgment) - Q9002: Counseling, individual, by chaplain services (Medicare: Carrier judgment) - Q9003: Counseling, group, by chaplain services (Medicare: Carrier judgment) - Q9004: Department of veterans affairs whole health partner services (Medicare: Carrier judgment) - Q9950: Injection, sulfur hexafluoride lipid microspheres, per ml (Medicare: Carrier judgment) - Q9951: Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9953: Injection, iron-based magnetic resonance contrast agent, per ml (Medicare: Special coverage instructions apply) - Q9954: Oral magnetic resonance contrast agent, per 100 ml (Medicare: Special coverage instructions apply) - Q9955: Injection, perflexane lipid microspheres, per ml (Medicare: Carrier judgment) - Q9956: Injection, octafluoropropane microspheres, per ml (Medicare: Carrier judgment) - Q9957: Injection, perflutren lipid microspheres, per ml (Medicare: Carrier judgment) - Q9958: High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9959: High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9960: High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9961: High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9962: High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9963: High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9964: High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9965: Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9966: Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9967: Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml (Medicare: Special coverage instructions apply) - Q9968: Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg (Medicare: Carrier judgment) - Q9969: Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose (Medicare: Special coverage instructions apply) - Q9970: Injection, ferric carboxymaltose, 1mg (Medicare: Carrier judgment) - Q9972: Injection, epoetin beta, 1 microgram, (for esrd on dialysis) (Medicare: Special coverage instructions apply) - Q9973: Injection, epoetin beta, 1 microgram, (non-esrd use) (Medicare: Special coverage instructions apply) - Q9974: Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg (Medicare: Special coverage instructions apply) - Q9975: Injection, factor viii fc fusion protein (recombinant), per iu (Medicare: Special coverage instructions apply) - Q9976: Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron (Medicare: Carrier judgment) - Q9977: Compounded drug, not otherwise classified (Medicare: Special coverage instructions apply) - Q9978: Netupitant 300 mg and palonosetron 0.5 mg (Medicare: Special coverage instructions apply) - Q9979: Injection, alemtuzumab, 1 mg (Medicare: Special coverage instructions apply) - Q9980: Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg (Medicare: Carrier judgment) - Q9981: Rolapitant, oral, 1 mg (Medicare: Special coverage instructions apply) - Q9982: Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries (Medicare: Special coverage instructions apply) - Q9983: Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries (Medicare: Special coverage instructions apply) - Q9984: Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg (Medicare: Non-covered by Medicare statute) - Q9985: Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg (Medicare: Carrier judgment) - Q9986: Injection, hydroxyprogesterone caproate, (makena), 10 mg (Medicare: Carrier judgment) - Q9987: Pathogen(s) test for platelets (Medicare: Special coverage instructions apply) - Q9988: Platelets, pheresis, pathogen-reduced, each unit (Medicare: Special coverage instructions apply) - Q9989: Ustekinumab, for intravenous injection, 1 mg (Medicare: Carrier judgment) - Q9991: Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg (Medicare: Carrier judgment) - Q9992: Injection, buprenorphine extended-release (sublocade), greater than 100 mg (Medicare: Carrier judgment) - Q9993: Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg (Medicare: Special coverage instructions apply) - Q9994: In-line cartridge containing digestive enzyme(s) for enteral feeding, each (Medicare: Carrier judgment) - Q9995: Injection, emicizumab-kxwh, 0.5 mg (Medicare: Carrier judgment) - Q9996: Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg (Medicare: Carrier judgment) - Q9997: Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg (Medicare: Carrier judgment) - Q9998: Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg (Medicare: Carrier judgment) - Q9999: Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg (Medicare: Carrier judgment) - R0070: Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen (Medicare: Special coverage instructions apply) - R0075: Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen (Medicare: Special coverage instructions apply) - R0076: Transportation of portable ekg to facility or location, per patient (Medicare: Special coverage instructions apply) - S0012: Butorphanol tartrate, nasal spray, 25 mg (Medicare: Not payable by Medicare) - S0013: Esketamine, nasal spray, 1 mg (Medicare: Not payable by Medicare) - S0014: Tacrine hydrochloride, 10 mg (Medicare: Not payable by Medicare) - S0017: Injection, aminocaproic acid, 5 grams (Medicare: Not payable by Medicare) - S0020: Injection, bupivicaine hydrochloride, 30 ml (Medicare: Not payable by Medicare) - S0021: Injection, cefoperazone sodium, 1 gram (Medicare: Not payable by Medicare) - S0023: Injection, cimetidine hydrochloride, 300 mg (Medicare: Not payable by Medicare) - S0028: Injection, famotidine, 20 mg (Medicare: Not payable by Medicare) - S0030: Injection, metronidazole, 500 mg (Medicare: Not payable by Medicare) - S0032: Injection, nafcillin sodium, 2 grams (Medicare: Not payable by Medicare) - S0034: Injection, ofloxacin, 400 mg (Medicare: Not payable by Medicare) - S0039: Injection, sulfamethoxazole and trimethoprim, 10 ml (Medicare: Not payable by Medicare) - S0040: Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams (Medicare: Not payable by Medicare) - S0073: Injection, aztreonam, 500 mg (Medicare: Not payable by Medicare) - S0074: Injection, cefotetan disodium, 500 mg (Medicare: Not payable by Medicare) - S0077: Injection, clindamycin phosphate, 300 mg (Medicare: Not payable by Medicare) - S0078: Injection, fosphenytoin sodium, 750 mg (Medicare: Not payable by Medicare) - S0080: Injection, pentamidine isethionate, 300 mg (Medicare: Not payable by Medicare) - S0081: Injection, piperacillin sodium, 500 mg (Medicare: Not payable by Medicare) - S0088: Imatinib, 100 mg (Medicare: Not payable by Medicare) - S0090: Sildenafil citrate, 25 mg (Medicare: Not payable by Medicare) - S0091: Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166) (Medicare: Not payable by Medicare) - S0092: Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump) (Medicare: Not payable by Medicare) - S0093: Injection, morphine sulfate, 500 mg (loading dose for infusion pump) (Medicare: Not payable by Medicare) - S0104: Zidovudine, oral, 100 mg (Medicare: Not payable by Medicare) - S0106: Bupropion hcl sustained release tablet, 150 mg, per bottle of 60 tablets (Medicare: Not payable by Medicare) - S0108: Mercaptopurine, oral, 50 mg (Medicare: Not payable by Medicare) - S0109: Methadone, oral, 5 mg (Medicare: Not payable by Medicare) - S0117: Tretinoin, topical, 5 grams (Medicare: Not payable by Medicare) - S0119: Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) (Medicare: Not payable by Medicare) - S0122: Injection, menotropins, 75 iu (Medicare: Not payable by Medicare) - S0126: Injection, follitropin alfa, 75 iu (Medicare: Not payable by Medicare) - S0128: Injection, follitropin beta, 75 iu (Medicare: Not payable by Medicare) - S0132: Injection, ganirelix acetate, 250 mcg (Medicare: Not payable by Medicare) - S0136: Clozapine, 25 mg (Medicare: Not payable by Medicare) - S0137: Didanosine (ddi), 25 mg (Medicare: Not payable by Medicare) - S0138: Finasteride, 5 mg (Medicare: Not payable by Medicare) - S0139: Minoxidil, 10 mg (Medicare: Not payable by Medicare) - S0140: Saquinavir, 200 mg (Medicare: Not payable by Medicare) - S0142: Colistimethate sodium, inhalation solution administered through dme, concentrated form, per mg (Medicare: Not payable by Medicare) - S0144: Injection, propofol, 10 mg (Medicare: Not payable by Medicare) - S0145: Injection, pegylated interferon alfa-2a, 180 mcg per ml (Medicare: Not payable by Medicare) - S0148: Injection, pegylated interferon alfa-2b, 10 mcg (Medicare: Not payable by Medicare) - S0155: Sterile dilutant for epoprostenol, 50 ml (Medicare: Not payable by Medicare) - S0156: Exemestane, 25 mg (Medicare: Not payable by Medicare) - S0157: Becaplermin gel 0.01%, 0.5 gm (Medicare: Not payable by Medicare) - S0160: Dextroamphetamine sulfate, 5 mg (Medicare: Not payable by Medicare) - S0164: Injection, pantoprazole sodium, 40 mg (Medicare: Not payable by Medicare) - S0166: Injection, olanzapine, 2.5 mg (Medicare: Not payable by Medicare) - S0169: Calcitrol, 0.25 microgram (Medicare: Not payable by Medicare) - S0170: Anastrozole, oral, 1 mg (Medicare: Not payable by Medicare) - S0171: Injection, bumetanide, 0.5 mg (Medicare: Not payable by Medicare) - S0172: Chlorambucil, oral, 2 mg (Medicare: Not payable by Medicare) - S0174: Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180) (Medicare: Not payable by Medicare) - S0175: Flutamide, oral, 125 mg (Medicare: Not payable by Medicare) - S0176: Hydroxyurea, oral, 500 mg (Medicare: Not payable by Medicare) - S0177: Levamisole hydrochloride, oral, 50 mg (Medicare: Not payable by Medicare) - S0178: Lomustine, oral, 10 mg (Medicare: Not payable by Medicare) - S0179: Megestrol acetate, oral, 20 mg (Medicare: Not payable by Medicare) - S0182: Procarbazine hydrochloride, oral, 50 mg (Medicare: Not payable by Medicare) - S0183: Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164) (Medicare: Not payable by Medicare) - S0187: Tamoxifen citrate, oral, 10 mg (Medicare: Not payable by Medicare) - S0189: Testosterone pellet, 75 mg (Medicare: Not payable by Medicare) - S0190: Mifepristone, oral, 200 mg (Medicare: Not payable by Medicare) - S0191: Misoprostol, oral, 200 mcg (Medicare: Not payable by Medicare) - S0194: Dialysis/stress vitamin supplement, oral, 100 capsules (Medicare: Not payable by Medicare) - S0195: Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from five years to nine years of age who have not previously received the vaccine (Medicare: Not payable by Medicare) - S0197: Prenatal vitamins, 30-day supply (Medicare: Not payable by Medicare) - S0199: 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 (Medicare: Not payable by Medicare) - S0201: Partial hospitalization services, less than 24 hours, per diem (Medicare: Not payable by Medicare) - S0207: Paramedic intercept, non-hospital-based als service (non-voluntary), non-transport (Medicare: Not payable by Medicare) - S0208: Paramedic intercept, hospital-based als service (non-voluntary), non-transport (Medicare: Not payable by Medicare) - S0209: Wheelchair van, mileage, per mile (Medicare: Not payable by Medicare) - S0215: Non-emergency transportation; mileage, per mile (Medicare: Not payable by Medicare) - S0220: 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 (Medicare: Not payable by Medicare) - S0221: 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 (Medicare: Not payable by Medicare) - S0250: Comprehensive geriatric assessment and treatment planning performed by assessment team (Medicare: Not payable by Medicare) - S0255: Hospice referral visit (advising patient and family of care options) performed by nurse, social worker, or other designated staff (Medicare: Not payable by Medicare) - S0257: 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) (Medicare: Not payable by Medicare) - S0260: History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service) (Medicare: Not payable by Medicare) - S0265: Genetic counseling, under physician supervision, each 15 minutes (Medicare: Not payable by Medicare) - S0270: Physician management of patient home care, standard monthly case rate (per 30 days) (Medicare: Not payable by Medicare) - S0271: Physician management of patient home care, hospice monthly case rate (per 30 days) (Medicare: Not payable by Medicare) - S0272: Physician management of patient home care, episodic care monthly case rate (per 30 days) (Medicare: Not payable by Medicare) - S0273: Physician visit at member's home, outside of a capitation arrangement (Medicare: Not payable by Medicare) - S0274: Nurse practitioner visit at member's home, outside of a capitation arrangement (Medicare: Not payable by Medicare) - S0280: Medical home program, comprehensive care coordination and planning, initial plan (Medicare: Not payable by Medicare) - S0281: Medical home program, comprehensive care coordination and planning, maintenance of plan (Medicare: Not payable by Medicare) - S0285: Colonoscopy consultation performed prior to a screening colonoscopy procedure (Medicare: Not payable by Medicare) - S0302: Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) (Medicare: Not payable by Medicare) - S0310: Hospitalist services (list separately in addition to code for appropriate evaluation and management service) (Medicare: Not payable by Medicare) - S0311: Comprehensive management and care coordination for advanced illness, per calendar month (Medicare: Not payable by Medicare) - S0315: Disease management program; initial assessment and initiation of the program (Medicare: Not payable by Medicare) - S0316: Disease management program, follow-up/reassessment (Medicare: Not payable by Medicare) - S0317: Disease management program; per diem (Medicare: Not payable by Medicare) - S0320: Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month (Medicare: Not payable by Medicare) - S0340: Lifestyle modification program for management of coronary artery disease, including all supportive services; first quarter / stage (Medicare: Not payable by Medicare) - S0341: Lifestyle modification program for management of coronary artery disease, including all supportive services; second or third quarter / stage (Medicare: Not payable by Medicare) - S0342: Lifestyle modification program for management of coronary artery disease, including all supportive services; fourth quarter / stage (Medicare: Not payable by Medicare) - S0353: Treatment planning and care coordination management for cancer, initial treatment (Medicare: Not payable by Medicare) - S0354: Treatment planning and care coordination management for cancer, established patient with a change of regimen (Medicare: Not payable by Medicare) - S0390: 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 (Medicare: Not payable by Medicare) - S0395: Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic (Medicare: Not payable by Medicare) - S0400: Global fee for extracorporeal shock wave lithotripsy treatment of kidney stone(s) (Medicare: Not payable by Medicare) - S0500: Disposable contact lens, per lens (Medicare: Not payable by Medicare) - S0504: Single vision prescription lens (safety, athletic, or sunglass), per lens (Medicare: Not payable by Medicare) - S0506: Bifocal vision prescription lens (safety, athletic, or sunglass), per lens (Medicare: Not payable by Medicare) - S0508: Trifocal vision prescription lens (safety, athletic, or sunglass), per lens (Medicare: Not payable by Medicare) - S0510: Non-prescription lens (safety, athletic, or sunglass), per lens (Medicare: Not payable by Medicare) - S0512: Daily wear specialty contact lens, per lens (Medicare: Not payable by Medicare) - S0514: Color contact lens, per lens (Medicare: Not payable by Medicare) - S0515: Scleral lens, liquid bandage device, per lens (Medicare: Not payable by Medicare) - S0516: Safety eyeglass frames (Medicare: Not payable by Medicare) - S0518: Sunglasses frames (Medicare: Not payable by Medicare) - S0580: Polycarbonate lens (list this code in addition to the basic code for the lens) (Medicare: Not payable by Medicare) - S0581: Nonstandard lens (list this code in addition to the basic code for the lens) (Medicare: Not payable by Medicare) - S0590: Integral lens service, miscellaneous services reported separately (Medicare: Not payable by Medicare) - S0592: Comprehensive contact lens evaluation (Medicare: Not payable by Medicare) - S0595: Dispensing new spectacle lenses for patient supplied frame (Medicare: Not payable by Medicare) - S0596: Phakic intraocular lens for correction of refractive error (Medicare: Not payable by Medicare) - S0601: Screening proctoscopy (Medicare: Not payable by Medicare) - S0610: Annual gynecological examination, new patient (Medicare: Not payable by Medicare) - S0612: Annual gynecological examination, established patient (Medicare: Not payable by Medicare) - S0613: Annual gynecological examination; clinical breast examination without pelvic evaluation (Medicare: Not payable by Medicare) - S0618: Audiometry for hearing aid evaluation to determine the level and degree of hearing loss (Medicare: Not payable by Medicare) - S0620: Routine ophthalmological examination including refraction; new patient (Medicare: Not payable by Medicare) - S0621: Routine ophthalmological examination including refraction; established patient (Medicare: Not payable by Medicare) - S0622: Physical exam for college, new or established patient (list separately in addition to appropriate evaluation and management code) (Medicare: Not payable by Medicare) - S0630: Removal of sutures; by a physician other than the physician who originally closed the wound (Medicare: Not payable by Medicare) - S0800: Laser in situ keratomileusis (lasik) (Medicare: Not payable by Medicare) - S0810: Photorefractive keratectomy (prk) (Medicare: Not payable by Medicare) - S0812: Phototherapeutic keratectomy (ptk) (Medicare: Not payable by Medicare) - S1001: Deluxe item, patient aware (list in addition to code for basic item) (Medicare: Not payable by Medicare) - S1002: Customized item (list in addition to code for basic item) (Medicare: Not payable by Medicare) - S1015: Iv tubing extension set (Medicare: Not payable by Medicare) - S1016: Non-pvc (polyvinyl chloride) intravenous administration set, for use with drugs that are not stable in pvc e.g., paclitaxel (Medicare: Not payable by Medicare) - S1030: Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code) (Medicare: Not payable by Medicare) - S1031: Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code) (Medicare: Not payable by Medicare) - S1034: 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 (Medicare: Not payable by Medicare) - S1035: Sensor; invasive (e.g., subcutaneous), disposable, for use with artificial pancreas device system (Medicare: Not payable by Medicare) - S1036: Transmitter; external, for use with artificial pancreas device system (Medicare: Not payable by Medicare) - S1037: Receiver (monitor); external, for use with artificial pancreas device system (Medicare: Not payable by Medicare) - S1040: Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) (Medicare: Not payable by Medicare) - S1090: Mometasone furoate sinus implant, 370 micrograms (Medicare: Not payable by Medicare) - S1091: Stent, non-coronary, temporary, with delivery system (propel) (Medicare: Not payable by Medicare) - S2053: Transplantation of small intestine and liver allografts (Medicare: Not payable by Medicare) - S2054: Transplantation of multivisceral organs (Medicare: Not payable by Medicare) - S2055: Harvesting of donor multivisceral organs, with preparation and maintenance of allografts; from cadaver donor (Medicare: Not payable by Medicare) - S2060: Lobar lung transplantation (Medicare: Not payable by Medicare) - S2061: Donor lobectomy (lung) for transplantation, living donor (Medicare: Not payable by Medicare) - S2065: Simultaneous pancreas kidney transplantation (Medicare: Not payable by Medicare) - S2066: 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 (Medicare: Not payable by Medicare) - S2067: 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 (Medicare: Not payable by Medicare) - S2068: 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 (Medicare: Not payable by Medicare) - S2070: Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with endoscopic laser treatment of ureteral calculi (includes ureteral catheterization) (Medicare: Not payable by Medicare) - S2079: Laparoscopic esophagomyotomy (heller type) (Medicare: Not payable by Medicare) - S2080: Laser-assisted uvulopalatoplasty (laup) (Medicare: Not payable by Medicare) - S2083: Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline (Medicare: Not payable by Medicare) - S2095: Transcatheter occlusion or embolization for tumor destruction, percutaneous, any method, using yttrium-90 microspheres (Medicare: Not payable by Medicare) - S2102: Islet cell tissue transplant from pancreas; allogeneic (Medicare: Not payable by Medicare) - S2103: Adrenal tissue transplant to brain (Medicare: Not payable by Medicare) - S2107: Adoptive immunotherapy i.e. development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment (Medicare: Not payable by Medicare) - S2112: Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells) (Medicare: Not payable by Medicare) - S2115: Osteotomy, periacetabular, with internal fixation (Medicare: Not payable by Medicare) - S2117: Arthroereisis, subtalar (Medicare: Not payable by Medicare) - S2118: Metal-on-metal total hip resurfacing, including acetabular and femoral components (Medicare: Not payable by Medicare) - S2120: Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation (Medicare: Not payable by Medicare) - S2140: Cord blood harvesting for transplantation, allogeneic (Medicare: Not payable by Medicare) - S2142: Cord blood-derived stem-cell transplantation, allogeneic (Medicare: Not payable by Medicare) - S2150: 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 (Medicare: Not payable by Medicare) - S2152: 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 (Medicare: Not payable by Medicare) - S2202: Echosclerotherapy (Medicare: Not payable by Medicare) - S2205: 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 (Medicare: Not payable by Medicare) - S2206: 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 (Medicare: Not payable by Medicare) - S2207: 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 (Medicare: Not payable by Medicare) - S2208: 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 (Medicare: Not payable by Medicare) - S2209: 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 (Medicare: Not payable by Medicare) - S2225: Myringotomy, laser-assisted (Medicare: Not payable by Medicare) - S2230: Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear (Medicare: Not payable by Medicare) - S2235: Implantation of auditory brain stem implant (Medicare: Not payable by Medicare) - S2260: Induced abortion, 17 to 24 weeks (Medicare: Not payable by Medicare) - S2265: Induced abortion, 25 to 28 weeks (Medicare: Not payable by Medicare) - S2266: Induced abortion, 29 to 31 weeks (Medicare: Not payable by Medicare) - S2267: Induced abortion, 32 weeks or greater (Medicare: Not payable by Medicare) - S2300: Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy (Medicare: Not payable by Medicare) - S2325: Hip core decompression (Medicare: Not payable by Medicare) - S2340: Chemodenervation of abductor muscle(s) of vocal cord (Medicare: Not payable by Medicare) - S2341: Chemodenervation of adductor muscle(s) of vocal cord (Medicare: Not payable by Medicare) - S2342: Nasal endoscopy for post-operative debridement following functional endoscopic sinus surgery, nasal and/or sinus cavity(s), unilateral or bilateral (Medicare: Not payable by Medicare) - S2348: Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbar (Medicare: Not payable by Medicare) - S2350: Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, single interspace (Medicare: Not payable by Medicare) - S2351: 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) (Medicare: Not payable by Medicare) - S2360: Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; cervical (Medicare: Not payable by Medicare) - S2361: Each additional cervical vertebral body (list separately in addition to code for primary procedure) (Medicare: Not payable by Medicare) - S2400: Repair, congenital diaphragmatic hernia in the fetus using temporary tracheal occlusion, procedure performed in utero (Medicare: Not payable by Medicare) - S2401: Repair, urinary tract obstruction in the fetus, procedure performed in utero (Medicare: Not payable by Medicare) - S2402: Repair, congenital cystic adenomatoid malformation in the fetus, procedure performed in utero (Medicare: Not payable by Medicare) - S2403: Repair, extralobar pulmonary sequestration in the fetus, procedure performed in utero (Medicare: Not payable by Medicare) - S2404: Repair, myelomeningocele in the fetus, procedure performed in utero (Medicare: Not payable by Medicare) - S2405: Repair of sacrococcygeal teratoma in the fetus, procedure performed in utero (Medicare: Not payable by Medicare) - S2409: Repair, congenital malformation of fetus, procedure performed in utero, not otherwise classified (Medicare: Not payable by Medicare) - S2411: Fetoscopic laser therapy for treatment of twin-to-twin transfusion syndrome (Medicare: Not payable by Medicare) - S2900: Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure) (Medicare: Not payable by Medicare) - S3000: Diabetic indicator; retinal eye exam, dilated, bilateral (Medicare: Not payable by Medicare) - S3005: Performance measurement, evaluation of patient self assessment, depression (Medicare: Not payable by Medicare) - S3600: Stat laboratory request (situations other than s3601) (Medicare: Not payable by Medicare) - S3601: Emergency stat laboratory charge for patient who is homebound or residing in a nursing facility (Medicare: Not payable by Medicare) - S3620: 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) (Medicare: Special coverage instructions apply) - S3630: Eosinophil count, blood, direct (Medicare: Not payable by Medicare) - S3645: Hiv-1 antibody testing of oral mucosal transudate (Medicare: Not payable by Medicare) - S3650: Saliva test, hormone level; during menopause (Medicare: Not payable by Medicare) - S3652: Saliva test, hormone level; to assess preterm labor risk (Medicare: Not payable by Medicare) - S3655: Antisperm antibodies test (immunobead) (Medicare: Not payable by Medicare) - S3708: Gastrointestinal fat absorption study (Medicare: Not payable by Medicare) - S3721: Prostate cancer antigen 3 (pca3) testing (Medicare: Not payable by Medicare) - S3722: Dose optimization by area under the curve (auc) analysis, for infusional 5-fluorouracil (Medicare: Not payable by Medicare) - S3800: Genetic testing for amyotrophic lateral sclerosis (als) (Medicare: Not payable by Medicare) - S3840: Dna analysis for germline mutations of the ret proto-oncogene for susceptibility to multiple endocrine neoplasia type 2 (Medicare: Not payable by Medicare) - S3841: Genetic testing for retinoblastoma (Medicare: Not payable by Medicare) - S3842: Genetic testing for von hippel-lindau disease (Medicare: Not payable by Medicare) - S3844: Dna analysis of the connexin 26 gene (gjb2) for susceptibility to congenital, profound deafness (Medicare: Not payable by Medicare) - S3845: Genetic testing for alpha-thalassemia (Medicare: Not payable by Medicare) - S3846: Genetic testing for hemoglobin e beta-thalassemia (Medicare: Not payable by Medicare) - S3849: Genetic testing for niemann-pick disease (Medicare: Not payable by Medicare) - S3850: Genetic testing for sickle cell anemia (Medicare: Not payable by Medicare) - S3852: Dna analysis for apoe epsilon 4 allele for susceptibility to alzheimer's disease (Medicare: Not payable by Medicare) - S3853: Genetic testing for myotonic muscular dystrophy (Medicare: Not payable by Medicare) - S3854: Gene expression profiling panel for use in the management of breast cancer treatment (Medicare: Not payable by Medicare) - S3855: Genetic testing for detection of mutations in the presenilin - 1 gene (Medicare: Not payable by Medicare) - S3861: Genetic testing, sodium channel, voltage-gated, type v, alpha subunit (scn5a) and variants for suspected brugada syndrome (Medicare: Not payable by Medicare) - S3865: Comprehensive gene sequence analysis for hypertrophic cardiomyopathy (Medicare: Not payable by Medicare) - S3866: Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy (hcm) in an individual with a known hcm mutation in the family (Medicare: Not payable by Medicare) - S3870: Comparative genomic hybridization (cgh) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability (Medicare: Not payable by Medicare) - S3890: Dna analysis, fecal, for colorectal cancer screening (Medicare: Not payable by Medicare) - S3900: Surface electromyography (emg) (Medicare: Not payable by Medicare) - S3902: Ballistocardiogram (Medicare: Not payable by Medicare) - S3904: Masters two step (Medicare: Not payable by Medicare) - S4005: Interim labor facility global (labor occurring but not resulting in delivery) (Medicare: Not payable by Medicare) - S4011: 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 (Medicare: Not payable by Medicare) - S4013: Complete cycle, gamete intrafallopian transfer (gift), case rate (Medicare: Not payable by Medicare) - S4014: Complete cycle, zygote intrafallopian transfer (zift), case rate (Medicare: Not payable by Medicare) - S4015: Complete in vitro fertilization cycle, not otherwise specified, case rate (Medicare: Not payable by Medicare) - S4016: Frozen in vitro fertilization cycle, case rate (Medicare: Not payable by Medicare) - S4017: Incomplete cycle, treatment cancelled prior to stimulation, case rate (Medicare: Not payable by Medicare) - S4018: Frozen embryo transfer procedure cancelled before transfer, case rate (Medicare: Not payable by Medicare) - S4020: In vitro fertilization procedure cancelled before aspiration, case rate (Medicare: Not payable by Medicare) - S4021: In vitro fertilization procedure cancelled after aspiration, case rate (Medicare: Not payable by Medicare) - S4022: Assisted oocyte fertilization, case rate (Medicare: Not payable by Medicare) - S4023: Donor egg cycle, incomplete, case rate (Medicare: Not payable by Medicare) - S4024: Air polymer-type a intrauterine foam, per study dose (Medicare: Not payable by Medicare) - S4025: Donor services for in vitro fertilization (sperm or embryo), case rate (Medicare: Not payable by Medicare) - S4026: Procurement of donor sperm from sperm bank (Medicare: Not payable by Medicare) - S4027: Storage of previously frozen embryos (Medicare: Not payable by Medicare) - S4028: Microsurgical epididymal sperm aspiration (mesa) (Medicare: Not payable by Medicare) - S4030: Sperm procurement and cryopreservation services; initial visit (Medicare: Not payable by Medicare) - S4031: Sperm procurement and cryopreservation services; subsequent visit (Medicare: Not payable by Medicare) - S4035: Stimulated intrauterine insemination (iui), case rate (Medicare: Not payable by Medicare) - S4037: Cryopreserved embryo transfer, case rate (Medicare: Not payable by Medicare) - S4040: Monitoring and storage of cryopreserved embryos, per 30 days (Medicare: Not payable by Medicare) - S4042: Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle (Medicare: Not payable by Medicare) - S4981: Insertion of levonorgestrel-releasing intrauterine system (Medicare: Not payable by Medicare) - S4988: Penile contracture device, manual, greater than 3 lbs traction force (Medicare: Not payable by Medicare) - S4989: Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies (Medicare: Not payable by Medicare) - S4990: Nicotine patches, legend (Medicare: Not payable by Medicare) - S4991: Nicotine patches, non-legend (Medicare: Not payable by Medicare) - S4993: Contraceptive pills for birth control (Medicare: Not payable by Medicare) - S4995: Smoking cessation gum (Medicare: Not payable by Medicare) - S5000: Prescription drug, generic (Medicare: Not payable by Medicare) - S5001: Prescription drug, brand name (Medicare: Not payable by Medicare) - S5010: 5% dextrose and 0.45% normal saline, 1000 ml (Medicare: Not payable by Medicare) - S5011: 5% dextrose in lactated ringer's, 1000 ml (Medicare: Not payable by Medicare) - S5012: 5% dextrose with potassium chloride, 1000 ml (Medicare: Not payable by Medicare) - S5013: 5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1000 ml (Medicare: Not payable by Medicare) - S5014: 5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1500 ml (Medicare: Not payable by Medicare) - S5035: Home infusion therapy, routine service of infusion device (e.g., pump maintenance) (Medicare: Not payable by Medicare) - S5036: Home infusion therapy, repair of infusion device (e.g., pump repair) (Medicare: Not payable by Medicare) - S5100: Day care services, adult; per 15 minutes (Medicare: Not payable by Medicare) - S5101: Day care services, adult; per half day (Medicare: Not payable by Medicare) - S5102: Day care services, adult; per diem (Medicare: Not payable by Medicare) - S5105: Day care services, center-based; services not included in program fee, per diem (Medicare: Not payable by Medicare) - S5108: Home care training to home care client, per 15 minutes (Medicare: Not payable by Medicare) - S5109: Home care training to home care client, per session (Medicare: Not payable by Medicare) - S5110: Home care training, family; per 15 minutes (Medicare: Not payable by Medicare) - S5111: Home care training, family; per session (Medicare: Not payable by Medicare) - S5115: Home care training, non-family; per 15 minutes (Medicare: Not payable by Medicare) - S5116: Home care training, non-family; per session (Medicare: Not payable by Medicare) - S5120: Chore services; per 15 minutes (Medicare: Not payable by Medicare) - S5121: Chore services; per diem (Medicare: Not payable by Medicare) - S5125: Attendant care services; per 15 minutes (Medicare: Not payable by Medicare) - S5126: Attendant care services; per diem (Medicare: Not payable by Medicare) - S5130: Homemaker service, nos; per 15 minutes (Medicare: Not payable by Medicare) - S5131: Homemaker service, nos; per diem (Medicare: Not payable by Medicare) - S5135: Companion care, adult (e.g., iadl/adl); per 15 minutes (Medicare: Not payable by Medicare) - S5136: Companion care, adult (e.g., iadl/adl); per diem (Medicare: Not payable by Medicare) - S5140: Foster care, adult; per diem (Medicare: Not payable by Medicare) - S5141: Foster care, adult; per month (Medicare: Not payable by Medicare) - S5145: Foster care, therapeutic, child; per diem (Medicare: Not payable by Medicare) - S5146: Foster care, therapeutic, child; per month (Medicare: Not payable by Medicare) - S5150: Unskilled respite care, not hospice; per 15 minutes (Medicare: Not payable by Medicare) - S5151: Unskilled respite care, not hospice; per diem (Medicare: Not payable by Medicare) - S5160: Emergency response system; installation and testing (Medicare: Not payable by Medicare) - S5161: Emergency response system; service fee, per month (excludes installation and testing) (Medicare: Not payable by Medicare) - S5162: Emergency response system; purchase only (Medicare: Not payable by Medicare) - S5165: Home modifications; per service (Medicare: Not payable by Medicare) - S5170: Home delivered meals, including preparation; per meal (Medicare: Not payable by Medicare) - S5175: Laundry service, external, professional; per order (Medicare: Not payable by Medicare) - S5180: Home health respiratory therapy, initial evaluation (Medicare: Not payable by Medicare) - S5181: Home health respiratory therapy, nos, per diem (Medicare: Not payable by Medicare) - S5185: Medication reminder service, non-face-to-face; per month (Medicare: Not payable by Medicare) - S5190: Wellness assessment, performed by non-physician (Medicare: Not payable by Medicare) - S5199: Personal care item, nos, each (Medicare: Not payable by Medicare) - S5497: 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 (Medicare: Not payable by Medicare) - S5498: 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 (Medicare: Not payable by Medicare) - S5501: 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 (Medicare: Not payable by Medicare) - S5502: 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) (Medicare: Not payable by Medicare) - S5517: Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting (Medicare: Not payable by Medicare) - S5518: Home infusion therapy, all supplies necessary for catheter repair (Medicare: Not payable by Medicare) - S5520: Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (picc) line insertion (Medicare: Not payable by Medicare) - S5521: Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion (Medicare: Not payable by Medicare) - S5522: Home infusion therapy, insertion of peripherally inserted central venous catheter (picc), nursing services only (no supplies or catheter included) (Medicare: Not payable by Medicare) - S5523: Home infusion therapy, insertion of midline venous catheter, nursing services only (no supplies or catheter included) (Medicare: Not payable by Medicare) - S5550: Insulin, rapid onset, 5 units (Medicare: Not payable by Medicare) - S5551: Insulin, most rapid onset (lispro or aspart); 5 units (Medicare: Not payable by Medicare) - S5552: Insulin, intermediate acting (nph or lente); 5 units (Medicare: Not payable by Medicare) - S5553: Insulin, long acting; 5 units (Medicare: Not payable by Medicare) - S5560: Insulin delivery device, reusable pen; 1.5 ml size (Medicare: Not payable by Medicare) - S5561: Insulin delivery device, reusable pen; 3 ml size (Medicare: Not payable by Medicare) - S5565: Insulin cartridge for use in insulin delivery device other than pump; 150 units (Medicare: Not payable by Medicare) - S5566: Insulin cartridge for use in insulin delivery device other than pump; 300 units (Medicare: Not payable by Medicare) - S5570: Insulin delivery device, disposable pen (including insulin); 1.5 ml size (Medicare: Not payable by Medicare) - S5571: Insulin delivery device, disposable pen (including insulin); 3 ml size (Medicare: Not payable by Medicare) - S8030: Scleral application of tantalum ring(s) for localization of lesions for proton beam therapy (Medicare: Not payable by Medicare) - S8032: Low-dose computed tomography for lung cancer screening (Medicare: Not payable by Medicare) - S8035: Magnetic source imaging (Medicare: Not payable by Medicare) - S8037: Magnetic resonance cholangiopancreatography (mrcp) (Medicare: Not payable by Medicare) - S8040: Topographic brain mapping (Medicare: Not payable by Medicare) - S8042: Magnetic resonance imaging (mri), low-field (Medicare: Not payable by Medicare) - S8055: 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) (Medicare: Not payable by Medicare) - S8080: Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical (Medicare: Not payable by Medicare) - S8085: Fluorine-18 fluorodeoxyglucose (f-18 fdg) imaging using dual-head coincidence detection system (non-dedicated pet scan) (Medicare: Not payable by Medicare) - S8092: Electron beam computed tomography (also known as ultrafast ct, cine ct) (Medicare: Not payable by Medicare) - S8096: Portable peak flow meter (Medicare: Not payable by Medicare) - S8097: Asthma kit (including but not limited to portable peak expiratory flow meter, instructional video, brochure, and/or spacer) (Medicare: Not payable by Medicare) - S8100: Holding chamber or spacer for use with an inhaler or nebulizer; without mask (Medicare: Not payable by Medicare) - S8101: Holding chamber or spacer for use with an inhaler or nebulizer; with mask (Medicare: Not payable by Medicare) - S8110: Peak expiratory flow rate (physician services) (Medicare: Not payable by Medicare) - S8120: Oxygen contents, gaseous, 1 unit equals 1 cubic foot (Medicare: Not payable by Medicare) - S8121: Oxygen contents, liquid, 1 unit equals 1 pound (Medicare: Not payable by Medicare) - S8130: Interferential current stimulator, 2 channel (Medicare: Not payable by Medicare) - S8131: Interferential current stimulator, 4 channel (Medicare: Not payable by Medicare) - S8185: Flutter device (Medicare: Not payable by Medicare) - S8186: Swivel adapter (Medicare: Not payable by Medicare) - S8189: Tracheostomy supply, not otherwise classified (Medicare: Not payable by Medicare) - S8210: Mucus trap (Medicare: Not payable by Medicare) - S8262: Mandibular orthopedic repositioning device, each (Medicare: Not payable by Medicare) - S8265: Haberman feeder for cleft lip/palate (Medicare: Not payable by Medicare) - S8270: Enuresis alarm, using auditory buzzer and/or vibration device (Medicare: Not payable by Medicare) - S8301: Infection control supplies, not otherwise specified (Medicare: Not payable by Medicare) - S8415: Supplies for home delivery of infant (Medicare: Not payable by Medicare) - S8420: Gradient pressure aid (sleeve and glove combination), custom made (Medicare: Not payable by Medicare) - S8421: Gradient pressure aid (sleeve and glove combination), ready made (Medicare: Not payable by Medicare) - S8422: Gradient pressure aid (sleeve), custom made, medium weight (Medicare: Not payable by Medicare) - S8423: Gradient pressure aid (sleeve), custom made, heavy weight (Medicare: Not payable by Medicare) - S8424: Gradient pressure aid (sleeve), ready made (Medicare: Not payable by Medicare) - S8425: Gradient pressure aid (glove), custom made, medium weight (Medicare: Not payable by Medicare) - S8426: Gradient pressure aid (glove), custom made, heavy weight (Medicare: Not payable by Medicare) - S8427: Gradient pressure aid (glove), ready made (Medicare: Not payable by Medicare) - S8428: Gradient pressure aid (gauntlet), ready made (Medicare: Not payable by Medicare) - S8429: Gradient pressure exterior wrap (Medicare: Not payable by Medicare) - S8430: Padding for compression bandage, roll (Medicare: Not payable by Medicare) - S8431: Compression bandage, roll (Medicare: Not payable by Medicare) - S8450: Splint, prefabricated, digit (specify digit by use of modifier) (Medicare: Not payable by Medicare) - S8451: Splint, prefabricated, wrist or ankle (Medicare: Not payable by Medicare) - S8452: Splint, prefabricated, elbow (Medicare: Not payable by Medicare) - S8460: Camisole, post-mastectomy (Medicare: Not payable by Medicare) - S8490: Insulin syringes (100 syringes, any size) (Medicare: Not payable by Medicare) - S8930: Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient (Medicare: Not payable by Medicare) - S8940: Equestrian/hippotherapy, per session (Medicare: Not payable by Medicare) - S8948: Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes (Medicare: Not payable by Medicare) - S8950: Complex lymphedema therapy, each 15 minutes (Medicare: Not payable by Medicare) - S8990: Physical or manipulative therapy performed for maintenance rather than restoration (Medicare: Not payable by Medicare) - S8999: Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) (Medicare: Not payable by Medicare) - S9001: Home uterine monitor with or without associated nursing services (Medicare: Not payable by Medicare) - S9002: Intra-vaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device (Medicare: Not payable by Medicare) - S9007: Ultrafiltration monitor (Medicare: Not payable by Medicare) - S9015: Automated eeg monitoring (Medicare: Not payable by Medicare) - S9024: Paranasal sinus ultrasound (Medicare: Not payable by Medicare) - S9025: Omnicardiogram/cardiointegram (Medicare: Not payable by Medicare) - S9034: Extracorporeal shockwave lithotripsy for gall stones (if performed with ercp, use 43265) (Medicare: Not payable by Medicare) - S9055: Procuren or other growth factor preparation to promote wound healing (Medicare: Not payable by Medicare) - S9056: Coma stimulation per diem (Medicare: Not payable by Medicare) - S9061: 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 (Medicare: Not payable by Medicare) - S9083: Global fee urgent care centers (Medicare: Not payable by Medicare) - S9088: Services provided in an urgent care center (list in addition to code for service) (Medicare: Not payable by Medicare) - S9090: Vertebral axial decompression, per session (Medicare: Not payable by Medicare) - S9097: Home visit for wound care (Medicare: Not payable by Medicare) - S9098: Home visit, phototherapy services (e.g., bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem (Medicare: Not payable by Medicare) - S9110: Telemonitoring of patient in their home, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month (Medicare: Not payable by Medicare) - S9117: Back school, per visit (Medicare: Not payable by Medicare) - S9122: Home health aide or certified nurse assistant, providing care in the home; per hour (Medicare: Not payable by Medicare) - S9123: Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used) (Medicare: Not payable by Medicare) - S9124: Nursing care, in the home; by licensed practical nurse, per hour (Medicare: Not payable by Medicare) - S9125: Respite care, in the home, per diem (Medicare: Not payable by Medicare) - S9126: Hospice care, in the home, per diem (Medicare: Not payable by Medicare) - S9127: Social work visit, in the home, per diem (Medicare: Not payable by Medicare) - S9128: Speech therapy, in the home, per diem (Medicare: Not payable by Medicare) - S9129: Occupational therapy, in the home, per diem (Medicare: Not payable by Medicare) - S9131: Physical therapy; in the home, per diem (Medicare: Not payable by Medicare) - S9140: Diabetic management program, follow-up visit to non-md provider (Medicare: Not payable by Medicare) - S9141: Diabetic management program, follow-up visit to md provider (Medicare: Not payable by Medicare) - S9145: Insulin pump initiation, instruction in initial use of pump (pump not included) (Medicare: Not payable by Medicare) - S9150: Evaluation by ocularist (Medicare: Not payable by Medicare) - S9152: Speech therapy, re-evaluation (Medicare: Not payable by Medicare) - S9208: 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) (Medicare: Not payable by Medicare) - S9209: 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) (Medicare: Not payable by Medicare) - S9211: 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) (Medicare: Not payable by Medicare) - S9212: 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) (Medicare: Not payable by Medicare) - S9213: 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) (Medicare: Not payable by Medicare) - S9214: 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) (Medicare: Not payable by Medicare) - S9325: 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) (Medicare: Not payable by Medicare) - S9326: 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 (Medicare: Not payable by Medicare) - S9327: 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 (Medicare: Not payable by Medicare) - S9328: 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 (Medicare: Not payable by Medicare) - S9329: 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) (Medicare: Not payable by Medicare) - S9330: 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 (Medicare: Not payable by Medicare) - S9331: 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 (Medicare: Not payable by Medicare) - S9335: Home therapy, hemodialysis; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately), per diem (Medicare: Not payable by Medicare) - S9336: 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 (Medicare: Not payable by Medicare) - S9338: 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 (Medicare: Not payable by Medicare) - S9339: 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 (Medicare: Not payable by Medicare) - S9340: 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 (Medicare: Not payable by Medicare) - S9341: 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 (Medicare: Not payable by Medicare) - S9342: 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 (Medicare: Not payable by Medicare) - S9343: 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 (Medicare: Not payable by Medicare) - S9345: 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 (Medicare: Not payable by Medicare) - S9346: 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 (Medicare: Not payable by Medicare) - S9347: 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 (Medicare: Not payable by Medicare) - S9348: 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 (Medicare: Not payable by Medicare) - S9349: 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 (Medicare: Not payable by Medicare) - S9351: 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 (Medicare: Not payable by Medicare) - S9353: 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 (Medicare: Not payable by Medicare) - S9355: 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 (Medicare: Not payable by Medicare) - S9357: 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 (Medicare: Not payable by Medicare) - S9359: 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 (Medicare: Not payable by Medicare) - S9361: 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 (Medicare: Not payable by Medicare) - S9363: 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 (Medicare: Not payable by Medicare) - S9364: 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) (Medicare: Not payable by Medicare) - S9365: 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 (Medicare: Not payable by Medicare) - S9366: 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 (Medicare: Not payable by Medicare) - S9367: 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 (Medicare: Not payable by Medicare) - S9368: 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 (Medicare: Not payable by Medicare) - S9370: 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 (Medicare: Not payable by Medicare) - S9372: 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) (Medicare: Not payable by Medicare) - S9373: 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) (Medicare: Not payable by Medicare) - S9374: 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 (Medicare: Not payable by Medicare) - S9375: 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 (Medicare: Not payable by Medicare) - S9376: 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 (Medicare: Not payable by Medicare) - S9377: 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 (Medicare: Not payable by Medicare) - S9379: 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 (Medicare: Not payable by Medicare) - S9381: Delivery or service to high risk areas requiring escort or extra protection, per visit (Medicare: Not payable by Medicare) - S9401: Anticoagulation clinic, inclusive of all services except laboratory tests, per session (Medicare: Not payable by Medicare) - S9430: Pharmacy compounding and dispensing services (Medicare: Not payable by Medicare) - S9432: Medical foods for non-inborn errors of metabolism (Medicare: Not payable by Medicare) - S9433: Medical food nutritionally complete, administered orally, providing 100% of nutritional intake (Medicare: Not payable by Medicare) - S9434: Modified solid food supplements for inborn errors of metabolism (Medicare: Not payable by Medicare) - S9435: Medical foods for inborn errors of metabolism (Medicare: Not payable by Medicare) - S9436: Childbirth preparation/lamaze classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9437: Childbirth refresher classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9438: Cesarean birth classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9439: Vbac (vaginal birth after cesarean) classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9441: Asthma education, non-physician provider, per session (Medicare: Not payable by Medicare) - S9442: Birthing classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9443: Lactation classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9444: Parenting classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9445: Patient education, not otherwise classified, non-physician provider, individual, per session (Medicare: Not payable by Medicare) - S9446: Patient education, not otherwise classified, non-physician provider, group, per session (Medicare: Not payable by Medicare) - S9447: Infant safety (including cpr) classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9449: Weight management classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9451: Exercise classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9452: Nutrition classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9453: Smoking cessation classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9454: Stress management classes, non-physician provider, per session (Medicare: Not payable by Medicare) - S9455: Diabetic management program, group session (Medicare: Not payable by Medicare) - S9460: Diabetic management program, nurse visit (Medicare: Not payable by Medicare) - S9465: Diabetic management program, dietitian visit (Medicare: Not payable by Medicare) - S9470: Nutritional counseling, dietitian visit (Medicare: Not payable by Medicare) - S9472: Cardiac rehabilitation program, non-physician provider, per diem (Medicare: Not payable by Medicare) - S9473: Pulmonary rehabilitation program, non-physician provider, per diem (Medicare: Not payable by Medicare) - S9474: Enterostomal therapy by a registered nurse certified in enterostomal therapy, per diem (Medicare: Not payable by Medicare) - S9475: Ambulatory setting substance abuse treatment or detoxification services, per diem (Medicare: Not payable by Medicare) - S9476: Vestibular rehabilitation program, non-physician provider, per diem (Medicare: Not payable by Medicare) - S9480: Intensive outpatient psychiatric services, per diem (Medicare: Not payable by Medicare) - S9482: Family stabilization services, per 15 minutes (Medicare: Not payable by Medicare) - S9484: Crisis intervention mental health services, per hour (Medicare: Not payable by Medicare) - S9485: Crisis intervention mental health services, per diem (Medicare: Not payable by Medicare) - S9490: 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 (Medicare: Not payable by Medicare) - S9494: 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) (Medicare: Not payable by Medicare) - S9497: 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 (Medicare: Not payable by Medicare) - S9500: 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 (Medicare: Not payable by Medicare) - S9501: 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 (Medicare: Not payable by Medicare) - S9502: 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 (Medicare: Not payable by Medicare) - S9503: 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 (Medicare: Not payable by Medicare) - S9504: 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 (Medicare: Not payable by Medicare) - S9529: Routine venipuncture for collection of specimen(s), single home bound, nursing home, or skilled nursing facility patient (Medicare: Not payable by Medicare) - S9537: 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 (Medicare: Not payable by Medicare) - S9538: 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 (Medicare: Not payable by Medicare) - S9542: 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 (Medicare: Not payable by Medicare) - S9558: 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 (Medicare: Not payable by Medicare) - S9559: 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 (Medicare: Not payable by Medicare) - S9560: 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 (Medicare: Not payable by Medicare) - S9562: 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 (Medicare: Not payable by Medicare) - S9563: 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 (Medicare: Not payable by Medicare) - S9590: 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 (Medicare: Not payable by Medicare) - S9810: 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) (Medicare: Not payable by Medicare) - S9900: Services by a journal-listed christian science practitioner for the purpose of healing, per diem (Medicare: Not payable by Medicare) - S9901: Services by a journal-listed christian science nurse, per hour (Medicare: Not payable by Medicare) - S9960: Ambulance service, conventional air service, nonemergency transport, one way (fixed wing) (Medicare: Not payable by Medicare) - S9961: Ambulance service, conventional air service, nonemergency transport, one way (rotary wing) (Medicare: Not payable by Medicare) - S9970: Health club membership, annual (Medicare: Not payable by Medicare) - S9975: Transplant related lodging, meals and transportation, per diem (Medicare: Not payable by Medicare) - S9976: Lodging, per diem, not otherwise classified (Medicare: Not payable by Medicare) - S9977: Meals, per diem, not otherwise specified (Medicare: Not payable by Medicare) - S9981: Medical records copying fee, administrative (Medicare: Not payable by Medicare) - S9982: Medical records copying fee, per page (Medicare: Not payable by Medicare) - S9986: Not medically necessary service (patient is aware that service not medically necessary) (Medicare: Not payable by Medicare) - S9988: Services provided as part of a phase i clinical trial (Medicare: Not payable by Medicare) - S9989: Services provided outside of the united states of america (list in addition to code(s) for service(s)) (Medicare: Not payable by Medicare) - S9990: Services provided as part of a phase ii clinical trial (Medicare: Not payable by Medicare) - S9991: Services provided as part of a phase iii clinical trial (Medicare: Not payable by Medicare) - S9992: 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 (Medicare: Not payable by Medicare) - S9994: Lodging costs (e.g., hotel charges) for clinical trial participant and one caregiver/companion (Medicare: Not payable by Medicare) - S9996: Meals for clinical trial participant and one caregiver/companion (Medicare: Not payable by Medicare) - S9999: Sales tax (Medicare: Not payable by Medicare) - T1000: Private duty / independent nursing service(s) - licensed, up to 15 minutes (Medicare: Not payable by Medicare) - T1001: Nursing assessment / evaluation (Medicare: Not payable by Medicare) - T1002: Rn services, up to 15 minutes (Medicare: Not payable by Medicare) - T1003: Lpn/lvn services, up to 15 minutes (Medicare: Not payable by Medicare) - T1004: Services of a qualified nursing aide, up to 15 minutes (Medicare: Not payable by Medicare) - T1005: Respite care services, up to 15 minutes (Medicare: Not payable by Medicare) - T1006: Alcohol and/or substance abuse services, family/couple counseling (Medicare: Not payable by Medicare) - T1007: Alcohol and/or substance abuse services, treatment plan development and/or modification (Medicare: Not payable by Medicare) - T1009: Child sitting services for children of the individual receiving alcohol and/or substance abuse services (Medicare: Not payable by Medicare) - T1010: Meals for individuals receiving alcohol and/or substance abuse services (when meals not included in the program) (Medicare: Not payable by Medicare) - T1012: Alcohol and/or substance abuse services, skills development (Medicare: Not payable by Medicare) - T1013: Sign language or oral interpretive services, per 15 minutes (Medicare: Not payable by Medicare) - T1014: Telehealth transmission, per minute, professional services bill separately (Medicare: Not payable by Medicare) - T1015: Clinic visit/encounter, all-inclusive (Medicare: Not payable by Medicare) - T1016: Case management, each 15 minutes (Medicare: Not payable by Medicare) - T1017: Targeted case management, each 15 minutes (Medicare: Not payable by Medicare) - T1018: School-based individualized education program (iep) services, bundled (Medicare: Not payable by Medicare) - T1019: 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) (Medicare: Not payable by Medicare) - T1020: 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) (Medicare: Not payable by Medicare) - T1021: Home health aide or certified nurse assistant, per visit (Medicare: Not payable by Medicare) - T1022: Contracted home health agency services, all services provided under contract, per day (Medicare: Not payable by Medicare) - T1023: Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter (Medicare: Not payable by Medicare) - T1024: Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter (Medicare: Not payable by Medicare) - T1025: Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem (Medicare: Not payable by Medicare) - T1026: Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour (Medicare: Not payable by Medicare) - T1027: Family training and counseling for child development, per 15 minutes (Medicare: Not payable by Medicare) - T1028: Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs (Medicare: Not payable by Medicare) - T1029: Comprehensive environmental lead investigation, not including laboratory analysis, per dwelling (Medicare: Not payable by Medicare) - T1030: Nursing care, in the home, by registered nurse, per diem (Medicare: Not payable by Medicare) - T1031: Nursing care, in the home, by licensed practical nurse, per diem (Medicare: Not payable by Medicare) - T1032: Services performed by a doula birth worker, per 15 minutes (Medicare: Not payable by Medicare) - T1033: Services performed by a doula birth worker, per diem (Medicare: Not payable by Medicare) - T1040: Medicaid certified community behavioral health clinic services, per diem (Medicare: Not payable by Medicare) - T1041: Medicaid certified community behavioral health clinic services, per month (Medicare: Not payable by Medicare) - T1502: Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit (Medicare: Not payable by Medicare) - T1503: Administration of medication, other than oral and/or injectable, by a health care agency/professional, per visit (Medicare: Not payable by Medicare) - T1505: Electronic medication compliance management device, includes all components and accessories, not otherwise classified (Medicare: Not payable by Medicare) - T1999: Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" (Medicare: Not payable by Medicare) - T2001: Non-emergency transportation; patient attendant/escort (Medicare: Not payable by Medicare) - T2002: Non-emergency transportation; per diem (Medicare: Not payable by Medicare) - T2003: Non-emergency transportation; encounter/trip (Medicare: Not payable by Medicare) - T2004: Non-emergency transport; commercial carrier, multi-pass (Medicare: Not payable by Medicare) - T2005: Non-emergency transportation; stretcher van (Medicare: Not payable by Medicare) - T2007: Transportation waiting time, air ambulance and non-emergency vehicle, one-half (1/2) hour increments (Medicare: Not payable by Medicare) - T2010: Preadmission screening and resident review (pasrr) level i identification screening, per screen (Medicare: Not payable by Medicare) - T2011: Preadmission screening and resident review (pasrr) level ii evaluation, per evaluation (Medicare: Not payable by Medicare) - T2012: Habilitation, educational; waiver, per diem (Medicare: Not payable by Medicare) - T2013: Habilitation, educational, waiver; per hour (Medicare: Not payable by Medicare) - T2014: Habilitation, prevocational, waiver; per diem (Medicare: Not payable by Medicare) - T2015: Habilitation, prevocational, waiver; per hour (Medicare: Not payable by Medicare) - T2016: Habilitation, residential, waiver; per diem (Medicare: Not payable by Medicare) - T2017: Habilitation, residential, waiver; 15 minutes (Medicare: Not payable by Medicare) - T2018: Habilitation, supported employment, waiver; per diem (Medicare: Not payable by Medicare) - T2019: Habilitation, supported employment, waiver; per 15 minutes (Medicare: Not payable by Medicare) - T2020: Day habilitation, waiver; per diem (Medicare: Not payable by Medicare) - T2021: Day habilitation, waiver; per 15 minutes (Medicare: Not payable by Medicare) - T2022: Case management, per month (Medicare: Not payable by Medicare) - T2023: Targeted case management; per month (Medicare: Not payable by Medicare) - T2024: Service assessment/plan of care development, waiver (Medicare: Not payable by Medicare) - T2025: Waiver services; not otherwise specified (nos) (Medicare: Not payable by Medicare) - T2026: Specialized childcare, waiver; per diem (Medicare: Not payable by Medicare) - T2027: Specialized childcare, waiver; per 15 minutes (Medicare: Not payable by Medicare) - T2028: Specialized supply, not otherwise specified, waiver (Medicare: Not payable by Medicare) - T2029: Specialized medical equipment, not otherwise specified, waiver (Medicare: Not payable by Medicare) - T2030: Assisted living, waiver; per month (Medicare: Not payable by Medicare) - T2031: Assisted living; waiver, per diem (Medicare: Not payable by Medicare) - T2032: Residential care, not otherwise specified (nos), waiver; per month (Medicare: Not payable by Medicare) - T2033: Residential care, not otherwise specified (nos), waiver; per diem (Medicare: Not payable by Medicare) - T2034: Crisis intervention, waiver; per diem (Medicare: Not payable by Medicare) - T2035: Utility services to support medical equipment and assistive technology/devices, waiver (Medicare: Not payable by Medicare) - T2036: Therapeutic camping, overnight, waiver; each session (Medicare: Not payable by Medicare) - T2037: Therapeutic camping, day, waiver; each session (Medicare: Not payable by Medicare) - T2038: Community transition, waiver; per service (Medicare: Not payable by Medicare) - T2039: Vehicle modifications, waiver; per service (Medicare: Not payable by Medicare) - T2040: Financial management, self-directed, waiver; per 15 minutes (Medicare: Not payable by Medicare) - T2041: Supports brokerage, self-directed, waiver; per 15 minutes (Medicare: Not payable by Medicare) - T2042: Hospice routine home care; per diem (Medicare: Not payable by Medicare) - T2043: Hospice continuous home care; per hour (Medicare: Not payable by Medicare) - T2044: Hospice inpatient respite care; per diem (Medicare: Not payable by Medicare) - T2045: Hospice general inpatient care; per diem (Medicare: Not payable by Medicare) - T2046: Hospice long term care, room and board only; per diem (Medicare: Not payable by Medicare) - T2047: Habilitation, prevocational, waiver; per 15 minutes (Medicare: Not payable by Medicare) - T2048: 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 (Medicare: Not payable by Medicare) - T2049: Non-emergency transportation; stretcher van, mileage; per mile (Medicare: Not payable by Medicare) - T2050: Financial management, self-directed, waiver; per diem (Medicare: Not payable by Medicare) - T2051: Supports brokerage, self-directed, waiver; per diem (Medicare: Not payable by Medicare) - T2101: Human breast milk processing, storage and distribution only (Medicare: Not payable by Medicare) - T4521: Adult sized disposable incontinence product, brief/diaper, small, each (Medicare: Non-covered by Medicare) - T4522: Adult sized disposable incontinence product, brief/diaper, medium, each (Medicare: Non-covered by Medicare) - T4523: Adult sized disposable incontinence product, brief/diaper, large, each (Medicare: Non-covered by Medicare) - T4524: Adult sized disposable incontinence product, brief/diaper, extra large, each (Medicare: Non-covered by Medicare) - T4525: Adult sized disposable incontinence product, protective underwear/pull-on, small size, each (Medicare: Non-covered by Medicare) - T4526: Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each (Medicare: Non-covered by Medicare) - T4527: Adult sized disposable incontinence product, protective underwear/pull-on, large size, each (Medicare: Non-covered by Medicare) - T4528: Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each (Medicare: Non-covered by Medicare) - T4529: Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each (Medicare: Non-covered by Medicare) - T4530: Pediatric sized disposable incontinence product, brief/diaper, large size, each (Medicare: Non-covered by Medicare) - T4531: Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each (Medicare: Non-covered by Medicare) - T4532: Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each (Medicare: Non-covered by Medicare) - T4533: Youth sized disposable incontinence product, brief/diaper, each (Medicare: Non-covered by Medicare) - T4534: Youth sized disposable incontinence product, protective underwear/pull-on, each (Medicare: Non-covered by Medicare) - T4535: Disposable liner/shield/guard/pad/undergarment, for incontinence, each (Medicare: Non-covered by Medicare) - T4536: Incontinence product, protective underwear/pull-on, reusable, any size, each (Medicare: Non-covered by Medicare) - T4537: Incontinence product, protective underpad, reusable, bed size, each (Medicare: Non-covered by Medicare) - T4538: Diaper service, reusable diaper, each diaper (Medicare: Non-covered by Medicare) - T4539: Incontinence product, diaper/brief, reusable, any size, each (Medicare: Non-covered by Medicare) - T4540: Incontinence product, protective underpad, reusable, chair size, each (Medicare: Non-covered by Medicare) - T4541: Incontinence product, disposable underpad, large, each (Medicare: Not payable by Medicare) - T4542: Incontinence product, disposable underpad, small size, each (Medicare: Not payable by Medicare) - T4543: Adult sized disposable incontinence product, protective brief/diaper, above extra large, each (Medicare: Non-covered by Medicare) - T4544: Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each (Medicare: Non-covered by Medicare) - T4545: Incontinence product, disposable, penile wrap, each (Medicare: Non-covered by Medicare) - T5001: Positioning seat for persons with special orthopedic needs (Medicare: Not payable by Medicare) - T5999: Supply, not otherwise specified (Medicare: Not payable by Medicare) - U0001: Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel (Medicare: Carrier judgment) - U0002: 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc (Medicare: Carrier judgment) - U0003: 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 (Medicare: Carrier judgment) - U0004: 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 (Medicare: Carrier judgment) - U0005: 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 (Medicare: Carrier judgment) - V2020: Frames, purchases (Medicare: Special coverage instructions apply) - V2025: Deluxe frame (Medicare: Non-covered by Medicare) - V2100: Sphere, single vision, plano to plus or minus 4.00, per lens (Medicare: Carrier judgment) - V2101: Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens (Medicare: Carrier judgment) - V2102: Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens (Medicare: Carrier judgment) - V2103: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens (Medicare: Carrier judgment) - V2104: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2105: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2106: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2107: Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens (Medicare: Carrier judgment) - V2108: Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2109: Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2110: Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2111: Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens (Medicare: Carrier judgment) - V2112: Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2113: Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2114: Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens (Medicare: Carrier judgment) - V2115: Lenticular, (myodisc), per lens, single vision (Medicare: Carrier judgment) - V2118: Aniseikonic lens, single vision (Medicare: Carrier judgment) - V2121: Lenticular lens, per lens, single (Medicare: Special coverage instructions apply) - V2199: Not otherwise classified, single vision lens (Medicare: Carrier judgment) - V2200: Sphere, bifocal, plano to plus or minus 4.00d, per lens (Medicare: Carrier judgment) - V2201: Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens (Medicare: Carrier judgment) - V2202: Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens (Medicare: Carrier judgment) - V2203: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens (Medicare: Carrier judgment) - V2204: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2205: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2206: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2207: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens (Medicare: Carrier judgment) - V2208: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2209: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2210: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2211: Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens (Medicare: Carrier judgment) - V2212: Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2213: Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2214: Spherocylinder, bifocal, sphere over plus or minus 12.00d, per lens (Medicare: Carrier judgment) - V2215: Lenticular (myodisc), per lens, bifocal (Medicare: Carrier judgment) - V2218: Aniseikonic, per lens, bifocal (Medicare: Carrier judgment) - V2219: Bifocal seg width over 28 mm (Medicare: Carrier judgment) - V2220: Bifocal add over 3.25d (Medicare: Carrier judgment) - V2221: Lenticular lens, per lens, bifocal (Medicare: Special coverage instructions apply) - V2299: Specialty bifocal (by report) (Medicare: Carrier judgment) - V2300: Sphere, trifocal, plano to plus or minus 4.00d, per lens (Medicare: Carrier judgment) - V2301: Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d, per lens (Medicare: Carrier judgment) - V2302: Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00, per lens (Medicare: Carrier judgment) - V2303: Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens (Medicare: Carrier judgment) - V2304: Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 2.25-4.00d cylinder, per lens (Medicare: Carrier judgment) - V2305: Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens (Medicare: Carrier judgment) - V2306: Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2307: Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, .12 to 2.00d cylinder, per lens (Medicare: Carrier judgment) - V2308: Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2309: Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2310: Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2311: Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens (Medicare: Carrier judgment) - V2312: Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens (Medicare: Carrier judgment) - V2313: Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens (Medicare: Carrier judgment) - V2314: Spherocylinder, trifocal, sphere over plus or minus 12.00d, per lens (Medicare: Carrier judgment) - V2315: Lenticular, (myodisc), per lens, trifocal (Medicare: Carrier judgment) - V2318: Aniseikonic lens, trifocal (Medicare: Carrier judgment) - V2319: Trifocal seg width over 28 mm (Medicare: Carrier judgment) - V2320: Trifocal add over 3.25d (Medicare: Carrier judgment) - V2321: Lenticular lens, per lens, trifocal (Medicare: Special coverage instructions apply) - V2399: Specialty trifocal (by report) (Medicare: Carrier judgment) - V2410: Variable asphericity lens, single vision, full field, glass or plastic, per lens (Medicare: Carrier judgment) - V2430: Variable asphericity lens, bifocal, full field, glass or plastic, per lens (Medicare: Carrier judgment) - V2499: Variable sphericity lens, other type (Medicare: Carrier judgment) - V2500: Contact lens, pmma, spherical, per lens (Medicare: Carrier judgment) - V2501: Contact lens, pmma, toric or prism ballast, per lens (Medicare: Carrier judgment) - V2502: Contact lens, pmma, bifocal, per lens (Medicare: Carrier judgment) - V2503: Contact lens, pmma, color vision deficiency, per lens (Medicare: Carrier judgment) - V2510: Contact lens, gas permeable, spherical, per lens (Medicare: Carrier judgment) - V2511: Contact lens, gas permeable, toric, prism ballast, per lens (Medicare: Carrier judgment) - V2512: Contact lens, gas permeable, bifocal, per lens (Medicare: Carrier judgment) - V2513: Contact lens, gas permeable, extended wear, per lens (Medicare: Carrier judgment) - V2520: Contact lens, hydrophilic, spherical, per lens (Medicare: Special coverage instructions apply) - V2521: Contact lens, hydrophilic, toric, or prism ballast, per lens (Medicare: Special coverage instructions apply) - V2522: Contact lens, hydrophilic, bifocal, per lens (Medicare: Special coverage instructions apply) - V2523: Contact lens, hydrophilic, extended wear, per lens (Medicare: Special coverage instructions apply) - V2524: Contact lens, hydrophilic, spherical, photochromic additive, per lens (Medicare: Special coverage instructions apply) - V2525: Contact lens, hydrophilic, dual focus, per lens (Medicare: Non-covered by Medicare) - V2526: Contact lens, hydrophilic, with blue-violet filter, per lens (Medicare: Non-covered by Medicare) - V2530: Contact lens, scleral, gas impermeable, per lens (for contact lens modification, see 92325) (Medicare: Carrier judgment) - V2531: Contact lens, scleral, gas permeable, per lens (for contact lens modification, see 92325) (Medicare: Special coverage instructions apply) - V2599: Contact lens, other type (Medicare: Carrier judgment) - V2600: Hand held low vision aids and other nonspectacle mounted aids (Medicare: Carrier judgment) - V2610: Single lens spectacle mounted low vision aids (Medicare: Carrier judgment) - V2615: Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system (Medicare: Carrier judgment) - V2623: Prosthetic eye, plastic, custom (Medicare: Special coverage instructions apply) - V2624: Polishing/resurfacing of ocular prosthesis (Medicare: Carrier judgment) - V2625: Enlargement of ocular prosthesis (Medicare: Carrier judgment) - V2626: Reduction of ocular prosthesis (Medicare: Carrier judgment) - V2627: Scleral cover shell (Medicare: Special coverage instructions apply) - V2628: Fabrication and fitting of ocular conformer (Medicare: Carrier judgment) - V2629: Prosthetic eye, other type (Medicare: Carrier judgment) - V2630: Anterior chamber intraocular lens (Medicare: Special coverage instructions apply) - V2631: Iris supported intraocular lens (Medicare: Special coverage instructions apply) - V2632: Posterior chamber intraocular lens (Medicare: Special coverage instructions apply) - V2700: Balance lens, per lens (Medicare: Carrier judgment) - V2702: Deluxe lens feature (Medicare: Non-covered by Medicare) - V2710: Slab off prism, glass or plastic, per lens (Medicare: Carrier judgment) - V2715: Prism, per lens (Medicare: Carrier judgment) - V2718: Press-on lens, fresnell prism, per lens (Medicare: Carrier judgment) - V2730: Special base curve, glass or plastic, per lens (Medicare: Carrier judgment) - V2744: Tint, photochromatic, per lens (Medicare: Special coverage instructions apply) - V2745: Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens (Medicare: Special coverage instructions apply) - V2750: Anti-reflective coating, per lens (Medicare: Special coverage instructions apply) - V2755: U-v lens, per lens (Medicare: Special coverage instructions apply) - V2756: Eye glass case (Medicare: Carrier judgment) - V2760: Scratch resistant coating, per lens (Medicare: Carrier judgment) - V2761: Mirror coating, any type, solid, gradient or equal, any lens material, per lens (Medicare: Special coverage instructions apply) - V2762: Polarization, any lens material, per lens (Medicare: Special coverage instructions apply) - V2770: Occluder lens, per lens (Medicare: Carrier judgment) - V2780: Oversize lens, per lens (Medicare: Carrier judgment) - V2781: Progressive lens, per lens (Medicare: Carrier judgment) - V2782: Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens (Medicare: Special coverage instructions apply) - V2783: Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens (Medicare: Special coverage instructions apply) - V2784: Lens, polycarbonate or equal, any index, per lens (Medicare: Special coverage instructions apply) - V2785: Processing, preserving and transporting corneal tissue (Medicare: Carrier judgment) - V2786: Specialty occupational multifocal lens, per lens (Medicare: Special coverage instructions apply) - V2787: Astigmatism correcting function of intraocular lens (Medicare: Non-covered by Medicare statute) - V2788: Presbyopia correcting function of intraocular lens (Medicare: Non-covered by Medicare statute) - V2790: Amniotic membrane for surgical reconstruction, per procedure (Medicare: Carrier judgment) - V2797: Vision supply, accessory and/or service component of another hcpcs vision code (Medicare: Carrier judgment) - V2799: Vision item or service, miscellaneous (Medicare: Carrier judgment) - V5008: Hearing screening (Medicare: Non-covered by Medicare) - V5010: Assessment for hearing aid (Medicare: Non-covered by Medicare statute) - V5011: Fitting/orientation/checking of hearing aid (Medicare: Non-covered by Medicare statute) - V5014: Repair/modification of a hearing aid (Medicare: Non-covered by Medicare statute) - V5020: Conformity evaluation (Medicare: Non-covered by Medicare statute) - V5030: Hearing aid, monaural, body worn, air conduction (Medicare: Non-covered by Medicare statute) - V5040: Hearing aid, monaural, body worn, bone conduction (Medicare: Non-covered by Medicare statute) - V5050: Hearing aid, monaural, in the ear (Medicare: Non-covered by Medicare statute) - V5060: Hearing aid, monaural, behind the ear (Medicare: Non-covered by Medicare statute) - V5070: Glasses, air conduction (Medicare: Non-covered by Medicare statute) - V5080: Glasses, bone conduction (Medicare: Non-covered by Medicare statute) - V5090: Dispensing fee, unspecified hearing aid (Medicare: Non-covered by Medicare statute) - V5095: Semi-implantable middle ear hearing prosthesis (Medicare: Non-covered by Medicare statute) - V5100: Hearing aid, bilateral, body worn (Medicare: Non-covered by Medicare statute) - V5110: Dispensing fee, bilateral (Medicare: Non-covered by Medicare statute) - V5120: Binaural, body (Medicare: Non-covered by Medicare statute) - V5130: Binaural, in the ear (Medicare: Non-covered by Medicare statute) - V5140: Binaural, behind the ear (Medicare: Non-covered by Medicare statute) - V5150: Binaural, glasses (Medicare: Non-covered by Medicare statute) - V5160: Dispensing fee, binaural (Medicare: Non-covered by Medicare statute) - V5170: Hearing aid, cros, in the ear (Medicare: Non-covered by Medicare statute) - V5171: Hearing aid, contralateral routing device, monaural, in the ear (ite) (Medicare: Non-covered by Medicare statute) - V5172: Hearing aid, contralateral routing device, monaural, in the canal (itc) (Medicare: Non-covered by Medicare statute) - V5180: Hearing aid, cros, behind the ear (Medicare: Non-covered by Medicare statute) - V5181: Hearing aid, contralateral routing device, monaural, behind the ear (bte) (Medicare: Non-covered by Medicare statute) - V5190: Hearing aid, contralateral routing, monaural, glasses (Medicare: Non-covered by Medicare statute) - V5200: Dispensing fee, contralateral, monaural (Medicare: Non-covered by Medicare statute) - V5210: Hearing aid, bicros, in the ear (Medicare: Non-covered by Medicare statute) - V5211: Hearing aid, contralateral routing system, binaural, ite/ite (Medicare: Non-covered by Medicare statute) - V5212: Hearing aid, contralateral routing system, binaural, ite/itc (Medicare: Non-covered by Medicare statute) - V5213: Hearing aid, contralateral routing system, binaural, ite/bte (Medicare: Non-covered by Medicare statute) - V5214: Hearing aid, contralateral routing system, binaural, itc/itc (Medicare: Non-covered by Medicare statute) - V5215: Hearing aid, contralateral routing system, binaural, itc/bte (Medicare: Non-covered by Medicare statute) - V5220: Hearing aid, bicros, behind the ear (Medicare: Non-covered by Medicare statute) - V5221: Hearing aid, contralateral routing system, binaural, bte/bte (Medicare: Non-covered by Medicare statute) - V5230: Hearing aid, contralateral routing system, binaural, glasses (Medicare: Non-covered by Medicare statute) - V5240: Dispensing fee, contralateral routing system, binaural (Medicare: Non-covered by Medicare statute) - V5241: Dispensing fee, monaural hearing aid, any type (Medicare: Non-covered by Medicare statute) - V5242: Hearing aid, analog, monaural, cic (completely in the ear canal) (Medicare: Non-covered by Medicare statute) - V5243: Hearing aid, analog, monaural, itc (in the canal) (Medicare: Non-covered by Medicare statute) - V5244: Hearing aid, digitally programmable analog, monaural, cic (Medicare: Non-covered by Medicare statute) - V5245: Hearing aid, digitally programmable, analog, monaural, itc (Medicare: Non-covered by Medicare statute) - V5246: Hearing aid, digitally programmable analog, monaural, ite (in the ear) (Medicare: Non-covered by Medicare statute) - V5247: Hearing aid, digitally programmable analog, monaural, bte (behind the ear) (Medicare: Non-covered by Medicare statute) - V5248: Hearing aid, analog, binaural, cic (Medicare: Non-covered by Medicare statute) - V5249: Hearing aid, analog, binaural, itc (Medicare: Non-covered by Medicare statute) - V5250: Hearing aid, digitally programmable analog, binaural, cic (Medicare: Non-covered by Medicare statute) - V5251: Hearing aid, digitally programmable analog, binaural, itc (Medicare: Non-covered by Medicare statute) - V5252: Hearing aid, digitally programmable, binaural, ite (Medicare: Non-covered by Medicare statute) - V5253: Hearing aid, digitally programmable, binaural, bte (Medicare: Non-covered by Medicare statute) - V5254: Hearing aid, digital, monaural, cic (Medicare: Non-covered by Medicare statute) - V5255: Hearing aid, digital, monaural, itc (Medicare: Non-covered by Medicare statute) - V5256: Hearing aid, digital, monaural, ite (Medicare: Non-covered by Medicare statute) - V5257: Hearing aid, digital, monaural, bte (Medicare: Non-covered by Medicare statute) - V5258: Hearing aid, digital, binaural, cic (Medicare: Non-covered by Medicare statute) - V5259: Hearing aid, digital, binaural, itc (Medicare: Non-covered by Medicare statute) - V5260: Hearing aid, digital, binaural, ite (Medicare: Non-covered by Medicare statute) - V5261: Hearing aid, digital, binaural, bte (Medicare: Non-covered by Medicare statute) - V5262: Hearing aid, disposable, any type, monaural (Medicare: Non-covered by Medicare statute) - V5263: Hearing aid, disposable, any type, binaural (Medicare: Non-covered by Medicare statute) - V5264: Ear mold/insert, not disposable, any type (Medicare: Non-covered by Medicare statute) - V5265: Ear mold/insert, disposable, any type (Medicare: Non-covered by Medicare statute) - V5266: Battery for use in hearing device (Medicare: Non-covered by Medicare statute) - V5267: Hearing aid or assistive listening device/supplies/accessories, not otherwise specified (Medicare: Non-covered by Medicare statute) - V5268: Assistive listening device, telephone amplifier, any type (Medicare: Non-covered by Medicare statute) - V5269: Assistive listening device, alerting, any type (Medicare: Non-covered by Medicare statute) - V5270: Assistive listening device, television amplifier, any type (Medicare: Non-covered by Medicare statute) - V5271: Assistive listening device, television caption decoder (Medicare: Non-covered by Medicare statute) - V5272: Assistive listening device, tdd (Medicare: Non-covered by Medicare statute) - V5273: Assistive listening device, for use with cochlear implant (Medicare: Non-covered by Medicare statute) - V5274: Assistive listening device, not otherwise specified (Medicare: Non-covered by Medicare statute) - V5275: Ear impression, each (Medicare: Non-covered by Medicare statute) - V5281: Assistive listening device, personal fm/dm system, monaural, (1 receiver, transmitter, microphone), any type (Medicare: Non-covered by Medicare statute) - V5282: Assistive listening device, personal fm/dm system, binaural, (2 receivers, transmitter, microphone), any type (Medicare: Non-covered by Medicare statute) - V5283: Assistive listening device, personal fm/dm neck, loop induction receiver (Medicare: Non-covered by Medicare statute) - V5284: Assistive listening device, personal fm/dm, ear level receiver (Medicare: Non-covered by Medicare statute) - V5285: Assistive listening device, personal fm/dm, direct audio input receiver (Medicare: Non-covered by Medicare statute) - V5286: Assistive listening device, personal blue tooth fm/dm receiver (Medicare: Non-covered by Medicare statute) - V5287: Assistive listening device, personal fm/dm receiver, not otherwise specified (Medicare: Non-covered by Medicare statute) - V5288: Assistive listening device, personal fm/dm transmitter assistive listening device (Medicare: Non-covered by Medicare statute) - V5289: Assistive listening device, personal fm/dm adapter/boot coupling device for receiver, any type (Medicare: Non-covered by Medicare statute) - V5290: Assistive listening device, transmitter microphone, any type (Medicare: Non-covered by Medicare statute) - V5298: Hearing aid, not otherwise classified (Medicare: Non-covered by Medicare statute) - V5299: Hearing service, miscellaneous (Medicare: Special coverage instructions apply) - V5336: Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid) (Medicare: Non-covered by Medicare statute) - V5362: Speech screening (Medicare: Non-covered by Medicare statute) - V5363: Language screening (Medicare: Non-covered by Medicare statute) - V5364: Dysphagia screening (Medicare: Non-covered by Medicare statute)