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Default Fee Schedule Part 5
Default Fee Schedule Part 5 150 150 bellaireurgent

Default Fee Schedule Part 5

Code Price Type Description
K0011 0 HCPCS / CPT® STND WT PWR WHLCHR W CONTROL
K0012 0 HCPCS / CPT® LTWT PORTBL POWER WHLCHR
K0013 0 HCPCS / CPT® CUSTOM POWER WHLCHR BASE
K0014 0 HCPCS / CPT® OTHER POWER WHLCHR BASE
K0015 0 HCPCS / CPT® DETACH NON-ADJ HT ARMRST REP
K0017 0 HCPCS / CPT® DETACH ADJUST ARMREST BASE
K0018 0 HCPCS / CPT® DETACH ADJUST ARMRST UPPER
K0019 0 HCPCS / CPT® ARM PAD REPL, EACH
K0020 0 HCPCS / CPT® FIXED ADJUST ARMREST PAIR
K0037 0 HCPCS / CPT® HI MOUNT FLIP-UP FTREST REPL
K0038 0 HCPCS / CPT® LEG STRAP EACH
K0039 0 HCPCS / CPT® LEG STRAP H STYLE EACH
K0040 0 HCPCS / CPT® ADJUSTABLE ANGLE FOOTPLATE
K0041 0 HCPCS / CPT® LARGE SIZE FOOTPLATE EACH
K0042 0 HCPCS / CPT® STANDARD SIZE FTPLATE REP EA
K0043 0 HCPCS / CPT® FTRST LOWR EXTEN TUBE REP EA
K0044 0 HCPCS / CPT® FTRST UPR HANGER BRAC REP EA
K0045 0 HCPCS / CPT® FTRST COMPL ASSEMBLY REPL EA
K0046 0 HCPCS / CPT® ELEV LGRST LWR EXTEN REPL EA
K0047 0 HCPCS / CPT® ELEV LEGRST UPR HANGR REP EA
K0050 0 HCPCS / CPT® RATCHET ASSEMBLY REPLACEMENT
K0051 0 HCPCS / CPT® CAM REL ASM FT/LEGRST REP EA
K0052 0 HCPCS / CPT® SWINGAWAY DETACH FTREST REPL
K0053 0 HCPCS / CPT® ELEVATE FOOTREST ARTICULATE
K0056 0 HCPCS / CPT® K0065 0 HCPCS / CPT® SPOKE PROTECTORS
K0069 0 HCPCS / CPT® RR WHL COMPL SOL TIRE REP EA
K0070 0 HCPCS / CPT® RR WHL COMPL PNE TIRE REP EA
K0071 0 HCPCS / CPT® FR CSTR COMP PNE TIRE REP EA
K0072 0 HCPCS / CPT® FR CSTR SEMI-PNE TIRE REP EA
K0073 0 HCPCS / CPT® CASTER PIN LOCK EACH
K0077 0 HCPCS / CPT® FR CSTR ASMB SOL TIRE REP EA
K0098 0 HCPCS / CPT® DRIVE BELT FOR PWC, REPL
K0105 0 HCPCS / CPT® IV HANGER
K0108 0 HCPCS / CPT® W/C COMPONENT-ACCESSORY NOS
K0195 0 HCPCS / CPT® ELEVATING WHLCHAIR LEG RESTS
K0455 0 HCPCS / CPT® PUMP UNINTERRUPTED INFUSION
K0462 0 HCPCS / CPT® TEMPORARY REPLACEMENT EQPMNT
K0552 0 HCPCS / CPT® SUP/EXT NON-INS INF PUMP SYR
K0601 0 HCPCS / CPT® REPL BATT SILVER OXIDE 1.5 V
K0602 0 HCPCS / CPT® REPL BATT SILVER OXIDE 3 V
K0603 0 HCPCS / CPT® REPL BATT ALKALINE 1.5 V
K0604 0 HCPCS / CPT® REPL BATT LITHIUM 3.6 V
K0605 0 HCPCS / CPT® REPL BATT LITHIUM 4.5 V
K0606 0 HCPCS / CPT® AED GARMENT W ELEC ANALYSIS
K0607 0 HCPCS / CPT® REPL BATT FOR AED
K0608 0 HCPCS / CPT® REPL GARMENT FOR AED
K0609 0 HCPCS / CPT® REPL ELECTRODE FOR AED
K0669 0 HCPCS / CPT® SEAT/BACK CUS NO DMEPDAC VER
K0672 0 HCPCS / CPT® REMOVABLE SOFT INTERFACE LE
K0730 0 HCPCS / CPT® CTRL DOSE INH DRUG DELIV SYS
K0733 0 HCPCS / CPT® 12-24HR SEALED LEAD ACID
K0738 0 HCPCS / CPT® PORTABLE GAS OXYGEN SYSTEM
K0739 0 HCPCS / CPT® REPAIR/SVC DME NON-OXYGEN EQ
K0740 0 HCPCS / CPT® REPAIR/SVC OXYGEN EQUIPMENT
K0743 0 HCPCS / CPT® PORTABLE HOME SUCTION PUMP
K0744 0 HCPCS / CPT® ABSORP DRG <= 16 SUC PUMP
K0745 0 HCPCS / CPT® ABSORP DRG >16<=48 SUC PUMP
K0746 0 HCPCS / CPT® K0800 0 HCPCS / CPT® POV GROUP 1 STD UP TO 300LBS
K0801 0 HCPCS / CPT® POV GROUP 1 HD 301-450 LBS
K0802 0 HCPCS / CPT® POV GROUP 1 VHD 451-600 LBS
K0806 0 HCPCS / CPT® POV GROUP 2 STD UP TO 300LBS
K0807 0 HCPCS / CPT® POV GROUP 2 HD 301-450 LBS
K0808 0 HCPCS / CPT® POV GROUP 2 VHD 451-600 LBS
K0812 0 HCPCS / CPT® POWER OPERATED VEHICLE NOC
K0813 0 HCPCS / CPT® PWC GP 1 STD PORT SEAT/BACK
K0814 0 HCPCS / CPT® PWC GP 1 STD PORT CAP CHAIR
K0815 0 HCPCS / CPT® PWC GP 1 STD SEAT/BACK
K0816 0 HCPCS / CPT® PWC GP 1 STD CAP CHAIR
K0820 0 HCPCS / CPT® PWC GP 2 STD PORT SEAT/BACK
K0821 0 HCPCS / CPT® PWC GP 2 STD PORT CAP CHAIR
K0822 0 HCPCS / CPT® PWC GP 2 STD SEAT/BACK
K0823 0 HCPCS / CPT® PWC GP 2 STD CAP CHAIR
K0824 0 HCPCS / CPT® PWC GP 2 HD SEAT/BACK
K0825 0 HCPCS / CPT® PWC GP 2 HD CAP CHAIR
K0826 0 HCPCS / CPT® PWC GP 2 VHD SEAT/BACK
K0827 0 HCPCS / CPT® PWC GP VHD CAP CHAIR
K0828 0 HCPCS / CPT® PWC GP 2 XTRA HD SEAT/BACK
K0829 0 HCPCS / CPT® PWC GP 2 XTRA HD CAP CHAIR
K0830 0 HCPCS / CPT® PWC GP2 STD SEAT ELEVATE S/B
K0831 0 HCPCS / CPT® PWC GP2 STD SEAT ELEVATE CAP
K0835 0 HCPCS / CPT® PWC GP2 STD SING POW OPT S/B
K0836 0 HCPCS / CPT® PWC GP2 STD SING POW OPT CAP
K0837 0 HCPCS / CPT® PWC GP 2 HD SING POW OPT S/B
K0838 0 HCPCS / CPT® PWC GP 2 HD SING POW OPT CAP
K0839 0 HCPCS / CPT® PWC GP2 VHD SING POW OPT S/B
K0840 0 HCPCS / CPT® PWC GP2 XHD SING POW OPT S/B
K0841 0 HCPCS / CPT® PWC GP2 STD MULT POW OPT S/B
K0842 0 HCPCS / CPT® PWC GP2 STD MULT POW OPT CAP
K0843 0 HCPCS / CPT® PWC GP2 HD MULT POW OPT S/B
K0848 0 HCPCS / CPT® PWC GP 3 STD SEAT/BACK
K0849 0 HCPCS / CPT® PWC GP 3 STD CAP CHAIR
K0850 0 HCPCS / CPT® PWC GP 3 HD SEAT/BACK
K0851 0 HCPCS / CPT® PWC GP 3 HD CAP CHAIR
K0852 0 HCPCS / CPT® PWC GP 3 VHD SEAT/BACK
K0853 0 HCPCS / CPT® PWC GP 3 VHD CAP CHAIR
K0854 0 HCPCS / CPT® PWC GP 3 XHD SEAT/BACK
K0855 0 HCPCS / CPT® PWC GP 3 XHD CAP CHAIR
K0856 0 HCPCS / CPT® PWC GP3 STD SING POW OPT S/B
K0857 0 HCPCS / CPT® PWC GP3 STD SING POW OPT CAP
K0858 0 HCPCS / CPT® PWC GP3 HD SING POW OPT S/B
K0859 0 HCPCS / CPT® PWC GP3 HD SING POW OPT CAP
K0860 0 HCPCS / CPT® PWC GP3 VHD SING POW OPT S/B
K0861 0 HCPCS / CPT® PWC GP3 STD MULT POW OPT S/B
K0862 0 HCPCS / CPT® PWC GP3 HD MULT POW OPT S/B
K0863 0 HCPCS / CPT® PWC GP3 VHD MULT POW OPT S/B
K0864 0 HCPCS / CPT® PWC GP3 XHD MULT POW OPT S/B
K0868 0 HCPCS / CPT® PWC GP 4 STD SEAT/BACK
K0869 0 HCPCS / CPT® PWC GP 4 STD CAP CHAIR
K0870 0 HCPCS / CPT® PWC GP 4 HD SEAT/BACK
K0871 0 HCPCS / CPT® PWC GP 4 VHD SEAT/BACK
K0877 0 HCPCS / CPT® PWC GP4 STD SING POW OPT S/B
K0878 0 HCPCS / CPT® PWC GP4 STD SING POW OPT CAP
K0879 0 HCPCS / CPT® PWC GP4 HD SING POW OPT S/B
K0880 0 HCPCS / CPT® PWC GP4 VHD SING POW OPT S/B
K0884 0 HCPCS / CPT® PWC GP4 STD MULT POW OPT S/B
K0885 0 HCPCS / CPT® PWC GP4 STD MULT POW OPT CAP
K0886 0 HCPCS / CPT® PWC GP4 HD MULT POW S/B
K0890 0 HCPCS / CPT® PWC GP5 PED SING POW OPT S/B
K0891 0 HCPCS / CPT® PWC GP5 PED MULT POW OPT S/B
K0898 0 HCPCS / CPT® POWER WHEELCHAIR NOC
K0899 0 HCPCS / CPT® POW MOBIL DEV NO DMEPDAC
K0900 0 HCPCS / CPT® CSTM DME OTHER THAN WHEELCHR
L0112 0 HCPCS / CPT® CRANIAL CERVICAL ORTHOSIS
L0113 0 HCPCS / CPT® CRANIAL CERVICAL TORTICOLLIS
L0120 0 HCPCS / CPT® CERV FLEX N/ADJ FOAM PRE OTS
L0130 0 HCPCS / CPT® FLEX THERMOPLASTIC COLLAR MO
L0140 0 HCPCS / CPT® CERVICAL SEMI-RIGID ADJUSTAB
L0150 0 HCPCS / CPT® CERV SEMI-RIG ADJ MOLDED CHN
L0160 0 HCPCS / CPT® CERV SR WIRE OCC/MAN PRE OTS
L0170 0 HCPCS / CPT® CERVICAL COLLAR MOLDED TO PT
L0172 37 HCPCS / CPT® CERV COL SR FOAM 2PC PRE OTS
L0174 0 HCPCS / CPT® CERV SR 2PC THOR EXT PRE OTS
L0180 0 HCPCS / CPT® CER POST COL OCC/MAN SUP ADJ
L0190 0 HCPCS / CPT® CERV COLLAR SUPP ADJ CERV BA
L0200 0 HCPCS / CPT® CERV COL SUPP ADJ BAR & THOR
L0220 0 HCPCS / CPT® THOR RIB BELT CUSTOM FABRICA
L0450 0 HCPCS / CPT® TLSO FLEX TRUNK/THOR PRE OTS
L0452 0 HCPCS / CPT® TLSO FLEX CUSTOM FAB THORACI
L0454 0 HCPCS / CPT® TLSO TRNK SJ-T9 PRE CST
L0455 0 HCPCS / CPT® TLSO FLEX TRNK SJ-T9 PRE OTS
L0456 0 HCPCS / CPT® TLSO FLEX TRNK SJ-SS PRE CST
L0457 0 HCPCS / CPT® TLSO FLEX TRNK SJ-SS PRE OTS
L0458 0 HCPCS / CPT® TLSO 2MOD SYMPHIS-XIPHO PRE
L0460 0 HCPCS / CPT® TLSO 2 SHL SYMPHYS-STERN CST
L0462 0 HCPCS / CPT® TLSO 3MOD SACRO-SCAP PRE
L0464 0 HCPCS / CPT® TLSO 4MOD SACRO-SCAP PRE
L0466 0 HCPCS / CPT® TLSO R FRAM SOFT ANT PRE CST
L0467 0 HCPCS / CPT® TLSO R FRAM SOFT PRE OTS
L0468 0 HCPCS / CPT® TLSO RIG FRAM PELVIC PRE CST
L0469 0 HCPCS / CPT® TLSO RIG FRAM PELVIC PRE OTS
L0470 0 HCPCS / CPT® TLSO RIGID FRAME PRE SUBCLAV
L0472 0 HCPCS / CPT® TLSO RIGID FRAME HYPEREX PRE
L0480 0 HCPCS / CPT® TLSO RIGID PLASTIC CUSTOM FA
L0482 0 HCPCS / CPT® TLSO RIGID LINED CUSTOM FAB
L0484 0 HCPCS / CPT® TLSO RIGID PLASTIC CUST FAB
L0486 0 HCPCS / CPT® TLSO RIGIDLINED CUST FAB TWO
L0488 0 HCPCS / CPT® TLSO RIGID LINED PRE ONE PIE
L0490 0 HCPCS / CPT® TLSO RIGID PLASTIC PRE ONE
L0491 0 HCPCS / CPT® TLSO 2 PIECE RIGID SHELL
L0492 0 HCPCS / CPT® TLSO 3 PIECE RIGID SHELL
L0621 0 HCPCS / CPT® SIO FLEX PELVIC/SACR PRE OTS
L0622 0 HCPCS / CPT® SIO FLEX PELVISACRAL CUSTOM
L0623 0 HCPCS / CPT® SIO RIG PNL PELV/SAC PRE OTS
L0624 0 HCPCS / CPT® SIO PANEL CUSTOM
L0625 0 HCPCS / CPT® LO FLEX L1-BELOW L5 PRE OTS
L0626 0 HCPCS / CPT® LO SAG RIG PNL STAYS PRE CST
L0627 0 HCPCS / CPT® LO SAG RI AN/POS PNL PRE CST
L0628 0 HCPCS / CPT® LSO FLEX NO RI STAYS PRE OTS
L0629 0 HCPCS / CPT® LSO FLEX W/RIGID STAYS CUST
L0630 0 HCPCS / CPT® LSO R POST PNL SJ-T9 PRE CST
L0631 0 HCPCS / CPT® LSO SAG R AN/POS PNL PRE CST
L0632 0 HCPCS / CPT® LSO SAG RIGID FRAME CUST
L0633 0 HCPCS / CPT® LSO SC R POS/LAT PNL PRE CST
L0634 0 HCPCS / CPT® LSO FLEXION CONTROL CUSTOM
L0635 0 HCPCS / CPT® LSO SAGIT RIGID PANEL PREFAB
L0636 0 HCPCS / CPT® LSO SAGITTAL RIGID PANEL CUS
L0637 0 HCPCS / CPT® LSO SC R ANT/POS PNL PRE CST
L0638 0 HCPCS / CPT® LSO SAG-CORONAL PANEL CUSTOM
L0639 0 HCPCS / CPT® LSO S/C SHELL/PANEL PREFAB
L0640 0 HCPCS / CPT® LSO S/C SHELL/PANEL CUSTOM
L0641 0 HCPCS / CPT® LO RIG POS PNL L1-L5 PRE OTS
L0642 0 HCPCS / CPT® LO SAG RI AN/POS PNL PRE OTS
L0643 0 HCPCS / CPT® LSO SAG CTR RIGI POS PRE OTS
L0648 0 HCPCS / CPT® LSO SAG R AN/POS PNL PRE OTS
L0649 0 HCPCS / CPT® LSO SC R POS/LAT PNL PRE OTS
L0650 0 HCPCS / CPT® LSO SC R ANT/POS PNL PRE OTS
L0651 0 HCPCS / CPT® LSO SAG-CO SHELL PNL PRE OTS
L0700 0 HCPCS / CPT® CTLSO A-P-L CONTROL MOLDED
L0710 0 HCPCS / CPT® CTLSO A-P-L CONTROL W/ INTER
L0810 0 HCPCS / CPT® HALO CERVICAL INTO JCKT VEST
L0820 0 HCPCS / CPT® HALO CERVICAL INTO BODY JACK
L0830 0 HCPCS / CPT® HALO CERV INTO MILWAUKEE TYP
L0859 0 HCPCS / CPT® MRI COMPATIBLE SYSTEM
L0861 0 HCPCS / CPT® HALO REPL LINER/INTERFACE
L0970 0 HCPCS / CPT® TLSO CORSET FRONT
L0972 0 HCPCS / CPT® LSO CORSET FRONT
L0974 0 HCPCS / CPT® TLSO FULL CORSET
L0976 0 HCPCS / CPT® LSO FULL CORSET
L0978 0 HCPCS / CPT® AXILLARY CRUTCH EXTENSION
L0980 0 HCPCS / CPT® PERONEAL STRAPS PAIR PRE OTS
L0982 0 HCPCS / CPT® STOCKING SUP GRIPS 4 PRE OTS
L0984 0 HCPCS / CPT® PROTECT BODY SOCK EA PRE OTS
L0999 0 HCPCS / CPT® ADD TO SPINAL ORTHOSIS NOS
L1000 0 HCPCS / CPT® CTLSO MILWAUKE INITIAL MODEL
L1001 0 HCPCS / CPT® CTLSO INFANT IMMOBILIZER
L1005 0 HCPCS / CPT® TENSION BASED SCOLIOSIS ORTH
L1010 0 HCPCS / CPT® CTLSO AXILLA SLING
L1020 0 HCPCS / CPT® KYPHOSIS PAD
L1025 0 HCPCS / CPT® KYPHOSIS PAD FLOATING
L1030 0 HCPCS / CPT® LUMBAR BOLSTER PAD
L1040 0 HCPCS / CPT® LUMBAR OR LUMBAR RIB PAD
L1050 0 HCPCS / CPT® STERNAL PAD
L1060 0 HCPCS / CPT® THORACIC PAD
L1070 0 HCPCS / CPT® TRAPEZIUS SLING
L1080 0 HCPCS / CPT® OUTRIGGER
L1085 0 HCPCS / CPT® OUTRIGGER BIL W/ VERT EXTENS
L1090 0 HCPCS / CPT® LUMBAR SLING
L1100 0 HCPCS / CPT® RING FLANGE PLASTIC/LEATHER
L1110 0 HCPCS / CPT® RING FLANGE PLAS/LEATHER MOL
L1120 0 HCPCS / CPT® COVERS FOR UPRIGHT EACH
L1200 0 HCPCS / CPT® FURNSH INITIAL ORTHOSIS ONLY
L1210 0 HCPCS / CPT® LATERAL THORACIC EXTENSION
L1220 0 HCPCS / CPT® ANTERIOR THORACIC EXTENSION
L1230 0 HCPCS / CPT® MILWAUKEE TYPE SUPERSTRUCTUR
L1240 0 HCPCS / CPT® LUMBAR DEROTATION PAD
L1250 0 HCPCS / CPT® ANTERIOR ASIS PAD
L1260 0 HCPCS / CPT® ANTERIOR THORACIC DEROTATION
L1270 0 HCPCS / CPT® ABDOMINAL PAD
L1280 0 HCPCS / CPT® RIB GUSSET (ELASTIC) EACH
L1290 0 HCPCS / CPT® LATERAL TROCHANTERIC PAD
L1300 0 HCPCS / CPT® BODY JACKET MOLD TO PATIENT
L1310 0 HCPCS / CPT® POST-OPERATIVE BODY JACKET
L1499 0 HCPCS / CPT® SPINAL ORTHOSIS NOS
L1600 0 HCPCS / CPT® HO FLEX FREJKA W/COV PRE CST
L1610 0 HCPCS / CPT® HO FREJKA COV ONLY PRE CST
L1620 0 HCPCS / CPT® HO FLEX PAVLIK HARNS PRE CST
L1630 0 HCPCS / CPT® ABDUCT CONTROL HIP SEMI-FLEX
L1640 0 HCPCS / CPT® PELV BAND/SPREAD BAR THIGH C
L1650 0 HCPCS / CPT® HO ABDUCTION HIP ADJUSTABLE
L1652 0 HCPCS / CPT® HO BI THIGHCUFFS W SPRDR BAR
L1660 0 HCPCS / CPT® HO ABDUCTION STATIC PLASTIC
L1680 0 HCPCS / CPT® PELVIC & HIP CONTROL THIGH C
L1685 0 HCPCS / CPT® POST-OP HIP ABDUCT CUSTOM FA
L1686 0 HCPCS / CPT® HO POST-OP HIP ABDUCTION
L1690 0 HCPCS / CPT® COMBINATION BILATERAL HO
L1700 0 HCPCS / CPT® LEG PERTHES ORTH TORONTO TYP
L1710 0 HCPCS / CPT® LEGG PERTHES ORTH NEWINGTON
L1720 0 HCPCS / CPT® LEGG PERTHES ORTHOSIS TRILAT
L1730 0 HCPCS / CPT® LEGG PERTHES ORTH SCOTTISH R
L1755 0 HCPCS / CPT® LEGG PERTHES PATTEN BOTTOM T
L1810 0 HCPCS / CPT® KO ELASTIC WITH JOINTS
L1812 0 HCPCS / CPT® KO ELASTIC W/JOINTS PRE OTS
L1820 0 HCPCS / CPT® KO ELAS W/ CONDYLE PADS & JO
L1830 42 HCPCS / CPT® KO IMMOB CANVAS LONG PRE OTS
L1831 0 HCPCS / CPT® KNEE ORTH POS LOCKING JOINT
L1832 0 HCPCS / CPT® KO ADJ JNT POS R SUP PRE CST
L1833 0 HCPCS / CPT® KO ADJ JNT POS R SUP PRE OTS
L1834 0 HCPCS / CPT® KO W/0 JOINT RIGID MOLDED TO
L1836 0 HCPCS / CPT® KO RIGID W/O JOINTS PRE OTS
L1840 0 HCPCS / CPT® KO DEROT ANT CRUCIATE CUSTOM
L1843 0 HCPCS / CPT® KO SINGLE UPRIGHT PRE CST
L1844 0 HCPCS / CPT® KO W/ADJ JT ROT CNTRL MOLDED
L1845 0 HCPCS / CPT® KO DOUBLE UPRIGHT PRE CST
L1846 0 HCPCS / CPT® KO W ADJ FLEX/EXT ROTAT MOLD
L1847 0 HCPCS / CPT® KO DBL UPRIGHT W/AIR PRE CST
L1848 0 HCPCS / CPT® KO DBL UPRIGHT W/AIR PRE OTS
L1850 0 HCPCS / CPT® KO SWEDISH TYPE PRE OTS
L1851 0 HCPCS / CPT® KO SINGLE UPRIGHT PREFAB OTS
L1852 0 HCPCS / CPT® KO DOUBLE UPRIGHT PREFAB OTS
L1860 0 HCPCS / CPT® KO SUPRACONDYLAR SOCKET MOLD
L1900 0 HCPCS / CPT® AFO SPRNG WIR DRSFLX CALF BD
L1902 0 HCPCS / CPT® AFO ANKLE GAUNTLET PRE OTS
L1904 0 HCPCS / CPT® AFO MOLDED ANKLE GAUNTLET
L1906 121 HCPCS / CPT® AFO MULTILIG ANK SUP PRE OTS
L1907 0 HCPCS / CPT® AFO SUPRAMALLEOLAR CUSTOM
L1910 0 HCPCS / CPT® AFO SING BAR CLASP ATTACH SH
L1920 0 HCPCS / CPT® AFO SING UPRIGHT W/ ADJUST S
L1930 0 HCPCS / CPT® AFO PLASTIC
L1932 0 HCPCS / CPT® AFO RIG ANT TIB PREFAB TCF/=
L1940 0 HCPCS / CPT® AFO MOLDED TO PATIENT PLASTI
L1945 0 HCPCS / CPT® AFO MOLDED PLAS RIG ANT TIB
L1950 0 HCPCS / CPT® AFO SPIRAL MOLDED TO PT PLAS
L1951 0 HCPCS / CPT® AFO SPIRAL PREFABRICATED
L1960 0 HCPCS / CPT® AFO POS SOLID ANK PLASTIC MO
L1970 0 HCPCS / CPT® AFO PLASTIC MOLDED W/ANKLE J
L1971 0 HCPCS / CPT® AFO W/ANKLE JOINT, PREFAB
L1980 0 HCPCS / CPT® AFO SING SOLID STIRRUP CALF
L1990 0 HCPCS / CPT® AFO DOUB SOLID STIRRUP CALF
L2000 0 HCPCS / CPT® KAFO SING FRE STIRR THI/CALF
L2005 0 HCPCS / CPT® KAFO SNG/DBL MECHANICAL ACT
L2010 0 HCPCS / CPT® KAFO SNG SOLID STIRRUP W/O J
L2020 0 HCPCS / CPT® KAFO DBL SOLID STIRRUP BAND/
L2030 0 HCPCS / CPT® KAFO DBL SOLID STIRRUP W/O J
L2034 0 HCPCS / CPT® KAFO PLA SIN UP W/WO K/A CUS
L2035 0 HCPCS / CPT® KAFO PLASTIC PEDIATRIC SIZE
L2036 0 HCPCS / CPT® KAFO PLAS DOUB FREE KNEE MOL
L2037 0 HCPCS / CPT® KAFO PLAS SING FREE KNEE MOL
L2038 0 HCPCS / CPT® KAFO W/O JOINT MULTI-AXIS AN
L2040 0 HCPCS / CPT® HKAFO TORSION BIL ROT STRAPS
L2050 0 HCPCS / CPT® HKAFO TORSION CABLE HIP PELV
L2060 0 HCPCS / CPT® HKAFO TORSION BALL BEARING J
L2070 0 HCPCS / CPT® HKAFO TORSION UNILAT ROT STR
L2080 0 HCPCS / CPT® HKAFO UNILAT TORSION CABLE
L2090 0 HCPCS / CPT® HKAFO UNILAT TORSION BALL BR
L2106 0 HCPCS / CPT® AFO TIB FX CAST PLASTER MOLD
L2108 0 HCPCS / CPT® AFO TIB FX CAST MOLDED TO PT
L2112 0 HCPCS / CPT® AFO TIBIAL FRACTURE SOFT
L2114 0 HCPCS / CPT® AFO TIB FX SEMI-RIGID
L2116 0 HCPCS / CPT® AFO TIBIAL FRACTURE RIGID
L2126 0 HCPCS / CPT® KAFO FEM FX CAST THERMOPLAS
L2128 0 HCPCS / CPT® KAFO FEM FX CAST MOLDED TO P
L2132 0 HCPCS / CPT® KAFO FEMORAL FX CAST SOFT
L2134 0 HCPCS / CPT® KAFO FEM FX CAST SEMI-RIGID
L2136 0 HCPCS / CPT® KAFO FEMORAL FX CAST RIGID
L2180 0 HCPCS / CPT® PLAS SHOE INSERT W ANK JOINT
L2182 0 HCPCS / CPT® DROP LOCK KNEE
L2184 0 HCPCS / CPT® LIMITED MOTION KNEE JOINT
L2186 0 HCPCS / CPT® ADJ MOTION KNEE JNT LERMAN T
L2188 0 HCPCS / CPT® QUADRILATERAL BRIM
L2190 0 HCPCS / CPT® WAIST BELT
L2192 0 HCPCS / CPT® PELVIC BAND & BELT THIGH FLA
L2200 0 HCPCS / CPT® LIMITED ANKLE MOTION EA JNT
L2210 0 HCPCS / CPT® DORSIFLEXION ASSIST EACH JOI
L2220 0 HCPCS / CPT® DORSI & PLANTAR FLEX ASS/RES
L2230 0 HCPCS / CPT® SPLIT FLAT CALIPER STIRR & P
L2232 0 HCPCS / CPT® ROCKER BOTTOM, CONTACT AFO
L2240 0 HCPCS / CPT® ROUND CALIPER AND PLATE ATTA
L2250 0 HCPCS / CPT® FOOT PLATE MOLDED STIRRUP AT
L2260 0 HCPCS / CPT® REINFORCED SOLID STIRRUP
L2265 0 HCPCS / CPT® LONG TONGUE STIRRUP
L2270 0 HCPCS / CPT® VARUS/VALGUS STRAP PADDED/LI
L2275 0 HCPCS / CPT® PLASTIC MOD LOW EXT PAD/LINE
L2280 0 HCPCS / CPT® MOLDED INNER BOOT
L2300 0 HCPCS / CPT® ABDUCTION BAR JOINTED ADJUST
L2310 0 HCPCS / CPT® ABDUCTION BAR-STRAIGHT
L2320 0 HCPCS / CPT® NON-MOLDED LACER
L2330 0 HCPCS / CPT® LACER MOLDED TO PATIENT MODE
L2335 0 HCPCS / CPT® ANTERIOR SWING BAND
L2340 0 HCPCS / CPT® PRE-TIBIAL SHELL MOLDED TO P
L2350 0 HCPCS / CPT® PROSTHETIC TYPE SOCKET MOLDE
L2360 0 HCPCS / CPT® EXTENDED STEEL SHANK
L2370 0 HCPCS / CPT® PATTEN BOTTOM
L2375 0 HCPCS / CPT® TORSION ANK & HALF SOLID STI
L2380 0 HCPCS / CPT® TORSION STRAIGHT KNEE JOINT
L2385 0 HCPCS / CPT® STRAIGHT KNEE JOINT HEAVY DU
L2387 0 HCPCS / CPT® ADD LE POLY KNEE CUSTOM KAFO
L2390 0 HCPCS / CPT® OFFSET KNEE JOINT EACH
L2395 0 HCPCS / CPT® OFFSET KNEE JOINT HEAVY DUTY
L2397 0 HCPCS / CPT® SUSPENSION SLEEVE LOWER EXT
L2405 0 HCPCS / CPT® KNEE JOINT DROP LOCK EA JNT
L2415 0 HCPCS / CPT® KNEE JOINT CAM LOCK EACH JOI
L2425 0 HCPCS / CPT® KNEE DISC/DIAL LOCK/ADJ FLEX
L2430 0 HCPCS / CPT® KNEE JNT RATCHET LOCK EA JNT
L2492 0 HCPCS / CPT® KNEE LIFT LOOP DROP LOCK RIN
L2500 0 HCPCS / CPT® THI/GLUT/ISCHIA WGT BEARING
L2510 0 HCPCS / CPT® TH/WGHT BEAR QUAD-LAT BRIM M
L2520 0 HCPCS / CPT® TH/WGHT BEAR QUAD-LAT BRIM C
L2525 0 HCPCS / CPT® TH/WGHT BEAR NAR M-L BRIM MO
L2526 0 HCPCS / CPT® TH/WGHT BEAR NAR M-L BRIM CU
L2530 0 HCPCS / CPT® THIGH/WGHT BEAR LACER NON-MO
L2540 0 HCPCS / CPT® THIGH/WGHT BEAR LACER MOLDED
L2550 0 HCPCS / CPT® THIGH/WGHT BEAR HIGH ROLL CU
L2570 0 HCPCS / CPT® HIP CLEVIS TYPE 2 POSIT JNT
L2580 0 HCPCS / CPT® PELVIC CONTROL PELVIC SLING
L2600 0 HCPCS / CPT® HIP CLEVIS/THRUST BEARING FR
L2610 0 HCPCS / CPT® HIP CLEVIS/THRUST BEARING LO
L2620 0 HCPCS / CPT® PELVIC CONTROL HIP HEAVY DUT
L2622 0 HCPCS / CPT® HIP JOINT ADJUSTABLE FLEXION
L2624 0 HCPCS / CPT® HIP ADJ FLEX EXT ABDUCT CONT
L2627 0 HCPCS / CPT® PLASTIC MOLD RECIPRO HIP & C
L2628 0 HCPCS / CPT® METAL FRAME RECIPRO HIP & CA
L2630 0 HCPCS / CPT® PELVIC CONTROL BAND & BELT U
L2640 0 HCPCS / CPT® PELVIC CONTROL BAND & BELT B
L2650 0 HCPCS / CPT® PELV & THOR CONTROL GLUTEAL
L2660 0 HCPCS / CPT® THORACIC CONTROL THORACIC BA
L2670 0 HCPCS / CPT® THORAC CONT PARASPINAL UPRIG
L2680 0 HCPCS / CPT® THORAC CONT LAT SUPPORT UPRI
L2750 0 HCPCS / CPT® PLATING CHROME/NICKEL PR BAR
L2755 0 HCPCS / CPT® CARBON GRAPHITE LAMINATION
L2760 0 HCPCS / CPT® EXTENSION PER EXTENSION PER
L2768 0 HCPCS / CPT® ORTHO SIDEBAR DISCONNECT
L2780 0 HCPCS / CPT® NON-CORROSIVE FINISH
L2785 0 HCPCS / CPT® DROP LOCK RETAINER EACH
L2795 0 HCPCS / CPT® KNEE CONTROL FULL KNEECAP
L2800 0 HCPCS / CPT® KNEE CAP MEDIAL OR LATERAL P
L2810 0 HCPCS / CPT® KNEE CONTROL CONDYLAR PAD
L2820 0 HCPCS / CPT® SOFT INTERFACE BELOW KNEE SE
L2830 0 HCPCS / CPT® SOFT INTERFACE ABOVE KNEE SE
L2840 0 HCPCS / CPT® TIBIAL LENGTH SOCK FX OR EQU
L2850 0 HCPCS / CPT® FEMORAL LGTH SOCK FX OR EQUA
L2861 0 HCPCS / CPT® TORSION MECHANISM KNEE/ANKLE
L2999 0 HCPCS / CPT® LOWER EXTREMITY ORTHOSIS NOS
L3000 0 HCPCS / CPT® FT INSERT UCB BERKELEY SHELL
L3001 0 HCPCS / CPT® FOOT INSERT REMOV MOLDED SPE
L3002 0 HCPCS / CPT® FOOT INSERT PLASTAZOTE OR EQ
L3003 0 HCPCS / CPT® FOOT INSERT SILICONE GEL EAC
L3010 0 HCPCS / CPT® FOOT LONGITUDINAL ARCH SUPPO
L3020 0 HCPCS / CPT® FOOT LONGITUD/METATARSAL SUP
L3030 0 HCPCS / CPT® FOOT ARCH SUPPORT REMOV PREM
L3031 0 HCPCS / CPT® FOOT LAMIN/PREPREG COMPOSITE
L3040 0 HCPCS / CPT® FT ARCH SUPRT PREMOLD LONGIT
L3050 0 HCPCS / CPT® FOOT ARCH SUPP PREMOLD METAT
L3060 0 HCPCS / CPT® FOOT ARCH SUPP LONGITUD/META
L3070 0 HCPCS / CPT® ARCH SUPRT ATT TO SHO LONGIT
L3080 0 HCPCS / CPT® ARCH SUPP ATT TO SHOE METATA
L3090 0 HCPCS / CPT® ARCH SUPP ATT TO SHOE LONG/M
L3100 0 HCPCS / CPT® HALLUS-VALGUS NT DYN PRE OTS
L3140 0 HCPCS / CPT® ABDUCTION ROTATION BAR SHOE
L3150 0 HCPCS / CPT® ABDUCT ROTATION BAR W/O SHOE
L3160 0 HCPCS / CPT® SHOE STYLED POSITIONING DEV
L3170 0 HCPCS / CPT® FOOT PLAS HEEL STABI PRE OTS
L3201 0 HCPCS / CPT® OXFORD W SUPINAT/PRONAT INF
L3202 0 HCPCS / CPT® OXFORD W/ SUPINAT/PRONATOR C
L3203 0 HCPCS / CPT® OXFORD W/ SUPINATOR/PRONATOR
L3204 0 HCPCS / CPT® HIGHTOP W/ SUPP/PRONATOR INF
L3206 0 HCPCS / CPT® HIGHTOP W/ SUPP/PRONATOR CHI
L3207 0 HCPCS / CPT® HIGHTOP W/ SUPP/PRONATOR JUN
L3208 0 HCPCS / CPT® SURGICAL BOOT EACH INFANT
L3209 0 HCPCS / CPT® SURGICAL BOOT EACH CHILD
L3211 0 HCPCS / CPT® SURGICAL BOOT EACH JUNIOR
L3212 0 HCPCS / CPT® BENESCH BOOT PAIR INFANT
L3213 0 HCPCS / CPT® BENESCH BOOT PAIR CHILD
L3214 0 HCPCS / CPT® BENESCH BOOT PAIR JUNIOR
L3215 0 HCPCS / CPT® ORTHOPEDIC FTWEAR LADIES OXF
L3216 0 HCPCS / CPT® ORTHOPED LADIES SHOES DPTH I
L3217 0 HCPCS / CPT® LADIES SHOES HIGHTOP DEPTH I
L3219 0 HCPCS / CPT® ORTHOPEDIC MENS SHOES OXFORD
L3221 0 HCPCS / CPT® ORTHOPEDIC MENS SHOES DPTH I
L3222 0 HCPCS / CPT® MENS SHOES HIGHTOP DEPTH INL
L3224 0 HCPCS / CPT® WOMAN’S SHOE OXFORD BRACE
L3225 0 HCPCS / CPT® MAN’S SHOE OXFORD BRACE
L3230 0 HCPCS / CPT® CUSTOM SHOES DEPTH INLAY
L3250 0 HCPCS / CPT® CUSTOM MOLD SHOE REMOV PROST
L3251 0 HCPCS / CPT® SHOE MOLDED TO PT SILICONE S
L3252 0 HCPCS / CPT® SHOE MOLDED PLASTAZOTE CUST
L3253 0 HCPCS / CPT® SHOE MOLDED PLASTAZOTE CUST
L3254 0 HCPCS / CPT® ORTH FOOT NON-STNDARD SIZE/W
L3255 0 HCPCS / CPT® ORTH FOOT NON-STANDARD SIZE/
L3257 0 HCPCS / CPT® ORTH FOOT ADD CHARGE SPLIT S
L3260 79 HCPCS / CPT® AMBULATORY SURGICAL BOOT EAC
L3265 0 HCPCS / CPT® PLASTAZOTE SANDAL EACH
L3300 0 HCPCS / CPT® SHO LIFT TAPER TO METATARSAL
L3310 0 HCPCS / CPT® SHOE LIFT ELEV HEEL/SOLE NEO
L3320 0 HCPCS / CPT® SHOE LIFT ELEV HEEL/SOLE COR
L3330 0 HCPCS / CPT® LIFTS ELEVATION METAL EXTENS
L3332 0 HCPCS / CPT® SHOE LIFTS TAPERED TO ONE-HA
L3334 0 HCPCS / CPT® SHOE LIFTS ELEVATION HEEL /I
L3340 0 HCPCS / CPT® SHOE WEDGE SACH
L3350 0 HCPCS / CPT® SHOE HEEL WEDGE
L3360 0 HCPCS / CPT® SHOE SOLE WEDGE OUTSIDE SOLE
L3370 0 HCPCS / CPT® SHOE SOLE WEDGE BETWEEN SOLE
L3380 0 HCPCS / CPT® SHOE CLUBFOOT WEDGE
L3390 0 HCPCS / CPT® SHOE OUTFLARE WEDGE
L3400 0 HCPCS / CPT® SHOE METATARSAL BAR WEDGE RO
L3410 0 HCPCS / CPT® SHOE METATARSAL BAR BETWEEN
L3420 0 HCPCS / CPT® FULL SOLE/HEEL WEDGE BTWEEN
L3430 0 HCPCS / CPT® SHO HEEL COUNT PLAST REINFOR
L3440 0 HCPCS / CPT® HEEL LEATHER REINFORCED
L3450 0 HCPCS / CPT® SHOE HEEL SACH CUSHION TYPE
L3455 0 HCPCS / CPT® SHOE HEEL NEW LEATHER STANDA
L3460 0 HCPCS / CPT® SHOE HEEL NEW RUBBER STANDAR
L3465 0 HCPCS / CPT® SHOE HEEL THOMAS WITH WEDGE
L3470 0 HCPCS / CPT® SHOE HEEL THOMAS EXTEND TO B
L3480 0 HCPCS / CPT® SHOE HEEL PAD & DEPRESS FOR
L3485 0 HCPCS / CPT® SHOE HEEL PAD REMOVABLE FOR
L3500 0 HCPCS / CPT® ORTHO SHOE ADD LEATHER INSOL
L3510 0 HCPCS / CPT® ORTHOPEDIC SHOE ADD RUB INSL
L3520 0 HCPCS / CPT® O SHOE ADD FELT W LEATH INSL
L3530 0 HCPCS / CPT® ORTHO SHOE ADD HALF SOLE
L3540 0 HCPCS / CPT® ORTHO SHOE ADD FULL SOLE
L3550 0 HCPCS / CPT® O SHOE ADD STANDARD TOE TAP
L3560 0 HCPCS / CPT® O SHOE ADD HORSESHOE TOE TAP
L3570 0 HCPCS / CPT® O SHOE ADD INSTEP EXTENSION
L3580 0 HCPCS / CPT® O SHOE ADD INSTEP VELCRO CLO
L3590 0 HCPCS / CPT® O SHOE CONVERT TO SOF COUNTE
L3595 0 HCPCS / CPT® ORTHO SHOE ADD MARCH BAR
L3600 0 HCPCS / CPT® TRANS SHOE CALIP PLATE EXIST
L3610 0 HCPCS / CPT® TRANS SHOE CALIPER PLATE NEW
L3620 0 HCPCS / CPT® TRANS SHOE SOLID STIRRUP EXI
L3630 0 HCPCS / CPT® TRANS SHOE SOLID STIRRUP NEW
L3640 0 HCPCS / CPT® SHOE DENNIS BROWNE SPLINT BO
L3649 0 HCPCS / CPT® ORTHOPEDIC SHOE MODIFICA NOS
L3650 0 HCPCS / CPT® SO 8 ABD RESTRAINT PRE OTS
L3660 0 HCPCS / CPT® SO 8 AB RSTR CAN/WEB PRE OTS
L3670 0 HCPCS / CPT® SO ACRO/CLAV CAN WEB PRE OTS
L3671 0 HCPCS / CPT® SO CAP DESIGN W/O JNTS CF
L3674 0 HCPCS / CPT® SO AIRPLANE W/WO JOINT CF
L3675 0 HCPCS / CPT® SO VEST CANVAS/WEB PRE OTS
L3677 0 HCPCS / CPT® SO HARD PLAS STABILI PRE CST
L3678 0 HCPCS / CPT® SO HARD PLAS STABILI PRE OTS
L3702 0 HCPCS / CPT® EO W/O JOINTS CF
L3710 0 HCPCS / CPT® EO ELAS W/METAL JNTS PRE OTS
L3720 0 HCPCS / CPT® FOREARM/ARM CUFFS FREE MOTIO
L3730 0 HCPCS / CPT® FOREARM/ARM CUFFS EXT/FLEX A
L3740 0 HCPCS / CPT® CUFFS ADJ LOCK W/ ACTIVE CON
L3760 0 HCPCS / CPT® EO WITHJOINT, PREFABRICATED
L3762 0 HCPCS / CPT® EO RIGID W/O JOINTS PRE OTS
L3763 0 HCPCS / CPT® EWHO RIGID W/O JNTS CF
L3764 0 HCPCS / CPT® EWHO W/JOINT(S) CF
L3765 0 HCPCS / CPT® EWHFO RIGID W/O JNTS CF
L3766 0 HCPCS / CPT® EWHFO W/JOINT(S) CF
L3806 0 HCPCS / CPT® WHFO W/JOINT(S) CUSTOM FAB
L3807 0 HCPCS / CPT® WHFO W/O JOINTS PRE CST
L3808 0 HCPCS / CPT® WHFO, RIGID W/O JOINTS
L3809 0 HCPCS / CPT® WHFO W/O JOINTS PRE OTS
L3891 0 HCPCS / CPT® TORSION MECHANISM WRIST/ELBO
L3900 0 HCPCS / CPT® HINGE EXTENSION/FLEX WRIST/F
L3901 0 HCPCS / CPT® HINGE EXT/FLEX WRIST FINGER
L3904 0 HCPCS / CPT® WHFO ELECTRIC CUSTOM FITTED
L3905 0 HCPCS / CPT® WHO W/NONTORSION JNT(S) CF
L3906 0 HCPCS / CPT® WHO W/O JOINTS CF
L3908 79 HCPCS / CPT® WHO COCK-UP NONMOLDE PRE OTS
L3912 0 HCPCS / CPT® HFO FLEXION GLOVE PRE OTS
L3913 0 HCPCS / CPT® HFO W/O JOINTS CF
L3915 0 HCPCS / CPT® WHO NONTORSION JNTS PRE CST
L3916 0 HCPCS / CPT® WHO NONTORSION JNTS PRE OTS
L3917 0 HCPCS / CPT® METACARP FX ORTHOSIS PRE CST
L3918 0 HCPCS / CPT® METACARP FX ORTHOSIS PRE OTS
L3919 0 HCPCS / CPT® HO W/O JOINTS CF
L3921 0 HCPCS / CPT® HFO W/JOINT(S) CF
L3923 0 HCPCS / CPT® HFO WITHOUT JOINTS PRE CST
L3924 0 HCPCS / CPT® HFO WITHOUT JOINTS PRE OTS
L3925 0 HCPCS / CPT® FO PIP DIP JNT/SPRNG PRE OTS
L3927 0 HCPCS / CPT® FO PIP DIP NO JT SPR PRE OTS
L3929 0 HCPCS / CPT® HFO NONTORSION JNTS PRE CST
L3930 0 HCPCS / CPT® HFO NONTORSION JNTS PRE OTS
L3931 0 HCPCS / CPT® WHFO NONTORSION JOINT PREFAB
L3933 0 HCPCS / CPT® FO W/O JOINTS CF
L3935 0 HCPCS / CPT® FO NONTORSION JOINT CF
L3956 0 HCPCS / CPT® ADD JOINT UPPER EXT ORTHOSIS
L3960 0 HCPCS / CPT® SEWHO AIRPLAN DESIG ABDU POS
L3961 0 HCPCS / CPT® SEWHO CAP DESIGN W/O JNTS CF
L3962 0 HCPCS / CPT® SEWHO ERBS PALSEY DESIGN ABD
L3967 0 HCPCS / CPT® SEWHO AIRPLANE W/O JNTS CF
L3971 0 HCPCS / CPT® SEWHO CAP DESIGN W/JNT(S) CF
L3973 0 HCPCS / CPT® SEWHO AIRPLANE W/JNT(S) CF
L3975 0 HCPCS / CPT® SEWHFO CAP DESIGN W/O JNT CF
L3976 0 HCPCS / CPT® SEWHFO AIRPLANE W/O JNTS CF
L3977 0 HCPCS / CPT® SEWHFO CAP DESGN W/JNT(S) CF
L3978 0 HCPCS / CPT® SEWHFO AIRPLANE W/JNT(S) CF
L3980 0 HCPCS / CPT® UP EXT FX ORTHOS HUMERAL NOS
L3981 0 HCPCS / CPT® UE FX ORTH SHOUL CAP FOREARM
L3982 0 HCPCS / CPT® UPPER EXT FX ORTHOSIS RAD/UL
L3984 0 HCPCS / CPT® UPPER EXT FX ORTHOSIS WRIST
L3995 0 HCPCS / CPT® SOCK FRACTURE OR EQUAL EACH
L3999 0 HCPCS / CPT® UPPER LIMB ORTHOSIS NOS
L4000 0 HCPCS / CPT® REPL GIRDLE MILWAUKEE ORTH
L4002 0 HCPCS / CPT® REPLACE STRAP, ANY ORTHOSIS
L4010 0 HCPCS / CPT® REPLACE TRILATERAL SOCKET BR
L4020 0 HCPCS / CPT® REPLACE QUADLAT SOCKET BRIM
L4030 0 HCPCS / CPT® REPLACE SOCKET BRIM CUST FIT
L4040 0 HCPCS / CPT® REPLACE MOLDED THIGH LACER
L4045 0 HCPCS / CPT® REPLACE NON-MOLDED THIGH LAC
L4050 0 HCPCS / CPT® REPLACE MOLDED CALF LACER
L4055 0 HCPCS / CPT® REPLACE NON-MOLDED CALF LACE
L4060 0 HCPCS / CPT® REPLACE HIGH ROLL CUFF
L4070 0 HCPCS / CPT® REPLACE PROX & DIST UPRIGHT
L4080 0 HCPCS / CPT® REPL MET BAND KAFO-AFO PROX
L4090 0 HCPCS / CPT® REPL MET BAND KAFO-AFO CALF/
L4100 0 HCPCS / CPT® REPL LEATH CUFF KAFO PROX TH
L4110 0 HCPCS / CPT® REPL LEATH CUFF KAFO-AFO CAL
L4130 0 HCPCS / CPT® REPLACE PRETIBIAL SHELL
L4205 0 HCPCS / CPT® ORTHO DVC REPAIR PER 15 MIN
L4210 0 HCPCS / CPT® ORTH DEV REPAIR/REPL MINOR P
L4350 412 HCPCS / CPT® ANKLE CONTROL ORTHO PRE OTS
L4360 106 HCPCS / CPT® PNEUMAT WALKING BOOT PRE CST
L4361 0 HCPCS / CPT® PNEUMA/VAC WALK BOOT PRE OTS
L4370 0 HCPCS / CPT® PNEUM FULL LEG SPLNT PRE OTS
L4380 114 HCPCS / CPT® PNEUMATIC KNEE SPLINT
L4386 153 HCPCS / CPT® NON-PNEUM WALK BOOT PRE CST
L4387 0 HCPCS / CPT® NON-PNEUM WALK BOOT PRE OTS
L4392 0 HCPCS / CPT® REPLACE AFO SOFT INTERFACE
L4394 0 HCPCS / CPT® REPLACE FOOT DROP SPINT
L4396 0 HCPCS / CPT® STATIC OR DYNAMI AFO PRE CST
L4397 0 HCPCS / CPT® STATIC OR DYNAMI AFO PRE OTS
L4398 0 HCPCS / CPT® FOOT DROP SPLINT PRE OTS
L4631 0 HCPCS / CPT® AFO, WALK BOOT TYPE, CUS FAB
L5000 0 HCPCS / CPT® SHO INSERT W ARCH TOE FILLER
L5010 0 HCPCS / CPT® MOLD SOCKET ANK HGT W/ TOE F
L5020 0 HCPCS / CPT® TIBIAL TUBERCLE HGT W/ TOE F
L5050 0 HCPCS / CPT® ANK SYMES MOLD SCKT SACH FT
L5060 0 HCPCS / CPT® SYMES MET FR LEATH SOCKET AR
L5100 0 HCPCS / CPT® MOLDED SOCKET SHIN SACH FOOT
L5105 0 HCPCS / CPT® PLAST SOCKET JTS/THGH LACER
L5150 0 HCPCS / CPT® MOLD SCKT EXT KNEE SHIN SACH
L5160 0 HCPCS / CPT® MOLD SOCKET BENT KNEE SHIN S
L5200 0 HCPCS / CPT® KNE SING AXIS FRIC SHIN SACH
L5210 0 HCPCS / CPT® NO KNEE/ANKLE JOINTS W/ FT B
L5220 0 HCPCS / CPT® NO KNEE JOINT WITH ARTIC ALI
L5230 0 HCPCS / CPT® FEM FOCAL DEFIC CONSTANT FRI
L5250 0 HCPCS / CPT® HIP CANAD SING AXI CONS FRIC
L5270 0 HCPCS / CPT® TILT TABLE LOCKING HIP SING
L5280 0 HCPCS / CPT® HEMIPELVECT CANAD SING AXIS
L5301 0 HCPCS / CPT® BK MOLD SOCKET SACH FT ENDO
L5312 0 HCPCS / CPT® KNEE DISART, SACH FT, ENDO
L5321 0 HCPCS / CPT® AK OPEN END SACH
L5331 0 HCPCS / CPT® HIP DISART CANADIAN SACH FT
L5341 0 HCPCS / CPT® HEMIPELVECTOMY CANADIAN SACH
L5400 0 HCPCS / CPT® POSTOP DRESS & 1 CAST CHG BK
L5410 0 HCPCS / CPT® POSTOP DSG BK EA ADD CAST CH
L5420 0 HCPCS / CPT® POSTOP DSG & 1 CAST CHG AK/D
L5430 0 HCPCS / CPT® POSTOP DSG AK EA ADD CAST CH
L5450 0 HCPCS / CPT® POSTOP APP NON-WGT BEAR DSG
L5460 0 HCPCS / CPT® POSTOP APP NON-WGT BEAR DSG
L5500 0 HCPCS / CPT® INIT BK PTB PLASTER DIRECT
L5505 0 HCPCS / CPT® INIT AK ISCHAL PLSTR DIRECT
L5510 0 HCPCS / CPT® PREP BK PTB PLASTER MOLDED
L5520 0 HCPCS / CPT® PERP BK PTB THERMOPLS DIRECT
L5530 0 HCPCS / CPT® PREP BK PTB THERMOPLS MOLDED
L5535 0 HCPCS / CPT® PREP BK PTB OPEN END SOCKET
L5540 0 HCPCS / CPT® PREP BK PTB LAMINATED SOCKET
L5560 0 HCPCS / CPT® PREP AK ISCHIAL PLAST MOLDED
L5570 0 HCPCS / CPT® PREP AK ISCHIAL DIRECT FORM
L5580 0 HCPCS / CPT® PREP AK ISCHIAL THERMO MOLD
L5585 0 HCPCS / CPT® PREP AK ISCHIAL OPEN END
L5590 0 HCPCS / CPT® PREP AK ISCHIAL LAMINATED
L5595 0 HCPCS / CPT® HIP DISARTIC SACH THERMOPLS
L5600 0 HCPCS / CPT® HIP DISART SACH LAMINAT MOLD
L5610 0 HCPCS / CPT® ABOVE KNEE HYDRACADENCE
L5611 0 HCPCS / CPT® AK 4 BAR LINK W/FRIC SWING
L5613 0 HCPCS / CPT® AK 4 BAR LING W/HYDRAUL SWIG
L5614 0 HCPCS / CPT® 4-BAR LINK ABOVE KNEE W/SWNG
L5616 0 HCPCS / CPT® AK UNIV MULTIPLEX SYS FRICT
L5617 0 HCPCS / CPT® AK/BK SELF-ALIGNING UNIT EA
L5618 0 HCPCS / CPT® TEST SOCKET SYMES
L5620 0 HCPCS / CPT® TEST SOCKET BELOW KNEE
L5622 0 HCPCS / CPT® TEST SOCKET KNEE DISARTICULA
L5624 0 HCPCS / CPT® TEST SOCKET ABOVE KNEE
L5626 0 HCPCS / CPT® TEST SOCKET HIP DISARTICULAT
L5628 0 HCPCS / CPT® TEST SOCKET HEMIPELVECTOMY
L5629 0 HCPCS / CPT® BELOW KNEE ACRYLIC SOCKET
L5630 0 HCPCS / CPT® SYME TYP EXPANDABL WALL SCKT
L5631 0 HCPCS / CPT® AK/KNEE DISARTIC ACRYLIC SOC
L5632 0 HCPCS / CPT® SYMES TYPE PTB BRIM DESIGN S
L5634 0 HCPCS / CPT® SYMES TYPE POSTER OPENING SO
L5636 0 HCPCS / CPT® SYMES TYPE MEDIAL OPENING SO
L5637 0 HCPCS / CPT® BELOW KNEE TOTAL CONTACT
L5638 0 HCPCS / CPT® BELOW KNEE LEATHER SOCKET
L5639 0 HCPCS / CPT® BELOW KNEE WOOD SOCKET
L5640 0 HCPCS / CPT® KNEE DISARTICULAT LEATHER SO
L5642 0 HCPCS / CPT® ABOVE KNEE LEATHER SOCKET
L5643 0 HCPCS / CPT® HIP FLEX INNER SOCKET EXT FR
L5644 0 HCPCS / CPT® ABOVE KNEE WOOD SOCKET
L5645 0 HCPCS / CPT® BK FLEX INNER SOCKET EXT FRA
L5646 0 HCPCS / CPT® BELOW KNEE CUSHION SOCKET
L5647 0 HCPCS / CPT® BELOW KNEE SUCTION SOCKET
L5648 0 HCPCS / CPT® ABOVE KNEE CUSHION SOCKET
L5649 0 HCPCS / CPT® ISCH CONTAINMT/NARROW M-L SO
L5650 0 HCPCS / CPT® TOT CONTACT AK/KNEE DISART S
L5651 0 HCPCS / CPT® AK FLEX INNER SOCKET EXT FRA
L5652 0 HCPCS / CPT® SUCTION SUSP AK/KNEE DISART
L5653 0 HCPCS / CPT® KNEE DISART EXPAND WALL SOCK
L5654 0 HCPCS / CPT® SOCKET INSERT SYMES
L5655 0 HCPCS / CPT® SOCKET INSERT BELOW KNEE
L5656 0 HCPCS / CPT® SOCKET INSERT KNEE ARTICULAT
L5658 0 HCPCS / CPT® SOCKET INSERT ABOVE KNEE
L5661 0 HCPCS / CPT® MULTI-DUROMETER SYMES
L5665 0 HCPCS / CPT® MULTI-DUROMETER BELOW KNEE
L5666 0 HCPCS / CPT® BELOW KNEE CUFF SUSPENSION
L5668 0 HCPCS / CPT® BK MOLDED DISTAL CUSHION
L5670 0 HCPCS / CPT® BK MOLDED SUPRACONDYLAR SUSP
L5671 0 HCPCS / CPT® BK/AK LOCKING MECHANISM
L5672 0 HCPCS / CPT® BK REMOVABLE MEDIAL BRIM SUS
L5673 0 HCPCS / CPT® SOCKET INSERT W LOCK MECH
L5676 0 HCPCS / CPT® BK KNEE JOINTS SINGLE AXIS P
L5677 0 HCPCS / CPT® BK KNEE JOINTS POLYCENTRIC P
L5678 0 HCPCS / CPT® BK JOINT COVERS PAIR
L5679 0 HCPCS / CPT® SOCKET INSERT W/O LOCK MECH
L5680 0 HCPCS / CPT® BK THIGH LACER NON-MOLDED
L5681 0 HCPCS / CPT® INTL CUSTM CONG/LATYP INSERT
L5682 0 HCPCS / CPT® BK THIGH LACER GLUT/ISCHIA M
L5683 0 HCPCS / CPT® INITIAL CUSTOM SOCKET INSERT
L5684 0 HCPCS / CPT® BK FORK STRAP
L5685 0 HCPCS / CPT® BELOW KNEE SUS/SEAL SLEEVE
L5686 0 HCPCS / CPT® BK BACK CHECK
L5688 0 HCPCS / CPT® BK WAIST BELT WEBBING
L5690 0 HCPCS / CPT® BK WAIST BELT PADDED AND LIN
L5692 0 HCPCS / CPT® AK PELVIC CONTROL BELT LIGHT
L5694 0 HCPCS / CPT® AK PELVIC CONTROL BELT PAD/L
L5695 0 HCPCS / CPT® AK SLEEVE SUSP NEOPRENE/EQUA
L5696 0 HCPCS / CPT® AK/KNEE DISARTIC PELVIC JOIN
L5697 0 HCPCS / CPT® AK/KNEE DISARTIC PELVIC BAND
L5698 0 HCPCS / CPT® AK/KNEE DISARTIC SILESIAN BA
L5699 0 HCPCS / CPT® SHOULDER HARNESS
L5700 0 HCPCS / CPT® REPLACE SOCKET BELOW KNEE
L5701 0 HCPCS / CPT® REPLACE SOCKET ABOVE KNEE
L5702 0 HCPCS / CPT® REPLACE SOCKET HIP
L5703 0 HCPCS / CPT® SYMES ANKLE W/O (SACH) FOOT
L5704 0 HCPCS / CPT® CUSTOM SHAPE COVER BK
L5705 0 HCPCS / CPT® CUSTOM SHAPE COVER AK
L5706 0 HCPCS / CPT® CUSTOM SHAPE CVR KNEE DISART
L5707 0 HCPCS / CPT® CUSTOM SHAPE CVR HIP DISART
L5710 0 HCPCS / CPT® KNE-SHIN EXO SNG AXI MNL LOC
L5711 0 HCPCS / CPT® KNEE-SHIN EXO MNL LOCK ULTRA
L5712 0 HCPCS / CPT® KNEE-SHIN EXO FRICT SWG & ST
L5714 0 HCPCS / CPT® KNEE-SHIN EXO VARIABLE FRICT
L5716 0 HCPCS / CPT® KNEE-SHIN EXO MECH STANCE PH
L5718 0 HCPCS / CPT® KNEE-SHIN EXO FRCT SWG & STA
L5722 0 HCPCS / CPT® KNEE-SHIN PNEUM SWG FRCT EXO
L5724 0 HCPCS / CPT® KNEE-SHIN EXO FLUID SWING PH
L5726 0 HCPCS / CPT® KNEE-SHIN EXT JNTS FLD SWG E
L5728 0 HCPCS / CPT® KNEE-SHIN FLUID SWG & STANCE
L5780 0 HCPCS / CPT® KNEE-SHIN PNEUM/HYDRA PNEUM
L5781 0 HCPCS / CPT® LOWER LIMB PROS VACUUM PUMP
L5782 0 HCPCS / CPT® HD LOW LIMB PROS VACUUM PUMP
L5785 0 HCPCS / CPT® EXOSKELETAL BK ULTRALT MATER
L5790 0 HCPCS / CPT® EXOSKELETAL AK ULTRA-LIGHT M
L5795 0 HCPCS / CPT® EXOSKEL HIP ULTRA-LIGHT MATE
L5810 0 HCPCS / CPT® ENDOSKEL KNEE-SHIN MNL LOCK
L5811 0 HCPCS / CPT® ENDO KNEE-SHIN MNL LCK ULTRA
L5812 0 HCPCS / CPT® ENDO KNEE-SHIN FRCT SWG & ST
L5814 0 HCPCS / CPT® ENDO KNEE-SHIN HYDRAL SWG PH
L5816 0 HCPCS / CPT® ENDO KNEE-SHIN POLYC MCH STA
L5818 0 HCPCS / CPT® ENDO KNEE-SHIN FRCT SWG & ST
L5822 0 HCPCS / CPT® ENDO KNEE-SHIN PNEUM SWG FRC
L5824 0 HCPCS / CPT® ENDO KNEE-SHIN FLUID SWING P
L5826 0 HCPCS / CPT® MINIATURE KNEE JOINT
L5828 0 HCPCS / CPT® ENDO KNEE-SHIN FLUID SWG/STA
L5830 0 HCPCS / CPT® ENDO KNEE-SHIN PNEUM/SWG PHA
L5840 0 HCPCS / CPT® MULTI-AXIAL KNEE/SHIN SYSTEM
L5845 0 HCPCS / CPT® KNEE-SHIN SYS STANCE FLEXION
L5848 0 HCPCS / CPT® KNEE-SHIN SYS HYDRAUL STANCE
L5850 0 HCPCS / CPT® ENDO AK/HIP KNEE EXTENS ASSI
L5855 0 HCPCS / CPT® MECH HIP EXTENSION ASSIST
L5856 0 HCPCS / CPT® ELEC KNEE-SHIN SWING/STANCE
L5857 0 HCPCS / CPT® ELEC KNEE-SHIN SWING ONLY
L5858 0 HCPCS / CPT® STANCE PHASE ONLY
L5859 0 HCPCS / CPT® KNEE-SHIN PRO FLEX/EXT CONT
L5910 0 HCPCS / CPT® ENDO BELOW KNEE ALIGNABLE SY
L5920 0 HCPCS / CPT® ENDO AK/HIP ALIGNABLE SYSTEM
L5925 0 HCPCS / CPT® ABOVE KNEE MANUAL LOCK
L5930 0 HCPCS / CPT® HIGH ACTIVITY KNEE FRAME
L5940 0 HCPCS / CPT® ENDO BK ULTRA-LIGHT MATERIAL
L5950 0 HCPCS / CPT® ENDO AK ULTRA-LIGHT MATERIAL
L5960 0 HCPCS / CPT® ENDO HIP ULTRA-LIGHT MATERIA
L5961 0 HCPCS / CPT® ENDO POLY HIP, PNEU/HYD/ROT
L5962 0 HCPCS / CPT® BELOW KNEE FLEX COVER SYSTEM
L5964 0 HCPCS / CPT® ABOVE KNEE FLEX COVER SYSTEM
L5966 0 HCPCS / CPT® HIP FLEXIBLE COVER SYSTEM
L5968 0 HCPCS / CPT® MULTIAXIAL ANKLE W DORSIFLEX
L5969 0 HCPCS / CPT® AK/FT POWER ASST INCL MOTORS
L5970 0 HCPCS / CPT® FOOT EXTERNAL KEEL SACH FOOT
L5971 0 HCPCS / CPT® SACH FOOT, REPLACEMENT
L5972 0 HCPCS / CPT® FLEXIBLE KEEL FOOT
L5973 0 HCPCS / CPT® ANK-FOOT SYS DORS-PLANT FLEX
L5974 0 HCPCS / CPT® FOOT SINGLE AXIS ANKLE/FOOT
L5975 0 HCPCS / CPT® COMBO ANKLE/FOOT PROSTHESIS
L5976 0 HCPCS / CPT® ENERGY STORING FOOT
L5978 0 HCPCS / CPT® FT PROSTH MULTIAXIAL ANKL/FT
L5979 0 HCPCS / CPT® MULTI-AXIAL ANKLE/FT PROSTH
L5980 0 HCPCS / CPT® FLEX FOOT SYSTEM
L5981 0 HCPCS / CPT® FLEX-WALK SYS LOW EXT PROSTH
L5982 0 HCPCS / CPT® EXOSKELETAL AXIAL ROTATION U
L5984 0 HCPCS / CPT® ENDOSKELETAL AXIAL ROTATION
L5985 0 HCPCS / CPT® LWR EXT DYNAMIC PROSTH PYLON
L5986 0 HCPCS / CPT® MULTI-AXIAL ROTATION UNIT
L5987 0 HCPCS / CPT® SHANK FT W VERT LOAD PYLON
L5988 0 HCPCS / CPT® VERTICAL SHOCK REDUCING PYLO
L5990 0 HCPCS / CPT® USER ADJUSTABLE HEEL HEIGHT
L5999 0 HCPCS / CPT® LOWR EXTREMITY PROSTHES NOS
L6000 0 HCPCS / CPT® PART HAND THUMB REM
L6010 0 HCPCS / CPT® PART HAND LITTLE/RING
L6020 0 HCPCS / CPT® PART HAND NO FINGERS
L6026 0 HCPCS / CPT® PART HAND MYO EXCLU TERM DEV
L6050 0 HCPCS / CPT® WRST MLD SCK FLX HNG TRI PAD
L6055 0 HCPCS / CPT® WRST MOLD SOCK W/EXP INTERFA
L6100 0 HCPCS / CPT® ELB MOLD SOCK FLEX HINGE PAD
L6110 0 HCPCS / CPT® ELBOW MOLD SOCK SUSPENSION T
L6120 0 HCPCS / CPT® ELBOW MOLD DOUB SPLT SOC STE
L6130 0 HCPCS / CPT® ELBOW STUMP ACTIVATED LOCK H
L6200 0 HCPCS / CPT® ELBOW MOLD OUTSID LOCK HINGE
L6205 0 HCPCS / CPT® ELBOW MOLDED W/ EXPAND INTER
L6250 0 HCPCS / CPT® ELBOW INTER LOC ELBOW FORARM
L6300 0 HCPCS / CPT® SHLDER DISART INT LOCK ELBOW
L6310 0 HCPCS / CPT® SHOULDER PASSIVE RESTOR COMP
L6320 0 HCPCS / CPT® SHOULDER PASSIVE RESTOR CAP
L6350 0 HCPCS / CPT® THORACIC INTERN LOCK ELBOW
L6360 0 HCPCS / CPT® THORACIC PASSIVE RESTOR COMP
L6370 0 HCPCS / CPT® THORACIC PASSIVE RESTOR CAP
L6380 0 HCPCS / CPT® POSTOP DSG CAST CHG WRST/ELB
L6382 0 HCPCS / CPT® POSTOP DSG CAST CHG ELB DIS/
L6384 0 HCPCS / CPT® POSTOP DSG CAST CHG SHLDER/T
L6386 0 HCPCS / CPT® POSTOP EA CAST CHG & REALIGN
L6388 0 HCPCS / CPT® POSTOP APPLICAT RIGID DSG ON
L6400 0 HCPCS / CPT® BELOW ELBOW PROSTH TISS SHAP
L6450 0 HCPCS / CPT® ELB DISART PROSTH TISS SHAP
L6500 0 HCPCS / CPT® ABOVE ELBOW PROSTH TISS SHAP
L6550 0 HCPCS / CPT® SHLDR DISAR PROSTH TISS SHAP
L6570 0 HCPCS / CPT® SCAP THORAC PROSTH TISS SHAP
L6580 0 HCPCS / CPT® WRIST/ELBOW BOWDEN CABLE MOL
L6582 0 HCPCS / CPT® WRIST/ELBOW BOWDEN CBL DIR F
L6584 0 HCPCS / CPT® ELBOW FAIR LEAD CABLE MOLDED
L6586 0 HCPCS / CPT® ELBOW FAIR LEAD CABLE DIR FO
L6588 0 HCPCS / CPT® SHDR FAIR LEAD CABLE MOLDED
L6590 0 HCPCS / CPT® SHDR FAIR LEAD CABLE DIRECT
L6600 0 HCPCS / CPT® POLYCENTRIC HINGE PAIR
L6605 0 HCPCS / CPT® SINGLE PIVOT HINGE PAIR
L6610 0 HCPCS / CPT® FLEXIBLE METAL HINGE PAIR
L6611 0 HCPCS / CPT® ADDITIONAL SWITCH, EXT POWER
L6615 0 HCPCS / CPT® DISCONNECT LOCKING WRIST UNI
L6616 0 HCPCS / CPT® DISCONNECT INSERT LOCKING WR
L6620 0 HCPCS / CPT® FLEXION/EXTENSION WRIST UNIT
L6621 0 HCPCS / CPT® FLEX/EXT WRIST W/WO FRICTION
L6623 0 HCPCS / CPT® SPRING-ASS ROT WRST W/ LATCH
L6624 0 HCPCS / CPT® FLEX/EXT/ROTATION WRIST UNIT
L6625 0 HCPCS / CPT® ROTATION WRST W/ CABLE LOCK
L6628 0 HCPCS / CPT® QUICK DISCONN HOOK ADAPTER O
L6629 0 HCPCS / CPT® LAMINATION COLLAR W/ COUPLIN
L6630 0 HCPCS / CPT® STAINLESS STEEL ANY WRIST
L6632 0 HCPCS / CPT® LATEX SUSPENSION SLEEVE EACH
L6635 0 HCPCS / CPT® LIFT ASSIST FOR ELBOW
L6637 0 HCPCS / CPT® NUDGE CONTROL ELBOW LOCK
L6638 0 HCPCS / CPT® ELEC LOCK ON MANUAL PW ELBOW
L6640 0 HCPCS / CPT® SHOULDER ABDUCTION JOINT PAI
L6641 0 HCPCS / CPT® EXCURSION AMPLIFIER PULLEY T
L6642 0 HCPCS / CPT® EXCURSION AMPLIFIER LEVER TY
L6645 0 HCPCS / CPT® SHOULDER FLEXION-ABDUCTION J
L6646 0 HCPCS / CPT® MULTIPO LOCKING SHOULDER JNT
L6647 0 HCPCS / CPT® SHOULDER LOCK ACTUATOR
L6648 0 HCPCS / CPT® EXT PWRD SHLDER LOCK/UNLOCK
L6650 0 HCPCS / CPT® SHOULDER UNIVERSAL JOINT
L6655 0 HCPCS / CPT® STANDARD CONTROL CABLE EXTRA
L6660 0 HCPCS / CPT® HEAVY DUTY CONTROL CABLE
L6665 0 HCPCS / CPT® TEFLON OR EQUAL CABLE LINING
L6670 0 HCPCS / CPT® HOOK TO HAND CABLE ADAPTER
L6672 0 HCPCS / CPT® HARNESS CHEST/SHLDER SADDLE
L6675 0 HCPCS / CPT® HARNESS FIGURE OF 8 SING CON
L6676 0 HCPCS / CPT® HARNESS FIGURE OF 8 DUAL CON
L6677 0 HCPCS / CPT® UE TRIPLE CONTROL HARNESS
L6680 0 HCPCS / CPT® TEST SOCK WRIST DISART/BEL E
L6682 0 HCPCS / CPT® TEST SOCK ELBW DISART/ABOVE
L6684 0 HCPCS / CPT® TEST SOCKET SHLDR DISART/THO
L6686 0 HCPCS / CPT® SUCTION SOCKET
L6687 0 HCPCS / CPT® FRAME TYP SOCKET BEL ELBOW/W
L6688 0 HCPCS / CPT® FRAME TYP SOCK ABOVE ELB/DIS
L6689 0 HCPCS / CPT® FRAME TYP SOCKET SHOULDER DI
L6690 0 HCPCS / CPT® FRAME TYP SOCK INTERSCAP-THO
L6691 0 HCPCS / CPT® REMOVABLE INSERT EACH
L6692 0 HCPCS / CPT® SILICONE GEL INSERT OR EQUAL
L6693 0 HCPCS / CPT® LOCKINGELBOW FOREARM CNTRBAL
L6694 0 HCPCS / CPT® ELBOW SOCKET INS USE W/LOCK
L6695 0 HCPCS / CPT® ELBOW SOCKET INS USE W/O LCK
L6696 0 HCPCS / CPT® CUS ELBO SKT IN FOR CON/ATYP
L6697 0 HCPCS / CPT® CUS ELBO SKT IN NOT CON/ATYP
L6698 0 HCPCS / CPT® BELOW/ABOVE ELBOW LOCK MECH
L6703 0 HCPCS / CPT® TERM DEV, PASSIVE HAND MITT
L6704 0 HCPCS / CPT® TERM DEV, SPORT/REC/WORK ATT
L6706 0 HCPCS / CPT® TERM DEV MECH HOOK VOL OPEN
L6707 0 HCPCS / CPT® TERM DEV MECH HOOK VOL CLOSE
L6708 0 HCPCS / CPT® TERM DEV MECH HAND VOL OPEN
L6709 0 HCPCS / CPT® TERM DEV MECH HAND VOL CLOSE
L6711 0 HCPCS / CPT® PED TERM DEV, HOOK, VOL OPEN
L6712 0 HCPCS / CPT® PED TERM DEV, HOOK, VOL CLOS
L6713 0 HCPCS / CPT® PED TERM DEV, HAND, VOL OPEN
L6714 0 HCPCS / CPT® PED TERM DEV, HAND, VOL CLOS
L6715 0 HCPCS / CPT® TERM DEVICE, MULTI ART DIGIT
L6721 0 HCPCS / CPT® HOOK/HAND, HVY DTY, VOL OPEN
L6722 0 HCPCS / CPT® HOOK/HAND, HVY DTY, VOL CLOS
L6805 0 HCPCS / CPT® TERM DEV MODIFIER WRIST UNIT
L6810 0 HCPCS / CPT® TERM DEV PRECISION PINCH DEV
L6880 0 HCPCS / CPT® ELEC HAND IND ART DIGITS
L6881 0 HCPCS / CPT® TERM DEV AUTO GRASP FEATURE
L6882 0 HCPCS / CPT® MICROPROCESSOR CONTROL UPLMB
L6883 0 HCPCS / CPT® REPLC SOCKT BELOW E/W DISA
L6884 0 HCPCS / CPT® REPLC SOCKT ABOVE ELBOW DISA
L6885 0 HCPCS / CPT® REPLC SOCKT SHLDR DIS/INTERC
L6890 0 HCPCS / CPT® PREFAB GLOVE FOR TERM DEVICE
L6895 0 HCPCS / CPT® CUSTOM GLOVE FOR TERM DEVICE
L6900 0 HCPCS / CPT® HAND RESTORAT THUMB/1 FINGER
L6905 0 HCPCS / CPT® HAND RESTORATION MULTIPLE FI
L6910 0 HCPCS / CPT® HAND RESTORATION NO FINGERS
L6915 0 HCPCS / CPT® HAND RESTORATION REPLACMNT G
L6920 0 HCPCS / CPT® WRIST DISARTICUL SWITCH CTRL
L6925 0 HCPCS / CPT® WRIST DISART MYOELECTRONIC C
L6930 0 HCPCS / CPT® BELOW ELBOW SWITCH CONTROL
L6935 0 HCPCS / CPT® BELOW ELBOW MYOELECTRONIC CT
L6940 0 HCPCS / CPT® ELBOW DISARTICULATION SWITCH
L6945 0 HCPCS / CPT® ELBOW DISART MYOELECTRONIC C
L6950 0 HCPCS / CPT® ABOVE ELBOW SWITCH CONTROL
L6955 0 HCPCS / CPT® ABOVE ELBOW MYOELECTRONIC CT
L6960 0 HCPCS / CPT® SHLDR DISARTIC SWITCH CONTRO
L6965 0 HCPCS / CPT® SHLDR DISARTIC MYOELECTRONIC
L6970 0 HCPCS / CPT® INTERSCAPULAR-THOR SWITCH CT
L6975 0 HCPCS / CPT® INTERSCAP-THOR MYOELECTRONIC
L7007 0 HCPCS / CPT® ADULT ELECTRIC HAND
L7008 0 HCPCS / CPT® PEDIATRIC ELECTRIC HAND
L7009 0 HCPCS / CPT® ADULT ELECTRIC HOOK
L7040 0 HCPCS / CPT® PREHENSILE ACTUATOR
L7045 0 HCPCS / CPT® PEDIATRIC ELECTRIC HOOK
L7170 0 HCPCS / CPT® ELECTRONIC ELBOW HOSMER SWIT
L7180 0 HCPCS / CPT® ELECTRONIC ELBOW SEQUENTIAL
L7181 0 HCPCS / CPT® ELECTRONIC ELBO SIMULTANEOUS
L7185 0 HCPCS / CPT® ELECTRON ELBOW ADOLESCENT SW
L7186 0 HCPCS / CPT® ELECTRON ELBOW CHILD SWITCH
L7190 0 HCPCS / CPT® ELBOW ADOLESCENT MYOELECTRON
L7191 0 HCPCS / CPT® ELBOW CHILD MYOELECTRONIC CT
L7259 0 HCPCS / CPT® ELECTRONIC WRIST ROTATOR ANY
L7360 0 HCPCS / CPT® SIX VOLT BAT OTTO BOCK/EQ EA
L7362 0 HCPCS / CPT® BATTERY CHRGR SIX VOLT OTTO
L7364 0 HCPCS / CPT® TWELVE VOLT BATTERY UTAH/EQU
L7366 0 HCPCS / CPT® BATTERY CHRGR 12 VOLT UTAH/E
L7367 0 HCPCS / CPT® REPLACEMNT LITHIUM IONBATTER
L7368 0 HCPCS / CPT® LITHIUM ION BATTERY CHARGER
L7400 0 HCPCS / CPT® ADD UE PROST BE/WD, ULTLITE
L7401 0 HCPCS / CPT® ADD UE PROST A/E ULTLITE MAT
L7402 0 HCPCS / CPT® ADD UE PROST S/D ULTLITE MAT
L7403 0 HCPCS / CPT® ADD UE PROST B/E ACRYLIC
L7404 0 HCPCS / CPT® ADD UE PROST A/E ACRYLIC
L7405 0 HCPCS / CPT® ADD UE PROST S/D ACRYLIC
L7499 0 HCPCS / CPT® UPPER EXTREMITY PROSTHES NOS
L7510 0 HCPCS / CPT® PROSTHETIC DEVICE REPAIR REP
L7520 0 HCPCS / CPT® REPAIR PROSTHESIS PER 15 MIN
L7600 0 HCPCS / CPT® PROSTHETIC DONNING SLEEVE
L7900 0 HCPCS / CPT® MALE VACUUM ERECTION SYSTEM
L7902 0 HCPCS / CPT® TENSION RING, VAC ERECT DEV
L8000 0 HCPCS / CPT® MASTECTOMY BRA
L8001 0 HCPCS / CPT® BREAST PROSTHESIS BRA & FORM
L8002 0 HCPCS / CPT® BRST PRSTH BRA & BILAT FORM
L8010 0 HCPCS / CPT® MASTECTOMY SLEEVE
L8015 0 HCPCS / CPT® EXT BREASTPROSTHESIS GARMENT
L8020 0 HCPCS / CPT® MASTECTOMY FORM
L8030 0 HCPCS / CPT® BREAST PROSTHES W/O ADHESIVE
L8031 0 HCPCS / CPT® BREAST PROSTHESIS W ADHESIVE
L8032 0 HCPCS / CPT® REUSABLE NIPPLE PROSTHESIS
L8035 0 HCPCS / CPT® CUSTOM BREAST PROSTHESIS
L8039 0 HCPCS / CPT® BREAST PROSTHESIS NOS
L8040 0 HCPCS / CPT® NASAL PROSTHESIS
L8041 0 HCPCS / CPT® MIDFACIAL PROSTHESIS
L8042 0 HCPCS / CPT® ORBITAL PROSTHESIS
L8043 0 HCPCS / CPT® UPPER FACIAL PROSTHESIS
L8044 0 HCPCS / CPT® HEMI-FACIAL PROSTHESIS
L8045 0 HCPCS / CPT® AURICULAR PROSTHESIS
L8046 0 HCPCS / CPT® PARTIAL FACIAL PROSTHESIS
L8047 0 HCPCS / CPT® NASAL SEPTAL PROSTHESIS
L8048 0 HCPCS / CPT® UNSPEC MAXILLOFACIAL PROSTH
L8049 0 HCPCS / CPT® REPAIR MAXILLOFACIAL PROSTH
L8300 0 HCPCS / CPT® TRUSS SINGLE W/ STANDARD PAD
L8310 0 HCPCS / CPT® TRUSS DOUBLE W/ STANDARD PAD
L8320 0 HCPCS / CPT® TRUSS ADDITION TO STD PAD WA
L8330 0 HCPCS / CPT® TRUSS ADD TO STD PAD SCROTAL
L8400 0 HCPCS / CPT® SHEATH BELOW KNEE
L8410 0 HCPCS / CPT® SHEATH ABOVE KNEE
L8415 0 HCPCS / CPT® SHEATH UPPER LIMB
L8417 0 HCPCS / CPT® PROS SHEATH/SOCK W GEL CUSHN
L8420 0 HCPCS / CPT® PROSTHETIC SOCK MULTI PLY BK
L8430 0 HCPCS / CPT® PROSTHETIC SOCK MULTI PLY AK
L8435 0 HCPCS / CPT® PROS SOCK MULTI PLY UPPER LM
L8440 0 HCPCS / CPT® SHRINKER BELOW KNEE
L8460 0 HCPCS / CPT® SHRINKER ABOVE KNEE
L8465 0 HCPCS / CPT® SHRINKER UPPER LIMB
L8470 0 HCPCS / CPT® PROS SOCK SINGLE PLY BK
L8480 0 HCPCS / CPT® PROS SOCK SINGLE PLY AK
L8485 0 HCPCS / CPT® PROS SOCK SINGLE PLY UPPER L
L8499 0 HCPCS / CPT® UNLISTED MISC PROSTHETIC SER
L8500 0 HCPCS / CPT® ARTIFICIAL LARYNX
L8501 0 HCPCS / CPT® TRACHEOSTOMY SPEAKING VALVE
L8505 0 HCPCS / CPT® ARTIFICIAL LARYNX, ACCESSORY
L8507 0 HCPCS / CPT® TRACH-ESOPH VOICE PROS PT IN
L8509 0 HCPCS / CPT® TRACH-ESOPH VOICE PROS MD IN
L8510 0 HCPCS / CPT® VOICE AMPLIFIER
L8511 0 HCPCS / CPT® INDWELLING TRACH INSERT
L8512 0 HCPCS / CPT® GEL CAP FOR TRACH VOICE PROS
L8513 0 HCPCS / CPT® TRACH PROS CLEANING DEVICE
L8514 0 HCPCS / CPT® REPL TRACH PUNCTURE DILATOR
L8515 0 HCPCS / CPT® GEL CAP APP DEVICE FOR TRACH
L8600 0 HCPCS / CPT® IMPLANT BREAST SILICONE/EQ
L8603 0 HCPCS / CPT® COLLAGEN IMP URINARY 2.5 ML
L8604 0 HCPCS / CPT® DEXTRANOMER/HYALURONIC ACID
L8605 0 HCPCS / CPT® INJ BULKING AGENT ANAL CANAL
L8606 0 HCPCS / CPT® SYNTHETIC IMPLNT URINARY 1ML
L8607 0 HCPCS / CPT® INJ VOCAL CORD BULKING AGENT
L8609 0 HCPCS / CPT® ARTIFICIAL CORNEA
L8610 0 HCPCS / CPT® OCULAR IMPLANT
L8612 0 HCPCS / CPT® AQUEOUS SHUNT PROSTHESIS
L8613 0 HCPCS / CPT® OSSICULAR IMPLANT
L8614 0 HCPCS / CPT® COCHLEAR DEVICE
L8615 0 HCPCS / CPT® COCH IMPLANT HEADSET REPLACE
L8616 0 HCPCS / CPT® COCH IMPLANT MICROPHONE REPL
L8617 0 HCPCS / CPT® COCH IMPLANT TRANS COIL REPL
L8618 0 HCPCS / CPT® COCH IMPLANT TRAN CABLE REPL
L8619 0 HCPCS / CPT® COCH IMP EXT PROC/CONTR RPLC
L8621 0 HCPCS / CPT® REPL ZINC AIR BATTERY
L8622 0 HCPCS / CPT® REPL ALKALINE BATTERY
L8623 0 HCPCS / CPT® LITH ION BATT CID,NON-EARLVL
L8624 0 HCPCS / CPT® LITH ION BATT CID, EAR LEVEL
L8627 0 HCPCS / CPT® CID EXT SPEECH PROCESS REPL
L8628 0 HCPCS / CPT® CID EXT CONTROLLER REPL
L8629 0 HCPCS / CPT® CID TRANSMIT COIL AND CABLE
L8630 0 HCPCS / CPT® METACARPOPHALANGEAL IMPLANT
L8631 0 HCPCS / CPT® MCP JOINT REPL 2 PC OR MORE
L8641 0 HCPCS / CPT® METATARSAL JOINT IMPLANT
L8642 0 HCPCS / CPT® HALLUX IMPLANT
L8658 0 HCPCS / CPT® INTERPHALANGEAL JOINT SPACER
L8659 0 HCPCS / CPT® INTERPHALANGEAL JOINT REPL
L8670 0 HCPCS / CPT® VASCULAR GRAFT, SYNTHETIC
L8679 0 HCPCS / CPT® IMP NEUROSTI PLS GN ANY TYPE
L8680 0 HCPCS / CPT® IMPLT NEUROSTIM ELCTR EACH
Default Fee Schedule Part 6
Default Fee Schedule Part 6 150 150 bellaireurgent

Default Fee Schedule Part 6

Code Price Type Description
L8681 0 HCPCS / CPT® PT PRGRM FOR IMPLT NEUROSTIM
L8682 0 HCPCS / CPT® IMPLT NEUROSTIM RADIOFQ REC
L8683 0 HCPCS / CPT® RADIOFQ TRSMTR FOR IMPLT NEU
L8684 0 HCPCS / CPT® RADIOF TRSMTR IMPLT SCRL NEU
L8685 0 HCPCS / CPT® IMPLT NROSTM PLS GEN SNG REC
L8686 0 HCPCS / CPT® IMPLT NROSTM PLS GEN SNG NON
L8687 0 HCPCS / CPT® IMPLT NROSTM PLS GEN DUA REC
L8688 0 HCPCS / CPT® IMPLT NROSTM PLS GEN DUA NON
L8689 0 HCPCS / CPT® EXTERNAL RECHARG SYS INTERN
L8690 0 HCPCS / CPT® AUD OSSEO DEV, INT/EXT COMP
L8691 0 HCPCS / CPT® OSSEOINTEGRATED SND PROC RPL
L8692 0 HCPCS / CPT® NON-OSSEOINTEGRATED SND PROC
L8693 0 HCPCS / CPT® AUD OSSEO DEV, ABUTMENT
L8695 0 HCPCS / CPT® EXTERNAL RECHARG SYS EXTERN
L8696 0 HCPCS / CPT® EXT ANTENNA PHREN NERVE STIM
L8699 0 HCPCS / CPT® PROSTHETIC IMPLANT NOS
L9900 0 HCPCS / CPT® O&P SUPPLY/ACCESSORY/SERVICE
M0075 0 HCPCS / CPT® CELLULAR THERAPY
M0076 0 HCPCS / CPT® PROLOTHERAPY
M0100 0 HCPCS / CPT® INTRAGASTRIC HYPOTHERMIA
M0300 0 HCPCS / CPT® IV CHELATIONTHERAPY
M0301 0 HCPCS / CPT® FABRIC WRAPPING OF ANEURYSM
P2028 0 HCPCS / CPT® CEPHALIN FLOCULATION TEST
P2029 0 HCPCS / CPT® CONGO RED BLOOD TEST
P2031 0 HCPCS / CPT® HAIR ANALYSIS
P2033 0 HCPCS / CPT® BLOOD THYMOL TURBIDITY
P2038 0 HCPCS / CPT® BLOOD MUCOPROTEIN
P3000 75 HCPCS / CPT® SCREEN PAP BY TECH W MD SUPV
P3001 0 HCPCS / CPT® SCREENING PAP SMEAR BY PHYS
P7001 81 HCPCS / CPT® CULTURE BACTERIAL URINE
P9010 0 HCPCS / CPT® WHOLE BLOOD FOR TRANSFUSION
P9011 0 HCPCS / CPT® BLOOD SPLIT UNIT
P9012 0 HCPCS / CPT® CRYOPRECIPITATE EACH UNIT
P9016 0 HCPCS / CPT® RBC LEUKOCYTES REDUCED
P9017 0 HCPCS / CPT® PLASMA 1 DONOR FRZ W/IN 8 HR
P9019 0 HCPCS / CPT® PLATELETS, EACH UNIT
P9020 0 HCPCS / CPT® PLAELET RICH PLASMA UNIT
P9021 0 HCPCS / CPT® RED BLOOD CELLS UNIT
P9022 0 HCPCS / CPT® WASHED RED BLOOD CELLS UNIT
P9023 0 HCPCS / CPT® FROZEN PLASMA, POOLED, SD
P9031 0 HCPCS / CPT® PLATELETS LEUKOCYTES REDUCED
P9032 0 HCPCS / CPT® PLATELETS, IRRADIATED
P9033 0 HCPCS / CPT® PLATELETS LEUKOREDUCED IRRAD
P9034 0 HCPCS / CPT® PLATELETS, PHERESIS
P9035 0 HCPCS / CPT® PLATELET PHERES LEUKOREDUCED
P9036 0 HCPCS / CPT® PLATELET PHERESIS IRRADIATED
P9037 0 HCPCS / CPT® PLATE PHERES LEUKOREDU IRRAD
P9038 0 HCPCS / CPT® RBC IRRADIATED
P9039 0 HCPCS / CPT® RBC DEGLYCEROLIZED
P9040 0 HCPCS / CPT® RBC LEUKOREDUCED IRRADIATED
P9041 0 HCPCS / CPT® ALBUMIN (HUMAN),5%, 50ML
P9043 0 HCPCS / CPT® PLASMA PROTEIN FRACT,5%,50ML
P9044 0 HCPCS / CPT® CRYOPRECIPITATEREDUCEDPLASMA
P9045 0 HCPCS / CPT® ALBUMIN (HUMAN), 5%, 250 ML
P9046 0 HCPCS / CPT® ALBUMIN (HUMAN), 25%, 20 ML
P9047 0 HCPCS / CPT® ALBUMIN (HUMAN), 25%, 50ML
P9048 0 HCPCS / CPT® PLASMAPROTEIN FRACT,5%,250ML
P9050 0 HCPCS / CPT® GRANULOCYTES, PHERESIS UNIT
P9051 0 HCPCS / CPT® BLOOD, L/R, CMV-NEG
P9052 0 HCPCS / CPT® PLATELETS, HLA-M, L/R, UNIT
P9053 0 HCPCS / CPT® PLT, PHER, L/R CMV-NEG, IRR
P9054 0 HCPCS / CPT® BLOOD, L/R, FROZ/DEGLY/WASH
P9055 0 HCPCS / CPT® PLT, APH/PHER, L/R, CMV-NEG
P9056 0 HCPCS / CPT® BLOOD, L/R, IRRADIATED
P9057 0 HCPCS / CPT® RBC, FRZ/DEG/WSH, L/R, IRRAD
P9058 0 HCPCS / CPT® RBC, L/R, CMV-NEG, IRRAD
P9059 0 HCPCS / CPT® PLASMA, FRZ BETWEEN 8-24HOUR
P9060 0 HCPCS / CPT® FR FRZ PLASMA DONOR RETESTED
P9070 0 HCPCS / CPT® PATHOGEN REDUCED PLASMA POOL
P9071 0 HCPCS / CPT® PATHOGEN REDUCED PLASMA SING
P9072 0 HCPCS / CPT® PLATE PATH RED/RAPID BAC TES
P9603 0 HCPCS / CPT® ONE-WAY ALLOW PRORATED MILES
P9604 0 HCPCS / CPT® ONE-WAY ALLOW PRORATED TRIP
P9612 161 HCPCS / CPT® CATHETERIZE FOR URINE SPEC
P9615 0 HCPCS / CPT® URINE SPECIMEN COLLECT MULT
Q0035 0 HCPCS / CPT® CARDIOKYMOGRAPHY
Q0081 0 HCPCS / CPT® INFUSION THER OTHER THAN CHE
Q0083 0 HCPCS / CPT® CHEMO BY OTHER THAN INFUSION
Q0084 0 HCPCS / CPT® CHEMOTHERAPY BY INFUSION
Q0085 0 HCPCS / CPT® CHEMO BY BOTH INFUSION AND O
Q0091 0 HCPCS / CPT® OBTAINING SCREEN PAP SMEAR
Q0092 0 HCPCS / CPT® SET UP PORT XRAY EQUIPMENT
Q0111 27 HCPCS / CPT® WET MOUNTS/ W PREPARATIONS
Q0112 0 HCPCS / CPT® POTASSIUM HYDROXIDE PREPS
Q0113 0 HCPCS / CPT® PINWORM EXAMINATIONS
Q0114 0 HCPCS / CPT® FERN TEST
Q0115 0 HCPCS / CPT® POST-COITAL MUCOUS EXAM
Q0138 0 HCPCS / CPT® FERUMOXYTOL, NON-ESRD
Q0139 0 HCPCS / CPT® FERUMOXYTOL, ESRD USE
Q0144 0 HCPCS / CPT® AZITHROMYCIN DIHYDRATE, ORAL
Q0161 0 HCPCS / CPT® CHLORPROMAZINE HCL 5MG ORAL
Q0162 150 HCPCS / CPT® ONDANSETRON ORAL
Q0163 0 HCPCS / CPT® DIPHENHYDRAMINE HCL 50MG
Q0164 0 HCPCS / CPT® PROCHLORPERAZINE MALEATE 5MG
Q0166 0 HCPCS / CPT® GRANISETRON HCL 1 MG ORAL
Q0167 0 HCPCS / CPT® DRONABINOL 2.5MG ORAL
Q0169 0 HCPCS / CPT® PROMETHAZINE HCL 12.5MG ORAL
Q0173 0 HCPCS / CPT® TRIMETHOBENZAMIDE HCL 250MG
Q0174 0 HCPCS / CPT® THIETHYLPERAZINE MALEATE10MG
Q0175 0 HCPCS / CPT® PERPHENAZINE 4MG ORAL
Q0177 0 HCPCS / CPT® HYDROXYZINE PAMOATE 25MG
Q0180 0 HCPCS / CPT® DOLASETRON MESYLATE ORAL
Q0181 0 HCPCS / CPT® UNSPECIFIED ORAL ANTI-EMETIC
Q0478 0 HCPCS / CPT® POWER ADAPTER, COMBO VAD
Q0479 0 HCPCS / CPT® POWER MODULE COMBO VAD, REP
Q0480 0 HCPCS / CPT® DRIVER PNEUMATIC VAD, REP
Q0481 0 HCPCS / CPT® MICROPRCSR CU ELEC VAD, REP
Q0482 0 HCPCS / CPT® MICROPRCSR CU COMBO VAD, REP
Q0483 0 HCPCS / CPT® MONITOR ELEC VAD, REP
Q0484 0 HCPCS / CPT® MONITOR ELEC OR COMB VAD REP
Q0485 0 HCPCS / CPT® MONITOR CABLE ELEC VAD, REP
Q0486 0 HCPCS / CPT® MON CABLE ELEC/PNEUM VAD REP
Q0487 0 HCPCS / CPT® LEADS ANY TYPE VAD, REP ONLY
Q0488 0 HCPCS / CPT® PWR PACK BASE ELEC VAD, REP
Q0489 0 HCPCS / CPT® PWR PCK BASE COMBO VAD, REP
Q0490 0 HCPCS / CPT® EMR PWR SOURCE ELEC VAD, REP
Q0491 0 HCPCS / CPT® EMR PWR SOURCE COMBO VAD REP
Q0492 0 HCPCS / CPT® EMR PWR CBL ELEC VAD, REP
Q0493 0 HCPCS / CPT® EMR PWR CBL COMBO VAD, REP
Q0494 0 HCPCS / CPT® EMR HD PMP ELEC/COMBO, REP
Q0495 0 HCPCS / CPT® CHARGER ELEC/COMBO VAD, REP
Q0496 0 HCPCS / CPT® BATTERY ELEC/COMBO VAD, REP
Q0497 0 HCPCS / CPT® BAT CLPS ELEC/COMB VAD, REP
Q0498 0 HCPCS / CPT® HOLSTER ELEC/COMBO VAD, REP
Q0499 0 HCPCS / CPT® BELT/VEST ELEC/COMBO VAD REP
Q0500 0 HCPCS / CPT® FILTERS ELEC/COMBO VAD, REP
Q0501 0 HCPCS / CPT® SHWR COV ELEC/COMBO VAD, REP
Q0502 0 HCPCS / CPT® MOBILITY CART PNEUM VAD, REP
Q0503 0 HCPCS / CPT® BATTERY PNEUM VAD REPLACEMNT
Q0504 0 HCPCS / CPT® PWR ADPT PNEUM VAD, REP VEH
Q0506 0 HCPCS / CPT® LITH-ION BATT ELEC/PNEUM VAD
Q0507 0 HCPCS / CPT® MISC SUP/ACC EXT VAD
Q0508 0 HCPCS / CPT® MIS SUP/ACC IMP VAD
Q0509 0 HCPCS / CPT® MIS SUP/AC IMP VAD NOPAY MED
Q0510 0 HCPCS / CPT® DISPENS FEE IMMUNOSUPRESSIVE
Q0511 0 HCPCS / CPT® SUP FEE ANTIEM,ANTICA,IMMUNO
Q0512 0 HCPCS / CPT® PX SUP FEE ANTI-CAN SUB PRES
Q0513 0 HCPCS / CPT® DISP FEE INHAL DRUGS/30 DAYS
Q0514 0 HCPCS / CPT® DISP FEE INHAL DRUGS/90 DAYS
Q0515 0 HCPCS / CPT® SERMORELIN ACETATE INJECTION
Q1004 0 HCPCS / CPT® NTIOL CATEGORY 4
Q1005 0 HCPCS / CPT® NTIOL CATEGORY 5
Q2004 0 HCPCS / CPT® BLADDER CALCULI IRRIG SOL
Q2009 0 HCPCS / CPT® FOSPHENYTOIN INJ PE
Q2017 0 HCPCS / CPT® TENIPOSIDE, 50 MG
Q2026 0 HCPCS / CPT® RADIESSE INJECTION
Q2028 0 HCPCS / CPT® INJ, SCULPTRA, 0.5MG
Q2034 0 HCPCS / CPT® AGRIFLU VACCINE
Q2035 0 HCPCS / CPT® Q2036 0 HCPCS / CPT® Q2037 0 HCPCS / CPT® Q2038 0 HCPCS / CPT® Q2039 0 HCPCS / CPT® INFLUENZA VIRUS VACCINE, NOS
Q2043 0 HCPCS / CPT® SIPULEUCEL-T AUTO CD54+
Q2049 0 HCPCS / CPT® IMPORTED LIPODOX INJ
Q2050 0 HCPCS / CPT® DOXORUBICIN INJ 10MG
Q2052 0 HCPCS / CPT® IVIG DEMO, SERVICES/SUPPLIES
Q3001 0 HCPCS / CPT® BRACHYTHERAPY RADIOELEMENTS
Q3014 0 HCPCS / CPT® TELEHEALTH FACILITY FEE
Q3027 0 HCPCS / CPT® INJ BETA INTERFERON IM 1 MCG
Q3028 0 HCPCS / CPT® INJ BETA INTERFERON SQ 1 MCG
Q3031 0 HCPCS / CPT® COLLAGEN SKIN TEST
Q4001 0 HCPCS / CPT® CAST SUP BODY CAST PLASTER
Q4002 0 HCPCS / CPT® CAST SUP BODY CAST FIBERGLAS
Q4003 0 HCPCS / CPT® CAST SUP SHOULDER CAST PLSTR
Q4004 0 HCPCS / CPT® CAST SUP SHOULDER CAST FBRGL
Q4005 0 HCPCS / CPT® CAST SUP LONG ARM ADULT PLST
Q4006 84 HCPCS / CPT® CAST SUP LONG ARM ADULT FBRG
Q4007 14 HCPCS / CPT® CAST SUP LONG ARM PED PLSTER
Q4008 36 HCPCS / CPT® CAST SUP LONG ARM PED FBRGLS
Q4009 127 HCPCS / CPT® CAST SUP SHT ARM ADULT PLSTR
Q4010 50 HCPCS / CPT® CAST SUP SHT ARM ADULT FBRGL
Q4011 0 HCPCS / CPT® CAST SUP SHT ARM PED PLASTER
Q4012 79 HCPCS / CPT® CAST SUP SHT ARM PED FBRGLAS
Q4013 0 HCPCS / CPT® CAST SUP GAUNTLET PLASTER
Q4014 0 HCPCS / CPT® CAST SUP GAUNTLET FIBERGLASS
Q4015 0 HCPCS / CPT® CAST SUP GAUNTLET PED PLSTER
Q4016 0 HCPCS / CPT® CAST SUP GAUNTLET PED FBRGLS
Q4017 0 HCPCS / CPT® CAST SUP LNG ARM SPLINT PLST
Q4018 0 HCPCS / CPT® CAST SUP LNG ARM SPLINT FBRG
Q4019 0 HCPCS / CPT® CAST SUP LNG ARM SPLNT PED P
Q4020 35 HCPCS / CPT® CAST SUP LNG ARM SPLNT PED F
Q4021 0 HCPCS / CPT® CAST SUP SHT ARM SPLINT PLST
Q4022 732 HCPCS / CPT® CAST SUP SHT ARM SPLINT FBRG
Q4023 0 HCPCS / CPT® CAST SUP SHT ARM SPLNT PED P
Q4024 0 HCPCS / CPT® CAST SUP SHT ARM SPLNT PED F
Q4025 0 HCPCS / CPT® CAST SUP HIP SPICA PLASTER
Q4026 0 HCPCS / CPT® CAST SUP HIP SPICA FIBERGLAS
Q4027 0 HCPCS / CPT® CAST SUP HIP SPICA PED PLSTR
Q4028 0 HCPCS / CPT® CAST SUP HIP SPICA PED FBRGL
Q4029 0 HCPCS / CPT® CAST SUP LONG LEG PLASTER
Q4030 0 HCPCS / CPT® CAST SUP LONG LEG FIBERGLASS
Q4031 0 HCPCS / CPT® CAST SUP LNG LEG PED PLASTER
Q4032 0 HCPCS / CPT® CAST SUP LNG LEG PED FBRGLS
Q4033 0 HCPCS / CPT® CAST SUP LNG LEG CYLINDER PL
Q4034 160 HCPCS / CPT® CAST SUP LNG LEG CYLINDER FB
Q4035 0 HCPCS / CPT® CAST SUP LNGLEG CYLNDR PED P
Q4036 0 HCPCS / CPT® CAST SUP LNGLEG CYLNDR PED F
Q4037 133 HCPCS / CPT® CAST SUP SHRT LEG PLASTER
Q4038 22 HCPCS / CPT® CAST SUP SHRT LEG FIBERGLASS
Q4039 157 HCPCS / CPT® CAST SUP SHRT LEG PED PLSTER
Q4040 0 HCPCS / CPT® CAST SUP SHRT LEG PED FBRGLS
Q4041 0 HCPCS / CPT® CAST SUP LNG LEG SPLNT PLSTR
Q4042 126 HCPCS / CPT® CAST SUP LNG LEG SPLNT FBRGL
Q4043 0 HCPCS / CPT® CAST SUP LNG LEG SPLNT PED P
Q4044 0 HCPCS / CPT® CAST SUP LNG LEG SPLNT PED F
Q4045 0 HCPCS / CPT® CAST SUP SHT LEG SPLNT PLSTR
Q4046 262 HCPCS / CPT® Q4047 0 HCPCS / CPT® CAST SUP SHT LEG SPLNT PED P
Q4048 216 HCPCS / CPT® Q4049 207 HCPCS / CPT® FINGER SPLINT, STATIC
Q4050 0 HCPCS / CPT® CAST SUPPLIES UNLISTED
Q4051 142 HCPCS / CPT® SPLINT SUPPLIES MISC
Q4074 0 HCPCS / CPT® ILOPROST NON-COMP UNIT DOSE
Q4081 0 HCPCS / CPT® EPOETIN ALFA, 100 UNITS ESRD
Q4082 0 HCPCS / CPT® DRUG/BIO NOC PART B DRUG CAP
Q4100 0 HCPCS / CPT® SKIN SUBSTITUTE, NOS
Q4101 0 HCPCS / CPT® APLIGRAF
Q4102 0 HCPCS / CPT® OASIS WOUND MATRIX
Q4103 0 HCPCS / CPT® OASIS BURN MATRIX
Q4104 0 HCPCS / CPT® INTEGRA BMWD
Q4105 0 HCPCS / CPT® INTEGRA DRT OR OMNIGRAFT
Q4106 0 HCPCS / CPT® DERMAGRAFT
Q4107 0 HCPCS / CPT® GRAFTJACKET
Q4108 0 HCPCS / CPT® INTEGRA MATRIX
Q4110 0 HCPCS / CPT® PRIMATRIX
Q4111 0 HCPCS / CPT® GAMMAGRAFT
Q4112 0 HCPCS / CPT® CYMETRA INJECTABLE
Q4113 0 HCPCS / CPT® GRAFTJACKET XPRESS
Q4114 0 HCPCS / CPT® INTEGRA FLOWABLE WOUND MATRI
Q4115 0 HCPCS / CPT® ALLOSKIN
Q4116 0 HCPCS / CPT® ALLODERM
Q4117 0 HCPCS / CPT® HYALOMATRIX
Q4118 0 HCPCS / CPT® MATRISTEM MICROMATRIX
Q4121 0 HCPCS / CPT® THERASKIN
Q4122 0 HCPCS / CPT® DERMACELL
Q4123 0 HCPCS / CPT® ALLOSKIN
Q4124 0 HCPCS / CPT® OASIS TRI-LAYER WOUND MATRIX
Q4125 0 HCPCS / CPT® ARTHROFLEX
Q4126 0 HCPCS / CPT® MEMODERM/DERMA/TRANZ/INTEGUP
Q4127 0 HCPCS / CPT® TALYMED
Q4128 0 HCPCS / CPT® FLEXHD/ALLOPATCHHD/MATRIXHD
Q4130 0 HCPCS / CPT® STRATTICE TM
Q4131 0 HCPCS / CPT® EPIFIX OR EPICORD
Q4132 0 HCPCS / CPT® GRAFIX CORE
Q4133 0 HCPCS / CPT® GRAFIX PRIME
Q4134 0 HCPCS / CPT® HMATRIX
Q4135 0 HCPCS / CPT® MEDISKIN
Q4136 0 HCPCS / CPT® EZDERM
Q4137 0 HCPCS / CPT® AMNIOEXCEL OR BIODEXCEL, 1CM
Q4138 0 HCPCS / CPT® BIODFENCE DRYFLEX, 1CM
Q4139 0 HCPCS / CPT® AMNIO OR BIODMATRIX, INJ 1CC
Q4140 0 HCPCS / CPT® BIODFENCE 1CM
Q4141 0 HCPCS / CPT® ALLOSKIN AC, 1 CM
Q4142 0 HCPCS / CPT® XCM BIOLOGIC TISS MATRIX 1CM
Q4143 0 HCPCS / CPT® REPRIZA, 1CM
Q4145 0 HCPCS / CPT® EPIFIX, INJ, 1MG
Q4146 0 HCPCS / CPT® TENSIX, 1CM
Q4147 0 HCPCS / CPT® ARCHITECT ECM PX FX 1 SQ CM
Q4148 0 HCPCS / CPT® NEOX 1K, 1CM
Q4149 0 HCPCS / CPT® EXCELLAGEN, 0.1 CC
Q4150 0 HCPCS / CPT® ALLOWRAP DS OR DRY 1 SQ CM
Q4151 0 HCPCS / CPT® AMNIOBAND, GUARDIAN 1 SQ CM
Q4152 0 HCPCS / CPT® DERMAPURE 1 SQUARE CM
Q4153 0 HCPCS / CPT® DERMAVEST, PLURIVEST SQ CM
Q4154 0 HCPCS / CPT® BIOVANCE 1 SQUARE CM
Q4155 0 HCPCS / CPT® NEOXFLO OR CLARIXFLO 1 MG
Q4156 0 HCPCS / CPT® NEOX 100 1 SQUARE CM
Q4157 0 HCPCS / CPT® REVITALON 1 SQUARE CM
Q4158 0 HCPCS / CPT® MARIGEN 1 SQUARE CM
Q4159 0 HCPCS / CPT® AFFINITY1 SQUARE CM
Q4160 0 HCPCS / CPT® NUSHIELD 1 SQUARE CM
Q4161 0 HCPCS / CPT® BIO-CONNEKT PER SQUARE CM
Q4162 0 HCPCS / CPT® AMNIO BIO AND WOUNDEX FLOW
Q4163 0 HCPCS / CPT® AMNIO BIO AND WOUNDEX SQ CM
Q4164 0 HCPCS / CPT® HELICOLL, PER SQUARE CM
Q4165 0 HCPCS / CPT® KERAMATRIX, PER SQUARE CM
Q4166 0 HCPCS / CPT® CYTAL, PER SQUARE CENTIMETER
Q4167 0 HCPCS / CPT® TRUSKIN, PER SQ CENTIMETER
Q4168 0 HCPCS / CPT® AMNIOBAND, 1 MG
Q4169 0 HCPCS / CPT® ARTACENT WOUND, PER SQ CM
Q4170 0 HCPCS / CPT® CYGNUS, PER SQ CM
Q4171 0 HCPCS / CPT® INTERFYL, 1 MG
Q4172 0 HCPCS / CPT® PURAPLY OR PURAPLY AM
Q4173 0 HCPCS / CPT® PALINGEN OR PALINGEN XPLUS
Q4174 0 HCPCS / CPT® PALINGEN OR PROMATRX
Q4175 0 HCPCS / CPT® MIRODERM
Q5001 0 HCPCS / CPT® HOSPICE OR HOME HLTH IN HOME
Q5002 0 HCPCS / CPT® HOSPICE/HOME HLTH IN ASST LV
Q5003 0 HCPCS / CPT® HOSPICE IN LT/NON-SKILLED NF
Q5004 0 HCPCS / CPT® HOSPICE IN SNF
Q5005 0 HCPCS / CPT® HOSPICE, INPATIENT HOSPITAL
Q5006 0 HCPCS / CPT® HOSPICE IN HOSPICE FACILITY
Q5007 0 HCPCS / CPT® HOSPICE IN LTCH
Q5008 0 HCPCS / CPT® HOSPICE IN INPATIENT PSYCH
Q5009 0 HCPCS / CPT® HOSPICE/HOME HLTH, PLACE NOS
Q5010 0 HCPCS / CPT® HOSPICE HOME CARE IN HOSPICE
Q5101 0 HCPCS / CPT® INJ FILGRASTIM GCSF BIOSIMIL
Q5102 0 HCPCS / CPT® INJ., INFLIXIMAB BIOSIMILAR
Q9950 0 HCPCS / CPT® INJ SULF HEXA LIPID MICROSPH
Q9951 0 HCPCS / CPT® Q9953 0 HCPCS / CPT® INJ FE-BASED MR CONTRAST,1ML
Q9954 557 HCPCS / CPT® ORAL MR CONTRAST, 100 ML
Q9955 0 HCPCS / CPT® INJ PERFLEXANE LIP MICROS,ML
Q9956 0 HCPCS / CPT® INJ OCTAFLUOROPROPANE MIC,ML
Q9957 0 HCPCS / CPT® INJ PERFLUTREN LIP MICROS,ML
Q9958 0 HCPCS / CPT® HOCM <=149 MG/ML IODINE, 1ML
Q9959 0 HCPCS / CPT® HOCM 150-199MG/ML IODINE,1ML
Q9960 0 HCPCS / CPT® HOCM 200-249MG/ML IODINE,1ML
Q9961 0 HCPCS / CPT® HOCM 250-299MG/ML IODINE,1ML
Q9962 0 HCPCS / CPT® HOCM 300-349MG/ML IODINE,1ML
Q9963 28 HCPCS / CPT® HOCM 350-399MG/ML IODINE,1ML
Q9964 0 HCPCS / CPT® Q9965 0 HCPCS / CPT® LOCM 100-199MG/ML IODINE,1ML
Q9966 22 HCPCS / CPT® LOCM 200-299MG/ML IODINE,1ML
Q9967 7 HCPCS / CPT® LOCM 300-399MG/ML IODINE,1ML
Q9968 0 HCPCS / CPT® VISUALIZATION ADJUNCT
Q9969 0 HCPCS / CPT® NON-HEU TC-99M ADD-ON/DOSE
Q9982 0 HCPCS / CPT® FLUTEMETAMOL F18 DIAGNOSTIC
Q9983 0 HCPCS / CPT® FLORBETABEN F18 DIAGNOSTIC
R0070 0 HCPCS / CPT® TRANSPORT PORTABLE X-RAY
R0075 0 HCPCS / CPT® TRANSPORT PORT X-RAY MULTIPL
R0076 0 HCPCS / CPT® TRANSPORT PORTABLE EKG
S0012 0 HCPCS / CPT® BUTORPHANOL TARTRATE, NASAL
S0014 0 HCPCS / CPT® TACRINE HYDROCHLORIDE, 10 MG
S0017 0 HCPCS / CPT® INJECTION, AMINOCAPROIC ACID
S0020 61 HCPCS / CPT® INJECTION, BUPIVICAINE HYDRO
S0021 0 HCPCS / CPT® INJECTION, CEFOPERAZONE SOD
S0023 0 HCPCS / CPT® INJECTION, CIMETIDINE HYDROC
S0028 66 HCPCS / CPT® INJECTION, FAMOTIDINE, 20 MG
S0030 97 HCPCS / CPT® INJECTION, METRONIDAZOLE
S0032 0 HCPCS / CPT® INJECTION, NAFCILLIN SODIUM
S0034 0 HCPCS / CPT® INJECTION, OFLOXACIN, 400 MG
S0039 0 HCPCS / CPT® INJECTION, SULFAMETHOXAZOLE
S0040 0 HCPCS / CPT® INJECTION, TICARCILLIN DISOD
S0073 0 HCPCS / CPT® INJECTION, AZTREONAM, 500 MG
S0074 0 HCPCS / CPT® INJECTION, CEFOTETAN DISODIU
S0077 38 HCPCS / CPT® INJECTION, CLINDAMYCIN PHOSP
S0078 0 HCPCS / CPT® INJECTION, FOSPHENYTOIN SODI
S0080 0 HCPCS / CPT® INJECTION, PENTAMIDINE ISETH
S0081 0 HCPCS / CPT® INJECTION, PIPERACILLIN SODI
S0088 0 HCPCS / CPT® IMATINIB 100 MG
S0090 0 HCPCS / CPT® SILDENAFIL CITRATE, 25 MG
S0091 0 HCPCS / CPT® GRANISETRON 1MG
S0092 0 HCPCS / CPT® HYDROMORPHONE 250 MG
S0093 0 HCPCS / CPT® MORPHINE 500 MG
S0104 0 HCPCS / CPT® ZIDOVUDINE, ORAL, 100 MG
S0106 0 HCPCS / CPT® BUPROPION HCL SR 60 TABLETS
S0108 0 HCPCS / CPT® MERCAPTOPURINE 50 MG
S0109 0 HCPCS / CPT® METHADONE ORAL 5MG
S0117 0 HCPCS / CPT® TRETINOIN TOPICAL 5 G
S0119 9 HCPCS / CPT® ONDANSETRON 4 MG
S0122 0 HCPCS / CPT® INJ MENOTROPINS 75 IU
S0126 0 HCPCS / CPT® INJ FOLLITROPIN ALFA 75 IU
S0128 0 HCPCS / CPT® INJ FOLLITROPIN BETA 75 IU
S0132 0 HCPCS / CPT® INJ GANIRELIX ACETAT 250 MCG
S0136 0 HCPCS / CPT® CLOZAPINE, 25 MG
S0137 0 HCPCS / CPT® DIDANOSINE, 25 MG
S0138 0 HCPCS / CPT® FINASTERIDE, 5 MG
S0139 0 HCPCS / CPT® MINOXIDIL, 10 MG
S0140 0 HCPCS / CPT® SAQUINAVIR, 200 MG
S0142 0 HCPCS / CPT® COLISTIMETHATE INH SOL MG
S0145 0 HCPCS / CPT® PEG INTERFERON ALFA-2A/180
S0148 0 HCPCS / CPT® PEG INTERFERON ALFA-2B/10
S0155 0 HCPCS / CPT® EPOPROSTENOL DILUTANT
S0156 0 HCPCS / CPT® EXEMESTANE, 25 MG
S0157 0 HCPCS / CPT® BECAPLERMIN GEL 1%, 0.5 GM
S0160 0 HCPCS / CPT® DEXTROAMPHETAMINE
S0164 87 HCPCS / CPT® INJECTION PANTROPRAZOLE
S0166 0 HCPCS / CPT® INJ OLANZAPINE 2.5MG
S0169 0 HCPCS / CPT® CALCITROL
S0170 0 HCPCS / CPT® ANASTROZOLE 1 MG
S0171 0 HCPCS / CPT® BUMETANIDE 0.5 MG
S0172 0 HCPCS / CPT® CHLORAMBUCIL 2 MG
S0174 0 HCPCS / CPT® DOLASETRON 50 MG
S0175 0 HCPCS / CPT® FLUTAMIDE 125 MG
S0176 0 HCPCS / CPT® HYDROXYUREA 500 MG
S0177 0 HCPCS / CPT® LEVAMISOLE 50 MG
S0178 0 HCPCS / CPT® LOMUSTINE 10 MG
S0179 0 HCPCS / CPT® MEGESTROL 20 MG
S0182 0 HCPCS / CPT® PROCARBAZINE, ORAL
S0183 0 HCPCS / CPT® PROCHLORPERAZINE 5 MG
S0187 0 HCPCS / CPT® TAMOXIFEN 10 MG
S0189 0 HCPCS / CPT® TESTOSTERONE PELLET 75 MG
S0190 0 HCPCS / CPT® MIFEPRISTONE, ORAL, 200 MG
S0191 0 HCPCS / CPT® MISOPROSTOL, ORAL, 200 MCG
S0194 0 HCPCS / CPT® VITAMIN SUPPL 100 CAPS
S0197 0 HCPCS / CPT® PRENATAL VITAMINS 30 DAY
S0199 0 HCPCS / CPT® MED ABORTION INC ALL EX DRUG
S0201 0 HCPCS / CPT® PARTIAL HOSPITALIZATION SERV
S0207 0 HCPCS / CPT® PARAMEDICINTERCEP NONHOSPALS
S0208 0 HCPCS / CPT® PARAMED INTRCEPT NONVOL
S0209 0 HCPCS / CPT® WC VAN MILEAGE PER MI
S0215 0 HCPCS / CPT® NONEMERG TRANSP MILEAGE
S0220 0 HCPCS / CPT® MEDICAL CONFERENCE BY PHYSIC
S0221 0 HCPCS / CPT® MEDICAL CONFERENCE, 60 MIN
S0250 0 HCPCS / CPT® COMP GERIATR ASSMT TEAM
S0255 0 HCPCS / CPT® HOSPICE REFER VISIT NONMD
S0257 0 HCPCS / CPT® END OF LIFE COUNSELING
S0260 0 HCPCS / CPT® H&P FOR SURGERY
S0265 0 HCPCS / CPT® GENETIC COUNSEL 15 MINS
S0270 0 HCPCS / CPT® HOME STD CASE RATE 30 DAYS
S0271 0 HCPCS / CPT® HOME HOSPICE CASE 30 DAYS
S0272 0 HCPCS / CPT® HOME EPISODIC CASE 30 DAYS
S0273 0 HCPCS / CPT® MD HOME VISIT OUTSIDE CAP
S0274 0 HCPCS / CPT® NURSE PRACTR VISIT OUTS CAP
S0280 0 HCPCS / CPT® MEDICAL HOME, INITIAL PLAN
S0281 0 HCPCS / CPT® MEDICAL HOME, MAINTENANCE
S0285 0 HCPCS / CPT® CNSLT BEFORE SCREEN COLONOSC
S0302 0 HCPCS / CPT® COMPLETED EPSDT
S0310 0 HCPCS / CPT® HOSPITALIST VISIT
S0311 0 HCPCS / CPT® COMP MGMT CARE COORD ADV ILL
S0315 0 HCPCS / CPT® DISEASE MANAGEMENT PROGRAM
S0316 0 HCPCS / CPT® FOLLOW-UP/REASSESSMENT
S0317 0 HCPCS / CPT® DISEASE MGMT PER DIEM
S0320 0 HCPCS / CPT® RN TELEPHONE CALLS TO DMP
S0340 0 HCPCS / CPT® LIFESTYLE MOD 1ST STAGE
S0341 0 HCPCS / CPT® LIFESTYLE MOD 2 OR 3 STAGE
S0342 0 HCPCS / CPT® LIFESTYLE MOD 4TH STAGE
S0353 0 HCPCS / CPT® CANCER TREATMENTPLAN INITIAL
S0354 0 HCPCS / CPT® CANCER TREATMENT PLAN CHANGE
S0390 0 HCPCS / CPT® ROUT FOOT CARE PER VISIT
S0395 0 HCPCS / CPT® IMPRESSION CASTING FT
S0400 0 HCPCS / CPT® GLOBAL ESWL KIDNEY
S0500 0 HCPCS / CPT® DISPOS CONT LENS
S0504 0 HCPCS / CPT® SINGL PRSCRP LENS
S0506 0 HCPCS / CPT® BIFOC PRSCP LENS
S0508 0 HCPCS / CPT® TRIFOC PRSCRP LENS
S0510 0 HCPCS / CPT® NON-PRSCRP LENS
S0512 0 HCPCS / CPT® DAILY CONT LENS
S0514 0 HCPCS / CPT® COLOR CONT LENS
S0515 0 HCPCS / CPT® SCLERAL LENS LIQUID BANDAGE
S0516 0 HCPCS / CPT® SAFETY FRAMES
S0518 0 HCPCS / CPT® SUNGLASS FRAMES
S0580 0 HCPCS / CPT® POLYCARB LENS
S0581 0 HCPCS / CPT® NONSTND LENS
S0590 0 HCPCS / CPT® MISC INTEGRAL LENS SERV
S0592 0 HCPCS / CPT® COMP CONT LENS EVAL
S0595 0 HCPCS / CPT® NEW LENSES IN PTS OLD FRAME
S0596 0 HCPCS / CPT® PHAKIC IOL REFRACTIVE ERROR
S0601 0 HCPCS / CPT® SCREENING PROCTOSCOPY
S0610 0 HCPCS / CPT® ANNUAL GYNECOLOGICAL EXAMINA
S0612 0 HCPCS / CPT® ANNUAL GYNECOLOGICAL EXAMINA
S0613 0 HCPCS / CPT® ANN BREAST EXAM
S0618 0 HCPCS / CPT® AUDIOMETRY FOR HEARING AID
S0620 0 HCPCS / CPT® ROUTINE OPHTHALMOLOGICAL EXA
S0621 0 HCPCS / CPT® ROUTINE OPHTHALMOLOGICAL EXA
S0622 0 HCPCS / CPT® PHYS EXAM FOR COLLEGE
S0630 88 HCPCS / CPT® REMOVAL OF SUTURES
S0800 0 HCPCS / CPT® LASER IN SITU KERATOMILEUSIS
S0810 0 HCPCS / CPT® PHOTOREFRACTIVE KERATECTOMY
S0812 0 HCPCS / CPT® PHOTOTHERAP KERATECT
S1001 0 HCPCS / CPT® DELUXE ITEM
S1002 0 HCPCS / CPT® CUSTOM ITEM
S1015 0 HCPCS / CPT® IV TUBING EXTENSION SET
S1016 0 HCPCS / CPT® NON-PVC INTRAVENOUS ADMINIST
S1030 0 HCPCS / CPT® GLUC MONITOR PURCHASE
S1031 0 HCPCS / CPT® GLUC MONITOR RENTAL
S1034 0 HCPCS / CPT® ART PANCREAS SYSTEM
S1035 0 HCPCS / CPT® ART PANCREAS INV DISP SENSOR
S1036 0 HCPCS / CPT® ART PANCREAS EXT TRANSMITTER
S1037 0 HCPCS / CPT® ART PANCREAS EXT RECEIVER
S1040 0 HCPCS / CPT® CRANIAL REMOLDING ORTHOSIS
S1090 0 HCPCS / CPT® MOMETASONE SINUS IMPLANT
S2053 0 HCPCS / CPT® TRANSPLANTATION OF SMALL INT
S2054 0 HCPCS / CPT® TRANSPLANTATION OF MULTIVISC
S2055 0 HCPCS / CPT® HARVESTING OF DONOR MULTIVIS
S2060 0 HCPCS / CPT® LOBAR LUNG TRANSPLANTATION
S2061 0 HCPCS / CPT® DONOR LOBECTOMY (LUNG)
S2065 0 HCPCS / CPT® SIMULT PANC KIDN TRANS
S2066 0 HCPCS / CPT® BREAST GAP FLAP RECONST
S2067 0 HCPCS / CPT® BREAST STACKED DIEP/GAP
S2068 0 HCPCS / CPT® BREAST DIEP OR SIEA FLAP
S2070 0 HCPCS / CPT® CYSTO LASER TX URETERAL CALC
S2079 0 HCPCS / CPT® LAP ESOPHAGOMYOTOMY
S2080 0 HCPCS / CPT® LAUP
S2083 0 HCPCS / CPT® ADJUSTMENT GASTRIC BAND
S2095 0 HCPCS / CPT® TRANSCATH EMBOLIZ MICROSPHER
S2102 0 HCPCS / CPT® ISLET CELL TISSUE TRANSPLANT
S2103 0 HCPCS / CPT® ADRENAL TISSUE TRANSPLANT
S2107 0 HCPCS / CPT® ADOPTIVE IMMUNOTHERAPY
S2112 0 HCPCS / CPT® KNEE ARTHROSCP HARV
S2115 0 HCPCS / CPT® PERIACETABULAR OSTEOTOMY
S2117 0 HCPCS / CPT® ARTHROEREISIS, SUBTALAR
S2118 0 HCPCS / CPT® TOTAL HIP RESURFACING
S2120 0 HCPCS / CPT® LOW DENSITY LIPOPROTEIN(LDL)
S2140 0 HCPCS / CPT® CORD BLOOD HARVESTING
S2142 0 HCPCS / CPT® CORD BLOOD-DERIVED STEM-CELL
S2150 0 HCPCS / CPT® BMT HARV/TRANSPL 28D PKG
S2152 0 HCPCS / CPT® SOLID ORGAN TRANSPL PKG
S2202 0 HCPCS / CPT® ECHOSCLEROTHERAPY
S2205 0 HCPCS / CPT® MINIMALLY INVASIVE DIRECT CO
S2206 0 HCPCS / CPT® MINIMALLY INVASIVE DIRECT CO
S2207 0 HCPCS / CPT® MINIMALLY INVASIVE DIRECT CO
S2208 0 HCPCS / CPT® MINIMALLY INVASIVE DIRECT CO
S2209 0 HCPCS / CPT® MINIMALLY INVASIVE DIRECT CO
S2225 0 HCPCS / CPT® MYRINGOTOMY LASER-ASSIST
S2230 0 HCPCS / CPT® IMPLANT SEMI-IMP HEAR
S2235 0 HCPCS / CPT® IMPLANT AUDITORY BRAIN IMP
S2260 0 HCPCS / CPT® INDUCED ABORTION 17-24 WEEKS
S2265 0 HCPCS / CPT® INDUCED ABORTION 25-28 WKS
S2266 0 HCPCS / CPT® INDUCED ABORTION 29-31 WKS
S2267 0 HCPCS / CPT® INDUCED ABORTION 32 OR MORE
S2300 0 HCPCS / CPT® ARTHROSCOPY, SHOULDER, SURGI
S2325 0 HCPCS / CPT® HIP CORE DECOMPRESSION
S2340 0 HCPCS / CPT® CHEMODENERVATION OF ABDUCTOR
S2341 0 HCPCS / CPT® CHEMODENERV ADDUCT VOCAL
S2342 0 HCPCS / CPT® NASAL ENDOSCOP PO DEBRID
S2348 0 HCPCS / CPT® DECOMPRESS DISC RF LUMBAR
S2350 0 HCPCS / CPT® DISKECTOMY, ANTERIOR, WITH D
S2351 0 HCPCS / CPT® DISKECTOMY, ANTERIOR, WITH D
S2400 0 HCPCS / CPT® FETAL SURG CONGEN HERNIA
S2401 0 HCPCS / CPT® FETAL SURG URIN TRAC OBSTR
S2402 0 HCPCS / CPT® FETAL SURG CONG CYST MALF
S2403 0 HCPCS / CPT® FETAL SURG PULMON SEQUEST
S2404 0 HCPCS / CPT® FETAL SURG MYELOMENINGO
S2405 0 HCPCS / CPT® FETAL SURG SACROCOC TERATOMA
S2409 0 HCPCS / CPT® FETAL SURG NOC
S2411 0 HCPCS / CPT® FETOSCOP LASER THER TTTS
S2900 0 HCPCS / CPT® ROBOTIC SURGICAL SYSTEM
S3000 17 HCPCS / CPT® BILAT DIL RETINAL EXAM
S3005 0 HCPCS / CPT® EVAL SELF-ASSESS DEPRESSION
S3600 0 HCPCS / CPT® STAT LAB
S3601 0 HCPCS / CPT® STAT LAB HOME/NF
S3620 0 HCPCS / CPT® NEWBORN METABOLIC SCREENING
S3630 0 HCPCS / CPT® EOSINOPHIL BLOOD COUNT
S3645 0 HCPCS / CPT® HIV-1 ANTIBODY TESTING OF OR
S3650 0 HCPCS / CPT® SALIVA TEST, HORMONE LEVEL;
S3652 0 HCPCS / CPT® SALIVA TEST, HORMONE LEVEL;
S3655 0 HCPCS / CPT® ANTISPERM ANTIBODIES TEST
S3708 0 HCPCS / CPT® GASTROINTESTINAL FAT ABSORPT
S3722 0 HCPCS / CPT® DOSE OPTIMIZATION AUC – 5FU
S3800 0 HCPCS / CPT® GENETIC TESTING ALS
S3840 0 HCPCS / CPT® DNA ANALYSIS RET-ONCOGENE
S3841 0 HCPCS / CPT® GENE TEST RETINOBLASTOMA
S3842 0 HCPCS / CPT® GENE TEST HIPPEL-LINDAU
S3844 0 HCPCS / CPT® DNA ANALYSIS DEAFNESS
S3845 0 HCPCS / CPT® GENE TEST ALPHA-THALASSEMIA
S3846 0 HCPCS / CPT® GENE TEST BETA-THALASSEMIA
S3849 0 HCPCS / CPT® GENE TEST NIEMANN-PICK
S3850 0 HCPCS / CPT® GENE TEST SICKLE CELL
S3852 0 HCPCS / CPT® DNA ANALYSIS APOE ALZHEIMER
S3853 0 HCPCS / CPT® GENE TEST MYO MUSCLR DYST
S3854 0 HCPCS / CPT® GENE PROFILE PANEL BREAST
S3861 0 HCPCS / CPT® GENETIC TEST BRUGADA
S3865 0 HCPCS / CPT® COMP GENET TEST HYP CARDIOMY
S3866 0 HCPCS / CPT® SPEC GENE TEST HYP CARDIOMY
S3870 0 HCPCS / CPT® CGH TEST DEVELOPMENTAL DELAY
S3900 0 HCPCS / CPT® SURFACE EMG
S3902 0 HCPCS / CPT® BALLISTOCARDIOGRAM
S3904 0 HCPCS / CPT® MASTERS TWO STEP
S4005 0 HCPCS / CPT® INTERIM LABOR FACILITY GLOBA
S4011 0 HCPCS / CPT® IVF PACKAGE
S4013 0 HCPCS / CPT® COMPL GIFT CASE RATE
S4014 0 HCPCS / CPT® COMPL ZIFT CASE RATE
S4015 0 HCPCS / CPT® COMPLETE IVF NOS CASE RATE
S4016 0 HCPCS / CPT® FROZEN IVF CASE RATE
S4017 0 HCPCS / CPT® IVF CANC A STIM CASE RATE
S4018 0 HCPCS / CPT® F EMB TRNS CANC CASE RATE
S4020 0 HCPCS / CPT® IVF CANC A ASPIR CASE RATE
S4021 0 HCPCS / CPT® IVF CANC P ASPIR CASE RATE
S4022 0 HCPCS / CPT® ASST OOCYTE FERT CASE RATE
S4023 0 HCPCS / CPT® INCOMPL DONOR EGG CASE RATE
S4025 0 HCPCS / CPT® DONOR SERV IVF CASE RATE
S4026 0 HCPCS / CPT® PROCURE DONOR SPERM
S4027 0 HCPCS / CPT® STORE PREV FROZ EMBRYOS
S4028 0 HCPCS / CPT® MICROSURG EPI SPERM ASP
S4030 0 HCPCS / CPT® SPERM PROCURE INIT VISIT
S4031 0 HCPCS / CPT® SPERM PROCURE SUBS VISIT
S4035 0 HCPCS / CPT® STIMULATED IUI CASE RATE
S4037 0 HCPCS / CPT® CRYO EMBRYO TRANSF CASE RATE
S4040 0 HCPCS / CPT® MONIT STORE CRYO EMBRYO 30 D
S4042 0 HCPCS / CPT® OVULATION MGMT PER CYCLE
S4981 0 HCPCS / CPT® INSERT LEVONORGESTREL IUS
S4989 0 HCPCS / CPT® CONTRACEPT IUD
S4990 0 HCPCS / CPT® NICOTINE PATCH LEGEND
S4991 0 HCPCS / CPT® NICOTINE PATCH NONLEGEND
S4993 0 HCPCS / CPT® CONTRACEPTIVE PILLS FOR BC
S4995 0 HCPCS / CPT® SMOKING CESSATION GUM
S5000 0 HCPCS / CPT® PRESCRIPTION DRUG, GENERIC
S5001 0 HCPCS / CPT® PRESCRIPTION DRUG,BRAND NAME
S5010 185 HCPCS / CPT® 5% DEXTROSE AND 0.45% SALINE
S5012 0 HCPCS / CPT® 5% DEXTROSE WITH POTASSIUM
S5013 0 HCPCS / CPT® 5%DEXTROSE/0.45%SALINE1000ML
S5014 0 HCPCS / CPT® D5W/0.45NS W KCL AND MGS04
S5035 0 HCPCS / CPT® HIT ROUTINE DEVICE MAINT
S5036 0 HCPCS / CPT® HIT DEVICE REPAIR
S5100 0 HCPCS / CPT® ADULT DAYCARE SERVICES 15MIN
S5101 0 HCPCS / CPT® ADULT DAY CARE PER HALF DAY
S5102 0 HCPCS / CPT® ADULT DAY CARE PER DIEM
S5105 0 HCPCS / CPT® CENTERBASED DAY CARE PERDIEM
S5108 0 HCPCS / CPT® HOMECARE TRAIN PT 15 MIN
S5109 0 HCPCS / CPT® HOMECARE TRAIN PT SESSION
S5110 0 HCPCS / CPT® FAMILY HOMECARE TRAINING 15M
S5111 0 HCPCS / CPT® FAMILY HOMECARE TRAIN/SESSIO
S5115 0 HCPCS / CPT® NONFAMILY HOMECARE TRAIN/15M
S5116 0 HCPCS / CPT® NONFAMILY HC TRAIN/SESSION
S5120 0 HCPCS / CPT® CHORE SERVICES PER 15 MIN
S5121 0 HCPCS / CPT® CHORE SERVICES PER DIEM
S5125 0 HCPCS / CPT® ATTENDANT CARE SERVICE /15M
S5126 0 HCPCS / CPT® ATTENDANT CARE SERVICE /DIEM
S5130 0 HCPCS / CPT® HOMAKER SERVICE NOS PER 15M
S5131 0 HCPCS / CPT® HOMEMAKER SERVICE NOS /DIEM
S5135 0 HCPCS / CPT® ADULT COMPANIONCARE PER 15M
S5136 0 HCPCS / CPT® ADULT COMPANIONCARE PER DIEM
S5140 0 HCPCS / CPT® ADULT FOSTER CARE PER DIEM
S5141 0 HCPCS / CPT® ADULT FOSTER CARE PER MONTH
S5145 0 HCPCS / CPT® CHILD FOSTERCARE TH PER DIEM
S5146 0 HCPCS / CPT® THER FOSTERCARE CHILD /MONTH
S5150 0 HCPCS / CPT® UNSKILLED RESPITE CARE /15M
S5151 0 HCPCS / CPT® UNSKILLED RESPITECARE /DIEM
S5160 0 HCPCS / CPT® EMER RESPONSE SYS INSTAL&TST
S5161 0 HCPCS / CPT® EMER RSPNS SYS SERV PERMONTH
S5162 0 HCPCS / CPT® EMER RSPNS SYSTEM PURCHASE
S5165 0 HCPCS / CPT® HOME MODIFICATIONS PER SERV
S5170 0 HCPCS / CPT® HOMEDELIVERED PREPARED MEAL
S5175 0 HCPCS / CPT® LAUNDRY SERV,EXT,PROF,/ORDER
S5180 0 HCPCS / CPT® HH RESPIRATORY THRPY IN EVAL
S5181 0 HCPCS / CPT® HH RESPIRATORY THRPY NOS/DAY
S5185 0 HCPCS / CPT® MED REMINDER SERV PER MONTH
S5190 0 HCPCS / CPT® WELLNESS ASSESSMENT BY NONPH
S5199 0 HCPCS / CPT® PERSONAL CARE ITEM NOS EACH
S5497 0 HCPCS / CPT® HIT CATH CARE NOC
S5498 0 HCPCS / CPT® HIT SIMPLE CATH CARE
S5501 0 HCPCS / CPT® HIT COMPLEX CATH CARE
S5502 0 HCPCS / CPT® HIT INTERIM CATH CARE
S5517 0 HCPCS / CPT® HIT DECLOTTING KIT
S5518 0 HCPCS / CPT® HIT CATH REPAIR KIT
S5520 0 HCPCS / CPT® HIT PICC INSERT KIT
S5521 0 HCPCS / CPT® HIT MIDLINE CATH INSERT KIT
S5522 0 HCPCS / CPT® HIT PICC INSERT NO SUPP
S5523 0 HCPCS / CPT® HIP MIDLINE CATH INSERT KIT
S5550 44 HCPCS / CPT® INSULIN RAPID 5 U
S5551 0 HCPCS / CPT® INSULIN MOST RAPID 5 U
S5552 0 HCPCS / CPT® INSULIN INTERMED 5 U
S5553 0 HCPCS / CPT® INSULIN LONG ACTING 5 U
S5560 0 HCPCS / CPT® INSULIN REUSE PEN 1.5 ML
S5561 0 HCPCS / CPT® INSULIN REUSE PEN 3 ML
S5565 0 HCPCS / CPT® INSULIN CARTRIDGE 150 U
S5566 0 HCPCS / CPT® INSULIN CARTRIDGE 300 U
S5570 0 HCPCS / CPT® INSULIN DISPOS PEN 1.5 ML
S5571 0 HCPCS / CPT® INSULIN DISPOS PEN 3 ML
S8030 0 HCPCS / CPT® TANTALUM RING APPLICATION
S8035 0 HCPCS / CPT® MAGNETIC SOURCE IMAGING
S8037 0 HCPCS / CPT® MRCP
S8040 0 HCPCS / CPT® TOPOGRAPHIC BRAIN MAPPING
S8042 0 HCPCS / CPT® MRI LOW FIELD
S8055 0 HCPCS / CPT® US GUIDANCE FETAL REDUCT
S8080 0 HCPCS / CPT® SCINTIMAMMOGRAPHY
S8085 0 HCPCS / CPT® FLUORINE-18 FLUORODEOXYGLUCO
S8092 0 HCPCS / CPT® ELECTRON BEAM COMPUTED TOMOG
S8096 0 HCPCS / CPT® PORTABLE PEAK FLOW METER
S8097 0 HCPCS / CPT® ASTHMA KIT
S8100 0 HCPCS / CPT® SPACER WITHOUT MASK
S8101 0 HCPCS / CPT® SPACER WITH MASK
S8110 0 HCPCS / CPT® PEAK EXPIRATORY FLOW RATE (P
S8120 0 HCPCS / CPT® O2 CONTENTS GAS CUBIC FT
S8121 0 HCPCS / CPT® O2 CONTENTS LIQUID LB
S8130 0 HCPCS / CPT® INTERFERENTIAL STIM 2 CHAN
S8131 0 HCPCS / CPT® INTERFERENTIAL STIM 4 CHAN
S8185 0 HCPCS / CPT® FLUTTER DEVICE
S8186 0 HCPCS / CPT® SWIVEL ADAPTOR
S8189 0 HCPCS / CPT® TRACH SUPPLY NOC
S8210 0 HCPCS / CPT® MUCUS TRAP
S8265 0 HCPCS / CPT® HABERMAN FEEDER
S8270 0 HCPCS / CPT® ENURESIS ALARM
S8301 0 HCPCS / CPT® INFECT CONTROL SUPPLIES NOS
S8415 0 HCPCS / CPT® SUPPLIES FOR HOME DELIVERY
S8420 0 HCPCS / CPT® CUSTOM GRADIENT SLEEV/GLOV
S8421 0 HCPCS / CPT® READY GRADIENT SLEEV/GLOV
S8422 0 HCPCS / CPT® CUSTOM GRAD SLEEVE MED
S8423 0 HCPCS / CPT® CUSTOM GRAD SLEEVE HEAVY
S8424 0 HCPCS / CPT® READY GRADIENT SLEEVE
S8425 0 HCPCS / CPT® CUSTOM GRAD GLOVE MED
S8426 0 HCPCS / CPT® CUSTOM GRAD GLOVE HEAVY
S8427 0 HCPCS / CPT® READY GRADIENT GLOVE
S8428 0 HCPCS / CPT® READY GRADIENT GAUNTLET
S8429 0 HCPCS / CPT® GRADIENT PRESSURE WRAP
S8430 0 HCPCS / CPT® PADDING FOR COMPRSSN BDG
S8431 0 HCPCS / CPT® COMPRESSION BANDAGE
S8450 76 HCPCS / CPT® SPLINT DIGIT
S8451 0 HCPCS / CPT® SPLINT WRIST OR ANKLE
S8452 0 HCPCS / CPT® SPLINT ELBOW
S8460 0 HCPCS / CPT® CAMISOLE POST-MAST
S8490 0 HCPCS / CPT® 100 INSULIN SYRINGES
S8930 0 HCPCS / CPT® AURICULAR ELECTROSTIMULATION
S8940 0 HCPCS / CPT® HIPPOTHERAPY PER SESSION
S8948 0 HCPCS / CPT® LOW-LEVEL LASER TRMT 15 MIN
S8950 0 HCPCS / CPT® COMPLEX LYMPHEDEMA THERAPY,
S8990 0 HCPCS / CPT® PT OR MANIP FOR MAINT
S8999 0 HCPCS / CPT® RESUSCITATION BAG
S9001 0 HCPCS / CPT® HOME UTERINE MONITOR WITH OR
S9007 0 HCPCS / CPT® ULTRAFILTRATION MONITOR
S9024 0 HCPCS / CPT® PARANASAL SINUS ULTRASOUND
S9025 0 HCPCS / CPT® OMNICARDIOGRAM/CARDIOINTEGRA
S9034 0 HCPCS / CPT® ESWL FOR GALLSTONES
S9055 0 HCPCS / CPT® PROCUREN OR OTHER GROWTH FAC
S9056 0 HCPCS / CPT® COMA STIMULATION PER DIEM
S9061 0 HCPCS / CPT® MEDICAL SUPPLIES AND EQUIPME
S9083 0 HCPCS / CPT® URGENT CARE CENTER GLOBAL
S9088 0 HCPCS / CPT® SERVICES PROVIDED IN URGENT
S9090 0 HCPCS / CPT® VERTEBRAL AXIAL DECOMPRESSIO
S9097 0 HCPCS / CPT® HOME VISIT WOUND CARE
S9098 0 HCPCS / CPT® HOME PHOTOTHERAPY VISIT
S9110 0 HCPCS / CPT® TELEMONITORING/HOME PER MNTH
S9117 0 HCPCS / CPT® BACK SCHOOL VISIT
S9122 0 HCPCS / CPT® HOME HEALTH AIDE OR CERTIFIE
S9123 0 HCPCS / CPT® NURSING CARE IN HOME RN
S9124 0 HCPCS / CPT® NURSING CARE, IN THE HOME; B
S9125 0 HCPCS / CPT® RESPITE CARE, IN THE HOME, P
S9126 0 HCPCS / CPT® HOSPICE CARE, IN THE HOME, P
S9127 0 HCPCS / CPT® SOCIAL WORK VISIT, IN THE HO
S9128 0 HCPCS / CPT® SPEECH THERAPY, IN THE HOME,
S9129 0 HCPCS / CPT® OCCUPATIONAL THERAPY, IN THE
S9131 0 HCPCS / CPT® PT IN THE HOME PER DIEM
S9140 0 HCPCS / CPT® DIABETIC MANAGEMENT PROGRAM,
S9141 0 HCPCS / CPT® DIABETIC MANAGEMENT PROGRAM,
S9145 0 HCPCS / CPT® INSULIN PUMP INITIATION
S9150 0 HCPCS / CPT® EVALUATION BY OCULARIST
S9152 0 HCPCS / CPT® SPEECH THERAPY, RE-EVAL
S9208 0 HCPCS / CPT® HOME MGMT PRETERM LABOR
S9209 0 HCPCS / CPT® HOME MGMT PPROM
S9211 0 HCPCS / CPT® HOME MGMT GEST HYPERTENSION
S9212 0 HCPCS / CPT® HM POSTPAR HYPER PER DIEM
S9213 0 HCPCS / CPT® HM PREECLAMP PER DIEM
S9214 0 HCPCS / CPT® HM GEST DM PER DIEM
S9325 0 HCPCS / CPT® HIT PAIN MGMT PER DIEM
S9326 0 HCPCS / CPT® HIT CONT PAIN PER DIEM
S9327 0 HCPCS / CPT® HIT INT PAIN PER DIEM
S9328 0 HCPCS / CPT® HIT PAIN IMP PUMP DIEM
S9329 0 HCPCS / CPT® HIT CHEMO PER DIEM
S9330 0 HCPCS / CPT® HIT CONT CHEM DIEM
S9331 0 HCPCS / CPT® HIT INTERMIT CHEMO DIEM
S9335 0 HCPCS / CPT® HT HEMODIALYSIS DIEM
S9336 0 HCPCS / CPT® HIT CONT ANTICOAG DIEM
S9338 0 HCPCS / CPT® HIT IMMUNOTHERAPY DIEM
S9339 0 HCPCS / CPT® HIT PERITON DIALYSIS DIEM
S9340 0 HCPCS / CPT® HIT ENTERAL PER DIEM
S9341 0 HCPCS / CPT® HIT ENTERAL GRAV DIEM
S9342 0 HCPCS / CPT® HIT ENTERAL PUMP DIEM
S9343 0 HCPCS / CPT® HIT ENTERAL BOLUS NURS
S9345 0 HCPCS / CPT® HIT ANTI-HEMOPHIL DIEM
S9346 0 HCPCS / CPT® HIT ALPHA-1-PROTEINAS DIEM
S9347 0 HCPCS / CPT® HIT LONGTERM INFUSION DIEM
S9348 0 HCPCS / CPT® HIT SYMPATHOMIM DIEM
S9349 0 HCPCS / CPT® HIT TOCOLYSIS DIEM
S9351 0 HCPCS / CPT® HIT CONT ANTIEMETIC DIEM
S9353 0 HCPCS / CPT® HIT CONT INSULIN DIEM
S9355 0 HCPCS / CPT® HIT CHELATION DIEM
S9357 0 HCPCS / CPT® HIT ENZYME REPLACE DIEM
S9359 0 HCPCS / CPT® HIT ANTI-TNF PER DIEM
S9361 0 HCPCS / CPT® HIT DIURETIC INFUS DIEM
S9363 0 HCPCS / CPT® HIT ANTI-SPASMOTIC DIEM
S9364 0 HCPCS / CPT® HIT TPN TOTAL DIEM
S9365 0 HCPCS / CPT® HIT TPN 1 LITER DIEM
S9366 0 HCPCS / CPT® HIT TPN 2 LITER DIEM
S9367 0 HCPCS / CPT® HIT TPN 3 LITER DIEM
S9368 0 HCPCS / CPT® HIT TPN OVER 3L DIEM
S9370 0 HCPCS / CPT® HT INJ ANTIEMETIC DIEM
S9372 0 HCPCS / CPT® HT INJ ANTICOAG DIEM
S9373 0 HCPCS / CPT® HIT HYDRA TOTAL DIEM
S9374 0 HCPCS / CPT® HIT HYDRA 1 LITER DIEM
S9375 0 HCPCS / CPT® HIT HYDRA 2 LITER DIEM
S9376 0 HCPCS / CPT® HIT HYDRA 3 LITER DIEM
S9377 0 HCPCS / CPT® HIT HYDRA OVER 3L DIEM
S9379 0 HCPCS / CPT® HIT NOC PER DIEM
S9381 0 HCPCS / CPT® HIT HIGH RISK/ESCORT
S9401 0 HCPCS / CPT® ANTICOAG CLINIC PER SESSION
S9430 0 HCPCS / CPT® PHARMACY COMP/DISP SERV
S9433 0 HCPCS / CPT® MEDICAL FOOD ORAL 100% NUTR
S9434 0 HCPCS / CPT® MOD SOLID FOOD SUPPL
S9435 0 HCPCS / CPT® MEDICAL FOODS FOR INBORN ERR
S9436 0 HCPCS / CPT® LAMAZE CLASS
S9437 0 HCPCS / CPT® CHILDBIRTH REFRESHER CLASS
S9438 0 HCPCS / CPT® CESAREAN BIRTH CLASS
S9439 0 HCPCS / CPT® VBAC CLASS
S9441 0 HCPCS / CPT® ASTHMA EDUCATION
S9442 0 HCPCS / CPT® BIRTHING CLASS
S9443 0 HCPCS / CPT® LACTATION CLASS
S9444 0 HCPCS / CPT® PARENTING CLASS
S9445 0 HCPCS / CPT® PT EDUCATION NOC INDIVID
S9446 0 HCPCS / CPT® PT EDUCATION NOC GROUP
S9447 0 HCPCS / CPT® INFANT SAFETY CLASS
S9449 0 HCPCS / CPT® WEIGHT MGMT CLASS
S9451 0 HCPCS / CPT® EXERCISE CLASS
S9452 0 HCPCS / CPT® NUTRITION CLASS
S9453 0 HCPCS / CPT® SMOKING CESSATION CLASS
S9454 0 HCPCS / CPT® STRESS MGMT CLASS
S9455 0 HCPCS / CPT® DIABETIC MANAGEMENT PROGRAM,
S9460 0 HCPCS / CPT® DIABETIC MANAGEMENT PROGRAM,
S9465 0 HCPCS / CPT® DIABETIC MANAGEMENT PROGRAM,
S9470 0 HCPCS / CPT® NUTRITIONAL COUNSELING, DIET
S9472 0 HCPCS / CPT® CARDIAC REHABILITATION PROGR
S9473 0 HCPCS / CPT® PULMONARY REHABILITATION PRO
S9474 0 HCPCS / CPT® ENTEROSTOMAL THERAPY BY A RE
S9475 0 HCPCS / CPT® AMBULATORY SETTING SUBSTANCE
S9476 0 HCPCS / CPT® VESTIBULAR REHAB PER DIEM
S9480 0 HCPCS / CPT® INTENSIVE OUTPATIENT PSYCHIA
S9482 0 HCPCS / CPT® FAMILY STABILIZATION 15 MIN
S9484 0 HCPCS / CPT® CRISIS INTERVENTION PER HOUR
S9485 0 HCPCS / CPT® CRISIS INTERVENTION MENTAL H
S9490 0 HCPCS / CPT® HIT CORTICOSTEROID/DIEM
S9494 0 HCPCS / CPT® HIT ANTIBIOTIC TOTAL DIEM
S9497 0 HCPCS / CPT® HIT ANTIBIOTIC Q3H DIEM
S9500 0 HCPCS / CPT® HIT ANTIBIOTIC Q24H DIEM
S9501 0 HCPCS / CPT® HIT ANTIBIOTIC Q12H DIEM
S9502 0 HCPCS / CPT® HIT ANTIBIOTIC Q8H DIEM
S9503 0 HCPCS / CPT® HIT ANTIBIOTIC Q6H DIEM
S9504 0 HCPCS / CPT® HIT ANTIBIOTIC Q4H DIEM
S9529 0 HCPCS / CPT® VENIPUNCTURE HOME/SNF
S9537 0 HCPCS / CPT® HT HEM HORM INJ DIEM
S9538 0 HCPCS / CPT® HIT BLOOD PRODUCTS DIEM
S9542 0 HCPCS / CPT® HT INJ NOC PER DIEM
S9558 0 HCPCS / CPT® HT INJ GROWTH HORM DIEM
S9559 0 HCPCS / CPT® HIT INJ INTERFERON DIEM
S9560 0 HCPCS / CPT® HT INJ HORMONE DIEM
S9562 0 HCPCS / CPT® HT INJ PALIVIZUMAB DIEM
S9590 0 HCPCS / CPT® HT IRRIGATION DIEM
S9810 0 HCPCS / CPT® HT PHARM PER HOUR
S9900 0 HCPCS / CPT® CHRISTIAN SCI PRACT VISIT
S9901 0 HCPCS / CPT® CHRISTIAN SCI NURSE VISIT
S9960 0 HCPCS / CPT® AIR AMBULANC NONEMERG FIXED
S9961 0 HCPCS / CPT® AIR AMBULAN NONEMERG ROTARY
S9970 0 HCPCS / CPT® HEALTH CLUB MEMBERSHIP YR
S9975 0 HCPCS / CPT® TRANSPLANT RELATED PER DIEM
S9976 0 HCPCS / CPT® LODGING PER DIEM
S9977 0 HCPCS / CPT® MEALS PER DIEM
S9981 55 HCPCS / CPT® MED RECORD COPY ADMIN
S9982 0 HCPCS / CPT® MED RECORD COPY PER PAGE
S9986 0 HCPCS / CPT® NOT MEDICALLY NECESSARY SVC
S9988 0 HCPCS / CPT® SERV PART OF PHASE I TRIAL
S9989 0 HCPCS / CPT® SERVICES OUTSIDE US
S9990 0 HCPCS / CPT® SERVICES PROVIDED AS PART OF
S9991 0 HCPCS / CPT® SERVICES PROVIDED AS PART OF
S9992 0 HCPCS / CPT® TRANSPORTATION COSTS TO AND
S9994 0 HCPCS / CPT® LODGING COSTS (E.G. HOTEL CH
S9996 0 HCPCS / CPT® MEALS FOR CLINICAL TRIAL PAR
S9999 0 HCPCS / CPT® SALES TAX
T1000 0 HCPCS / CPT® PRIVATE DUTY/INDEPENDENT NSG
T1001 0 HCPCS / CPT® NURSING ASSESSMENT/EVALUATN
T1002 0 HCPCS / CPT® RN SERVICES UP TO 15 MINUTES
T1003 0 HCPCS / CPT® LPN/LVN SERVICES UP TO 15MIN
T1004 0 HCPCS / CPT® NSG AIDE SERVICE UP TO 15MIN
T1005 0 HCPCS / CPT® RESPITE CARE SERVICE 15 MIN
T1006 0 HCPCS / CPT® FAMILY/COUPLE COUNSELING
T1007 0 HCPCS / CPT® TREATMENT PLAN DEVELOPMENT
T1009 0 HCPCS / CPT® CHILD SITTING SERVICES
T1010 0 HCPCS / CPT® MEALS WHEN RECEIVE SERVICES
T1012 0 HCPCS / CPT® ALCOHOL/SUBSTANCE ABUSE SKIL
T1013 0 HCPCS / CPT® SIGN LANG/ORAL INTERPRETER
T1014 0 HCPCS / CPT® TELEHEALTH TRANSMIT, PER MIN
T1015 0 HCPCS / CPT® CLINIC SERVICE
T1016 0 HCPCS / CPT® CASE MANAGEMENT
T1017 0 HCPCS / CPT® TARGETED CASE MANAGEMENT
T1018 0 HCPCS / CPT® SCHOOL-BASED IEP SER BUNDLED
T1019 0 HCPCS / CPT® PERSONAL CARE SER PER 15 MIN
T1020 0 HCPCS / CPT® PERSONAL CARE SER PER DIEM
T1021 0 HCPCS / CPT® HH AIDE OR CN AIDE PER VISIT
T1022 0 HCPCS / CPT® CONTRACTED SERVICES PER DAY
T1023 0 HCPCS / CPT® PROGRAM INTAKE ASSESSMENT
T1024 0 HCPCS / CPT® TEAM EVALUATION & MANAGEMENT
T1025 0 HCPCS / CPT® PED COMPR CARE PKG, PER DIEM
T1026 0 HCPCS / CPT® PED COMPR CARE PKG, PER HOUR
T1027 0 HCPCS / CPT® FAMILY TRAINING & COUNSELING
T1028 0 HCPCS / CPT® HOME ENVIRONMENT ASSESSMENT
T1029 0 HCPCS / CPT® DWELLING LEAD INVESTIGATION
T1030 0 HCPCS / CPT® RN HOME CARE PER DIEM
T1031 0 HCPCS / CPT® LPN HOME CARE PER DIEM
T1040 0 HCPCS / CPT® COMM BH CLINIC SVC PER DIEM
T1041 0 HCPCS / CPT® COMM BH CLINIC SVC PER MONTH
T1502 0 HCPCS / CPT® MEDICATION ADMIN VISIT
T1503 0 HCPCS / CPT® MED ADMIN, NOT ORAL/INJECT
T1505 0 HCPCS / CPT® ELEC MED COMP DEV, NOC
T1999 0 HCPCS / CPT® NOC RETAIL ITEMS ANDSUPPLIES
T2001 0 HCPCS / CPT® N-ET; PATIENT ATTEND/ESCORT
T2002 0 HCPCS / CPT® N-ET; PER DIEM
T2003 0 HCPCS / CPT® N-ET; ENCOUNTER/TRIP
T2004 0 HCPCS / CPT® N-ET; COMMERC CARRIER PASS
T2005 0 HCPCS / CPT® N-ET; STRETCHER VAN
T2007 0 HCPCS / CPT® NON-EMER TRANSPORT WAIT TIME
T2010 0 HCPCS / CPT® PASRR LEVEL I
T2011 0 HCPCS / CPT® PASRR LEVEL II
T2012 0 HCPCS / CPT® HABIL ED WAIVER, PER DIEM
T2013 0 HCPCS / CPT® HABIL ED WAIVER PER HOUR
T2014 0 HCPCS / CPT® HABIL PREVOC WAIVER, PER D
T2015 0 HCPCS / CPT® HABIL PREVOC WAIVER PER HR
T2016 0 HCPCS / CPT® HABIL RES WAIVER PER DIEM
T2017 0 HCPCS / CPT® HABIL RES WAIVER 15 MIN
T2018 0 HCPCS / CPT® HABIL SUP EMPL WAIVER/DIEM
T2019 0 HCPCS / CPT® HABIL SUP EMPL WAIVER 15MIN
T2020 0 HCPCS / CPT® DAY HABIL WAIVER PER DIEM
T2021 0 HCPCS / CPT® DAY HABIL WAIVER PER 15 MIN
T2022 0 HCPCS / CPT® CASE MANAGEMENT, PER MONTH
T2023 0 HCPCS / CPT® TARGETED CASE MGMT PER MONTH
T2024 0 HCPCS / CPT® SERV ASMNT/CARE PLAN WAIVER
T2025 0 HCPCS / CPT® WAIVER SERVICE, NOS
T2026 0 HCPCS / CPT® SPECIAL CHILDCARE WAIVER/D
T2027 0 HCPCS / CPT® SPEC CHILDCARE WAIVER 15 MIN
T2028 0 HCPCS / CPT® SPECIAL SUPPLY, NOS WAIVER
T2029 0 HCPCS / CPT® SPECIAL MED EQUIP, NOSWAIVER
T2030 0 HCPCS / CPT® ASSIST LIVING WAIVER/MONTH
T2031 0 HCPCS / CPT® ASSIST LIVING WAIVER/DIEM
T2032 0 HCPCS / CPT® RES CARE, NOS WAIVER/MONTH
T2033 0 HCPCS / CPT® RES, NOS WAIVER PER DIEM
T2034 0 HCPCS / CPT® CRISIS INTERVEN WAIVER/DIEM
T2035 0 HCPCS / CPT® UTILITY SERVICES WAIVER
T2036 0 HCPCS / CPT® CAMP OVERNITE WAIVER/SESSION
T2037 0 HCPCS / CPT® CAMP DAY WAIVER/SESSION
T2038 0 HCPCS / CPT® COMM TRANS WAIVER/SERVICE
T2039 0 HCPCS / CPT® VEHICLE MOD WAIVER/SERVICE
T2040 0 HCPCS / CPT® FINANCIAL MGT WAIVER/15MIN
T2041 0 HCPCS / CPT® SUPPORT BROKER WAIVER/15 MIN
T2042 0 HCPCS / CPT® HOSPICE ROUTINE HOME CARE
T2043 0 HCPCS / CPT® HOSPICE CONTINUOUS HOME CARE
T2044 0 HCPCS / CPT® HOSPICE RESPITE CARE
T2045 0 HCPCS / CPT® HOSPICE GENERAL CARE
T2046 0 HCPCS / CPT® HOSPICE LONG TERM CARE, R&B
T2048 0 HCPCS / CPT® BH LTC RES R&B, PER DIEM
T2049 0 HCPCS / CPT® N-ET; STRETCHER VAN, MILEAGE
T2101 0 HCPCS / CPT® BREAST MILK PROC/STORE/DIST
T4521 0 HCPCS / CPT® ADULT SIZE BRIEF/DIAPER SM
T4522 0 HCPCS / CPT® ADULT SIZE BRIEF/DIAPER MED
T4523 0 HCPCS / CPT® ADULT SIZE BRIEF/DIAPER LG
T4524 0 HCPCS / CPT® ADULT SIZE BRIEF/DIAPER XL
T4525 0 HCPCS / CPT® ADULT SIZE PULL-ON SM
T4526 0 HCPCS / CPT® ADULT SIZE PULL-ON MED
T4527 0 HCPCS / CPT® ADULT SIZE PULL-ON LG
T4528 0 HCPCS / CPT® ADULT SIZE PULL-ON XL
T4529 0 HCPCS / CPT® PED SIZE BRIEF/DIAPER SM/MED
T4530 0 HCPCS / CPT® PED SIZE BRIEF/DIAPER LG
T4531 0 HCPCS / CPT® PED SIZE PULL-ON SM/MED
T4532 0 HCPCS / CPT® PED SIZE PULL-ON LG
T4533 0 HCPCS / CPT® YOUTH SIZE BRIEF/DIAPER
T4534 0 HCPCS / CPT® YOUTH SIZE PULL-ON
T4535 0 HCPCS / CPT® DISPOSABLE LINER/SHIELD/PAD
T4536 0 HCPCS / CPT® REUSABLE PULL-ON ANY SIZE
T4537 0 HCPCS / CPT® REUSABLE UNDERPAD BED SIZE
T4538 0 HCPCS / CPT® DIAPER SERV REUSABLE DIAPER
T4539 0 HCPCS / CPT® REUSE DIAPER/BRIEF ANY SIZE
T4540 0 HCPCS / CPT® REUSABLE UNDERPAD CHAIR SIZE
T4541 0 HCPCS / CPT® LARGE DISPOSABLE UNDERPAD
T4542 0 HCPCS / CPT® SMALL DISPOSABLE UNDERPAD
T4543 0 HCPCS / CPT® ADULT DISP BRIEF/DIAP ABV XL
T4544 0 HCPCS / CPT® ADLT DISP UND/PULL ON ABV XL
T5001 0 HCPCS / CPT® POSITION SEAT SPEC ORTH NEED
T5999 0 HCPCS / CPT® SUPPLY, NOS
V2020 0 HCPCS / CPT® VISION SVCS FRAMES PURCHASES
V2025 0 HCPCS / CPT® EYEGLASSES DELUX FRAMES
V2100 0 HCPCS / CPT® LENS SPHER SINGLE PLANO 4.00
V2101 0 HCPCS / CPT® SINGLE VISN SPHERE 4.12-7.00
V2102 0 HCPCS / CPT® SINGL VISN SPHERE 7.12-20.00
V2103 0 HCPCS / CPT® SPHEROCYLINDR 4.00D/12-2.00D
V2104 0 HCPCS / CPT® SPHEROCYLINDR 4.00D/2.12-4D
V2105 0 HCPCS / CPT® SPHEROCYLINDER 4.00D/4.25-6D
V2106 0 HCPCS / CPT® V2107 0 HCPCS / CPT® SPHEROCYLINDER 4.25D/12-2D
V2108 0 HCPCS / CPT® SPHEROCYLINDER 4.25D/2.12-4D
V2109 0 HCPCS / CPT® SPHEROCYLINDER 4.25D/4.25-6D
V2110 0 HCPCS / CPT® SPHEROCYLINDER 4.25D/OVER 6D
V2111 0 HCPCS / CPT® SPHEROCYLINDR 7.25D/.25-2.25
V2112 0 HCPCS / CPT® SPHEROCYLINDR 7.25D/2.25-4D
V2113 0 HCPCS / CPT® SPHEROCYLINDR 7.25D/4.25-6D
V2114 0 HCPCS / CPT® SPHEROCYLINDER OVER 12.00D
V2115 0 HCPCS / CPT® LENS LENTICULAR BIFOCAL
V2118 0 HCPCS / CPT® LENS ANISEIKONIC SINGLE
V2121 0 HCPCS / CPT® LENTICULAR LENS, SINGLE
V2199 0 HCPCS / CPT® LENS SINGLE VISION NOT OTH C
V2200 0 HCPCS / CPT® LENS SPHER BIFOC PLANO 4.00D
V2201 0 HCPCS / CPT® LENS SPHERE BIFOCAL 4.12-7.0
V2202 0 HCPCS / CPT® LENS SPHERE BIFOCAL 7.12-20.
V2203 0 HCPCS / CPT® LENS SPHCYL BIFOCAL 4.00D/.1
V2204 0 HCPCS / CPT® LENS SPHCY BIFOCAL 4.00D/2.1
V2205 0 HCPCS / CPT® LENS SPHCY BIFOCAL 4.00D/4.2
V2206 0 HCPCS / CPT® LENS SPHCY BIFOCAL 4.00D/OVE
V2207 0 HCPCS / CPT® LENS SPHCY BIFOCAL 4.25-7D/.
V2208 0 HCPCS / CPT® LENS SPHCY BIFOCAL 4.25-7/2.
V2209 0 HCPCS / CPT® LENS SPHCY BIFOCAL 4.25-7/4.
V2210 0 HCPCS / CPT® LENS SPHCY BIFOCAL 4.25-7/OV
V2211 0 HCPCS / CPT® LENS SPHCY BIFO 7.25-12/.25-
V2212 0 HCPCS / CPT® LENS SPHCYL BIFO 7.25-12/2.2
V2213 0 HCPCS / CPT® LENS SPHCYL BIFO 7.25-12/4.2
V2214 0 HCPCS / CPT® LENS SPHCYL BIFOCAL OVER 12.
V2215 0 HCPCS / CPT® LENS LENTICULAR BIFOCAL
V2218 0 HCPCS / CPT® LENS ANISEIKONIC BIFOCAL
V2219 0 HCPCS / CPT® LENS BIFOCAL SEG WIDTH OVER
V2220 0 HCPCS / CPT® LENS BIFOCAL ADD OVER 3.25D
V2221 0 HCPCS / CPT® LENTICULAR LENS, BIFOCAL
V2299 0 HCPCS / CPT® LENS BIFOCAL SPECIALITY
V2300 0 HCPCS / CPT® LENS SPHERE TRIFOCAL 4.00D
V2301 0 HCPCS / CPT® LENS SPHERE TRIFOCAL 4.12-7.
V2302 0 HCPCS / CPT® LENS SPHERE TRIFOCAL 7.12-20
V2303 0 HCPCS / CPT® LENS SPHCY TRIFOCAL 4.0/.12-
V2304 0 HCPCS / CPT® LENS SPHCY TRIFOCAL 4.0/2.25
V2305 0 HCPCS / CPT® LENS SPHCY TRIFOCAL 4.0/4.25
V2306 0 HCPCS / CPT® V2307 0 HCPCS / CPT® LENS SPHCY TRIFOCAL 4.25-7/.
V2308 0 HCPCS / CPT® LENS SPHC TRIFOCAL 4.25-7/2.
V2309 0 HCPCS / CPT® LENS SPHC TRIFOCAL 4.25-7/4.
V2310 0 HCPCS / CPT® V2311 0 HCPCS / CPT® LENS SPHC TRIFO 7.25-12/.25-
V2312 0 HCPCS / CPT® LENS SPHC TRIFO 7.25-12/2.25
V2313 0 HCPCS / CPT® LENS SPHC TRIFO 7.25-12/4.25
V2314 0 HCPCS / CPT® LENS SPHCYL TRIFOCAL OVER 12
V2315 0 HCPCS / CPT® LENS LENTICULAR TRIFOCAL
V2318 0 HCPCS / CPT® LENS ANISEIKONIC TRIFOCAL
V2319 0 HCPCS / CPT® V2320 0 HCPCS / CPT® LENS TRIFOCAL ADD OVER 3.25D
V2321 0 HCPCS / CPT® LENTICULAR LENS, TRIFOCAL
V2399 0 HCPCS / CPT® LENS TRIFOCAL SPECIALITY
V2410 0 HCPCS / CPT® LENS VARIAB ASPHERICITY SING
V2430 0 HCPCS / CPT® LENS VARIABLE ASPHERICITY BI
V2499 0 HCPCS / CPT® VARIABLE ASPHERICITY LENS
V2500 0 HCPCS / CPT® CONTACT LENS PMMA SPHERICAL
V2501 0 HCPCS / CPT® CNTCT LENS PMMA-TORIC/PRISM
V2502 0 HCPCS / CPT® CONTACT LENS PMMA BIFOCAL
V2503 0 HCPCS / CPT® CNTCT LENS PMMA COLOR VISION
V2510 0 HCPCS / CPT® CNTCT GAS PERMEABLE SPHERICL
V2511 0 HCPCS / CPT® CNTCT TORIC PRISM BALLAST
V2512 0 HCPCS / CPT® CNTCT LENS GAS PERMBL BIFOCL
V2513 0 HCPCS / CPT® CONTACT LENS EXTENDED WEAR
V2520 0 HCPCS / CPT® CONTACT LENS HYDROPHILIC
V2521 0 HCPCS / CPT® CNTCT LENS HYDROPHILIC TORIC
V2522 0 HCPCS / CPT® CNTCT LENS HYDROPHIL BIFOCL
V2523 0 HCPCS / CPT® CNTCT LENS HYDROPHIL EXTEND
V2530 0 HCPCS / CPT® CONTACT LENS GAS IMPERMEABLE
V2531 0 HCPCS / CPT® CONTACT LENS GAS PERMEABLE
V2599 0 HCPCS / CPT® CONTACT LENS/ES OTHER TYPE
V2600 0 HCPCS / CPT® HAND HELD LOW VISION AIDS
V2610 0 HCPCS / CPT® SINGLE LENS SPECTACLE MOUNT
V2615 0 HCPCS / CPT® TELESCOP/OTHR COMPOUND LENS
V2623 0 HCPCS / CPT® PLASTIC EYE PROSTH CUSTOM
V2624 0 HCPCS / CPT® POLISHING ARTIFICAL EYE
V2625 0 HCPCS / CPT® ENLARGEMNT OF EYE PROSTHESIS
V2626 0 HCPCS / CPT® REDUCTION OF EYE PROSTHESIS
V2627 0 HCPCS / CPT® SCLERAL COVER SHELL
V2628 0 HCPCS / CPT® FABRICATION & FITTING
V2629 0 HCPCS / CPT® PROSTHETIC EYE OTHER TYPE
V2630 0 HCPCS / CPT® ANTER CHAMBER INTRAOCUL LENS
V2631 0 HCPCS / CPT® IRIS SUPPORT INTRAOCLR LENS
V2632 0 HCPCS / CPT® POST CHMBR INTRAOCULAR LENS
V2700 0 HCPCS / CPT® BALANCE LENS
V2702 0 HCPCS / CPT® DELUXE LENS FEATURE
V2710 0 HCPCS / CPT® GLASS/PLASTIC SLAB OFF PRISM
V2715 0 HCPCS / CPT® PRISM LENS/ES
V2718 0 HCPCS / CPT® FRESNELL PRISM PRESS-ON LENS
V2730 0 HCPCS / CPT® SPECIAL BASE CURVE
V2744 0 HCPCS / CPT® TINT PHOTOCHROMATIC LENS/ES
V2745 0 HCPCS / CPT® TINT, ANY COLOR/SOLID/GRAD
V2750 0 HCPCS / CPT® ANTI-REFLECTIVE COATING
V2755 0 HCPCS / CPT® UV LENS/ES
V2756 0 HCPCS / CPT® EYE GLASS CASE
V2760 0 HCPCS / CPT® SCRATCH RESISTANT COATING
V2761 0 HCPCS / CPT® MIRROR COATING
V2762 0 HCPCS / CPT® POLARIZATION, ANY LENS
V2770 0 HCPCS / CPT® OCCLUDER LENS/ES
V2780 0 HCPCS / CPT® OVERSIZE LENS/ES
V2781 0 HCPCS / CPT® PROGRESSIVE LENS PER LENS
V2782 0 HCPCS / CPT® LENS, 1.54-1.65 P/1.60-1.79G
V2783 0 HCPCS / CPT® V2784 0 HCPCS / CPT® LENS POLYCARB OR EQUAL
V2785 0 HCPCS / CPT® CORNEAL TISSUE PROCESSING
V2786 0 HCPCS / CPT® OCCUPATIONAL MULTIFOCAL LENS
V2787 0 HCPCS / CPT® ASTIGMATISM-CORRECT FUNCTION
V2788 0 HCPCS / CPT® PRESBYOPIA-CORRECT FUNCTION
V2790 0 HCPCS / CPT® AMNIOTIC MEMBRANE
V2797 0 HCPCS / CPT® VIS ITEM/SVC IN OTHER CODE
V2799 0 HCPCS / CPT® MISC VISION ITEM OR SERVICE
V5008 0 HCPCS / CPT® HEARING SCREENING
V5010 0 HCPCS / CPT® ASSESSMENT FOR HEARING AID
V5011 0 HCPCS / CPT® HEARING AID FITTING/CHECKING
V5014 0 HCPCS / CPT® HEARING AID REPAIR/MODIFYING
V5020 0 HCPCS / CPT® CONFORMITY EVALUATION
V5030 0 HCPCS / CPT® BODY-WORN HEARING AID AIR
V5040 0 HCPCS / CPT® BODY-WORN HEARING AID BONE
V5050 0 HCPCS / CPT® HEARING AID MONAURAL IN EAR
V5060 0 HCPCS / CPT® BEHIND EAR HEARING AID
V5070 0 HCPCS / CPT® GLASSES AIR CONDUCTION
V5080 0 HCPCS / CPT® GLASSES BONE CONDUCTION
V5090 0 HCPCS / CPT® HEARING AID DISPENSING FEE
V5095 0 HCPCS / CPT® IMPLANT MID EAR HEARING PROS
V5100 0 HCPCS / CPT® BODY-WORN BILAT HEARING AID
V5110 0 HCPCS / CPT® HEARING AID DISPENSING FEE
V5120 0 HCPCS / CPT® BODY-WORN BINAUR HEARING AID
V5130 0 HCPCS / CPT® IN EAR BINAURAL HEARING AID
V5140 0 HCPCS / CPT® BEHIND EAR BINAUR HEARING AI
V5150 0 HCPCS / CPT® GLASSES BINAURAL HEARING AID
V5160 0 HCPCS / CPT® DISPENSING FEE BINAURAL
V5170 0 HCPCS / CPT® WITHIN EAR CROS HEARING AID
V5180 0 HCPCS / CPT® BEHIND EAR CROS HEARING AID
V5190 0 HCPCS / CPT® GLASSES CROS HEARING AID
V5200 0 HCPCS / CPT® CROS HEARING AID DISPENS FEE
V5210 0 HCPCS / CPT® IN EAR BICROS HEARING AID
V5220 0 HCPCS / CPT® BEHIND EAR BICROS HEARING AI
V5230 0 HCPCS / CPT® GLASSES BICROS HEARING AID
V5240 0 HCPCS / CPT® DISPENSING FEE BICROS
V5241 0 HCPCS / CPT® DISPENSING FEE, MONAURAL
V5242 0 HCPCS / CPT® HEARING AID, MONAURAL, CIC
V5243 0 HCPCS / CPT® HEARING AID, MONAURAL, ITC
V5244 0 HCPCS / CPT® HEARING AID, PROG, MON, CIC
V5245 0 HCPCS / CPT® HEARING AID, PROG, MON, ITC
V5246 0 HCPCS / CPT® HEARING AID, PROG, MON, ITE
V5247 0 HCPCS / CPT® HEARING AID, PROG, MON, BTE
V5248 0 HCPCS / CPT® HEARING AID, BINAURAL, CIC
V5249 0 HCPCS / CPT® HEARING AID, BINAURAL, ITC
V5250 0 HCPCS / CPT® HEARING AID, PROG, BIN, CIC
V5251 0 HCPCS / CPT® HEARING AID, PROG, BIN, ITC
V5252 0 HCPCS / CPT® HEARING AID, PROG, BIN, ITE
V5253 0 HCPCS / CPT® HEARING AID, PROG, BIN, BTE
V5254 0 HCPCS / CPT® HEARING ID, DIGIT, MON, CIC
V5255 0 HCPCS / CPT® HEARING AID, DIGIT, MON, ITC
V5256 0 HCPCS / CPT® HEARING AID, DIGIT, MON, ITE
V5257 0 HCPCS / CPT® HEARING AID, DIGIT, MON, BTE
V5258 0 HCPCS / CPT® HEARING AID, DIGIT, BIN, CIC
V5259 0 HCPCS / CPT® HEARING AID, DIGIT, BIN, ITC
V5260 0 HCPCS / CPT® HEARING AID, DIGIT, BIN, ITE
V5261 0 HCPCS / CPT® HEARING AID, DIGIT, BIN, BTE
V5262 0 HCPCS / CPT® HEARING AID, DISP, MONAURAL
V5263 0 HCPCS / CPT® HEARING AID, DISP, BINAURAL
V5264 0 HCPCS / CPT® EAR MOLD/INSERT
V5265 0 HCPCS / CPT® EAR MOLD/INSERT, DISP
V5266 0 HCPCS / CPT® BATTERY FOR HEARING DEVICE
V5267 0 HCPCS / CPT® HEARING AID SUP/ACCESS/DEV
V5268 0 HCPCS / CPT® ALD TELEPHONE AMPLIFIER
V5269 0 HCPCS / CPT® ALERTING DEVICE, ANY TYPE
V5270 0 HCPCS / CPT® ALD, TV AMPLIFIER, ANY TYPE
V5271 0 HCPCS / CPT® ALD, TV CAPTION DECODER
V5272 0 HCPCS / CPT® TDD
V5273 0 HCPCS / CPT® ALD FOR COCHLEAR IMPLANT
V5274 0 HCPCS / CPT® ALD UNSPECIFIED
V5275 0 HCPCS / CPT® EAR IMPRESSION
V5281 0 HCPCS / CPT® ALD FM/DM SYSTEM, MONAURAL
V5282 0 HCPCS / CPT® ALD FM/DM SYSTEM BINAURAL
V5283 0 HCPCS / CPT® ALD NECK, LOOP IND RECEIVER
V5284 0 HCPCS / CPT® ALD FM/DM EAR LEVEL RECEIVER
V5285 0 HCPCS / CPT® ALD FM/DM AUD INPUT RECEIVER
V5286 0 HCPCS / CPT® ALD BLU TOOTH FM/DM RECEIVER
V5287 0 HCPCS / CPT® ALD FM/DM RECEIVER, NOS
V5288 0 HCPCS / CPT® ALD FM/DM TRANSMITTER ALD
V5289 0 HCPCS / CPT® ALD FM/DM ADAPT/BOOT COUPLIN
V5290 0 HCPCS / CPT® ALD TRANSMITTER MICROPHONE
V5298 0 HCPCS / CPT® HEARING AID NOC
V5299 0 HCPCS / CPT® HEARING SERVICE
V5336 0 HCPCS / CPT® REPAIR COMMUNICATION DEVICE
V5362 0 HCPCS / CPT® SPEECH SCREENING
V5363 0 HCPCS / CPT® LANGUAGE SCREENING
V5364 0 HCPCS / CPT® DYSPHAGIA SCREENING
20 0 Revenue HEALTH INSURANCE – PROSPECTIVE PAYMENT SYSTEM (HIPPS) – RESERVED
122 0 Revenue Room/Board -OB
221 0 Revenue SPECIAL CHARGES – ADMISSION CHARGE
251 0 Revenue GENERIC DRUGS
252 0 Revenue NON- GENERIC DRUGS
257 0 Revenue NON PRESCRIPTION DRUGS
258 0 Revenue IV SOLUTION
263 0 Revenue INFUSION SERVICES
271 0 Revenue NON STERILE SUPPLIES
272 0 Revenue STERILE SUPPLIES
273 0 Revenue TAKE HOME SUPPLIES
274 0 Revenue SUPPLIES- ORHTO – PROSTHETIC
292 0 Revenue NEW DME
300 0 Revenue LAB- GENERAL
301 0 Revenue LAB-CHEMISTRY
306 0 Revenue LAB-BACTERIAL AND MICRO
320 0 Revenue RAD-GENERAL
324 0 Revenue RAD- CHEST XRAY
351 0 Revenue CT- HEAD
352 0 Revenue CT- BODY
402 0 Revenue ULTRASOUND
450 0 Revenue EMERGENCY ROOM-GENERAL
451 0 Revenue EMERGENCY – MSE
452 0 Revenue EMERGENCY SERVICES
460 0 Revenue PULMONARY FUNCTION
471 0 Revenue AUDIOLOGY- DIAGNOSTIC
472 0 Revenue AUDIOLOGY- TREATMENT
621 0 Revenue PHARMACY- ASSOCIATED WITH RADIOLOGY
636 0 Revenue PHARMACY-EXTENSION OF 25X – DRUGS REQUIRING DETAILED CODING (A)
730 0 Revenue EGK/ECG ELECTROCARDIOGRAM
762 1678 Revenue Observation hours
771 0 Revenue PREVENTIVE CARE SERVICES – VACCINE ADMINISTRATION
923 0 Revenue PAP SMEAR
925 0 Revenue PREGNANCY TEST