August 1, 2013

Procedure Code 59840 59841 59850 59851 59852 59855 59856 59857 59866 A0426 A0428 A0430 59899 H1002 H1005 96570 96571 C9287

Procedure Description Induced Abortion By Dilation And Curettage Induced Abortion By Dilation And Evacuation Induced Abortion By Injection(S) Incl Hosp Delivery, Fetus And Secundines Abortion Legal Inject W D&c And/Or Evacuation Abort Legal Inject W Hysteroto Abortion, Induced Abortion, Induced W/D&c Induced Abortion W/Hysterotomy Multifetal Pregnancy Reductions (Mpr) Ambulance Service, Advanced Life Support, Non-Emergency Transport, Level 1 (Als Ambulance Service Basic Life Support, Non-Emergency Transport, (Bls) Ambulance Service Conventional Air Services, Transport, One Way (Fixed Wing) Unlst Proc Maternity & Deliver Prenatal Care, At Risk Enhanced Service,care Coordination Prenatal Care,at-Risk Enhanced Service Pkg(Includes H1001-H1004) Photodynamic Therapy By Endoscopic App Of Light To Ab Tissue 1st 30 Min Photodynamic Therapy By Endoscopic App Of Light To Ab Tissue Ea Addl.15 Injection, Brentuximab Vedotin, 1 Mg

C9295 C9296

Injection, carfilzomib, 1 mg Injection, ziv-aflibercept, 1 mg

J0894 J9010

Injection, Decitabine, 1 Mg Injection Alemtuzumab 10 Mg

J9019

Injection, asparaginase (erwinaze), 1,000 iu

J9027 J9033 J9035 J9040 J9041

Injection, Clofarabine, 1 Mg Injection, Bendamustine Hcl, 1 Mg Injection, Bevacizumab, 10 Mg Injection Bleomycin Sulfate, 15 Units Injection, Bortezomib, 0.1 Mg

J9042

Injection, brentuximab vedotin, 1 mg

J9043 J9045 J9055 J9171 J9179 J9201 J9202 J9206 J9207 J9213 J9214 J9215 J9217 J9218 J9219 J9225

Inj, Cabazitaxel, 1 Mg Injection Carboplatin, 50 Mg [paraplatin] Injection, Cetuximab, 10 Mg Injection, Docetaxel, 1 Mg Injection, Eribulin Mesylate, 0.1 Mg Injection Gemcitabine Hcl 200 Mg Goserelin Acetate Implant, Per 3.6 Mg Injection Irinotecan 20 Mg Injection, Ixabepilone, 1 Mg Injection Interferon Alfa-2a Recombinant 3 Million Units Injection Interferon Alfa-2b Recombinant 1 Million Units Injection Interferon, Alfa-N3 Human Leukocyte Derived 250,000 Iu Leuprolide Acetate (For Depot Suspension), 7.5 Mg Leuprolide Acetate, Per 1 Mg Leuprolide Acetate Implant, 65 Mg Histrelin Implant (Vantas) 50 Mg CC32013443

August 1, 2013 J9226 J9228 J9264 J9293 J9302 J9303 J9305 J9307 J9310 J9315 J9320 J9328 J9330 J9351 J9355 J9357 J9390 J9600 A4264 99002 K0672 L0170 L0200 L0430 L0456 L0458 L0460 L0462 L0464 L0468 L0470 L0480 L0482 L0484 L0486 L0488 L0491 L0624 L0631 L0635 L0636 L0637 L0638 L0639 L0640 L0700 L0710

Histrelin Implant (Supprelin La), 50 Mg Injection, Ipilimumab, 1 Mg Injection, Paclitaxel Protein-Bound Particles, 1 Mg Mitoxantrone Hcl, Per 5 Mg - Injection Injection, Ofatumumab, 10 Mg Injection, Panitumumab, 10 Mg Injection, Pemetrexed, 10 Mg Injection, Pralatrexate, 1 Mg Injection Rituximab 100 Mg Injection, Romidepsin, 1 Mg Injection Streptozocin 1 G Injection, Temozolomide, 1 Mg Injection, Temsirolimus, 1 Mg Injection, Topotecan, 0.1 Mg Injection Trastuzumab 10 Mg Injection Valrubicin, Intravesical 200 Mg Injection Vinorelbine Tartrate 10 Mg Injection Porfimer Sodium 75 Mg. Intratubal Occlusion Device Handle/Convey W/Order W/Devices To Be Fit/Adj By Phys Add Low Extremity,orthosis, Remv Soft Interface,replacement Only, Each Cervical,collar,molded To Patient Model Cervical,multiple Post Collar,occipital/Mandibular Supports,adj Cerv Bar. Spinal Orth,ant,post,lat W/Interface Custom,dewall Posture Protector Only T Lso, Flex, Prov Trunk Support,thoracic Region,rigid Post Panel Tlso,triplanar Control,modular Segmented Spinal Syst, 2 Rigid Plastic Shells Tlso,triplanar Control,modular Segmented Spinal System,2 Rigid Plastic Shells Tlso,triplanar Control,modular Segment Spinal System,t3 Rigid Plastic Shells Tlso,triplanar Control,modular Segmented Spinal System,4 Rigid Plastic Shells Tlso,sagittal-Coronal,rigid Posterior Frame/Flex Soft Anterior Apron Tlso,triplanar Control,rigid Posterior Frame/Flexible Soft Anterior Apron Tlso,triplanar Control, 1 Piece Rigid Plastic Shell W/O Interface Liner Tlso,triplanar Control, 1 Piece Rigid Plastic Shell W/Interface Liner Tlso,triplanar Control, 2 Piece Rigid Plastic Shell W/O Interface Liner Tlso,triplanar Control, 2 Piece Rigid Plastic Shell With Interface Liner Tlso,triplanar Control, 1 Piece Rigid Plastic Shell With Interface Liner Tlso, Sagittal-Coronal Control, Modular Segmented Spinal System, Two Rigid Sacroiliac Orthosis, Provides Pelvic-Sacral Support, With Rigid Or Semi-Rigid Lumbar-Sacral Orthosis, Sagittal Control, With Rigid Anterior And Posterior Lumbar-Sacral Orthosis, Sagittal-Coronal Control, Lumbar Flexion, Rigid Lumbar Sacral Orthosis, Sagittal-Coronal Control, Lumbar Flexion, Rigid Lumbar-Sacral Orthosis, Sagittal-Coronal Control, With Rigid Anterior And Lumbar-Sacral Orthosis, Sagittal-Coronal Control, With Rigid Anterior And Lumbar-Sacral Orthosis, Sagittal-Coronal Control, Rigid Shell(S)/Panel(S), Lumbar-Sacral Orthosis, Sagittal-Coronal Control , Rigid Shell(S)/Panel(S), Ctlso,anterior-Posterior-Lateral Control,molded To Patient Model Ctlso,anterior-Posterior-Lat Control,molded To Pt Model, W/Interface Material CC32013443

August 1, 2013 L0810 L0820 L0830 L0978 L0999 L1000 L1001 L1005 L1070 L1090 L1110 L1200 L1300 L1310 L1499 L1610 L1680 L1685 L1686 L1690 L1700 L1710 L1720 L1730 L1755 L1832 L1834 L1840 L1843 L1844 L1845 L1846 L1847 L1860 L1907 L1932 L1945 L1950 L1951 L1960 L1970 L2000 L2005 L2010 L2020 L2030 L2034

Halo Procedure,cervical Halo Incorporated Into Jacket Vest Halo Procedure,cervical Halo Incorporated Into Plaster Body Jacket Halo Procedure,cerv Halo Incorporated Into Milwaukee Type Orthosis Axillary Crutch Extension Addition To Spinal Orthosis, Not Otherwise Specified Ctlso(Milwaukee),inclusive Of Furnishing Initial Orthosis,including Model Ctlso Infant Immobilizer Tension Based Scoliosis Orthosis And Accessory Pads, Includes Fit Add To Ctlso, Trapezius Add/Ctlso Orth Lumbar Sling Add To Ctlso, Ring Flange Tlso,inclusive Of Furnishing Initial Orthosis Only Other Scoliosis Procedure,body Jacket Molded To Patient Model Other Scoliosis Procedure,postoperative Body Jacket Unlisted Proc Spinal Orthosis Ho,abduction Control Of Hip Joints,flexible,(Frejka Cover Only),prefab Ho,abduction Control Of Hip Joints,dynamic,pelvic Control,adj Hip Motion Ho,abduction Control Of Hip Joint,postoperative Hip Abduction Type Ho,abduction Control Of Hip Joint,postop Hip Abduction Type,prefab Combination,bil Lumbo-Sacral,hip,femur Orthosis Providing Adduction Legg Perthes Orthosis,(Toronto Type),custom Fabricated Legg Perthes Orthosis,(Newington Type),custom Fabricated Legg Perthes Orthosis,trilateral,(Tachdijan Type),custom Fabricated Legg Perthes Orthosis,(Scottish Rite Type),custom Fabricated Legg Perthes Orthosis,(Patten Bottom Type),custom Fabricated Knee Orthosis,adjustable Knee Joints,positional Orthosis,rigid Support Ko,w/O Knee Joint,rigid, Custom Fabricated Ko, Derotation, M-L Ant Cruc Lig Ko,single Upright Thigh/Calf W/Adj Flex & Ext Jnt,med-Lat & R0t Cntrl Ko, Sngl Upright, Thigh & Calf Ko, Double Upright Molded Ko Upright Thigh/Calf Md To Pt Knee Orthosis,double Upright W Adjust Joint,w Inflat Support Chambers Ko,modification Of Supracondylar Prosthetic Socket,custom Fab Afo,supramalleolar With Straps, W/Wo Interface/Pads,custom Fabricated Afo, Rigid Anterior Tibial Section, Total Carbon Fiber Or Equal Material, Afo,molded To Patient Model,plastic,rigid Anterior Tibial Section,custom Fab Afo,spiral,(Inst Of Rhab Med Type),plastic,custom-Fabricated Afo,spiral,(Inst Of Rehab Med Type),plastic/Other Material,prefab,fit/Adjust Afo,posterior Solid Ankle,plastic,custom Fabricated Afo,plastic,with Ankle Joint,custom Fabricated Kafo,single Upright Free Knee,free Ankle,solid Stirrup,thigh-Calf Bands/Cuff Knee Ankle Foot Orthosis, Any Material Single Or Double Upright Stance Kafo,single Upright,free Ankle,solid Stirrup,thigh/Calf Bands-Cuffs Kafo,double Upright,free Knee,free Ankle,solid Stirrup,thigh/Calf Bands Kafo,double Upright,free Ankle,solid Stirrup,thigh & Calf Bands/Cuffs Knee Ankle Foot Orthosis, Full Plastic, Single Upright, With Or Without Free CC32013443

August 1, 2013 L2036 L2037 L2038 L2060 L2090 L2106 L2108 L2114 L2116 L2126 L2128 L2132 L2134 L2136 L2280 L2350 L2500 L2510 L2525 L2526 L2580 L2627 L2628 L2670 L2861 L2999 L3160 L3671 L3677 L3720 L3730 L3740 L3763 L3764 L3765 L3766 L3891 L3900 L3901 L3904 L3905 L3960 L3961 L3962 L3971 L3973 L3999

Kafo,full Plastic,double Upright,w/Wo Free Motion Knee/Ankle,custom Kafo,full Plastic,single Upright,w/Wo Free Motion Knee-Ankle Custom Kafo,full Plastic,w/Wo Free Motion Knee,multi-Axis Ankle,custom Fab Hkafo,torsion Control,bilat Torsion Cables,ball Bearing Hip Joint Hkafo,torsion Control,unilat Torsion Cable,ballbearing Hip Joint,pelvic Band Afo,fx Orthosis,tibial Fx Cast Orthosis,thermoplastic Type Cast Material Afo,fx Orthosis,tibial Fx Cast Orthosis,custom Fabricated Afo,fx Orthosis,tibial Fx Orthosis,semi-Rigid,prefab,fitting/Adjustment Afo,fx Orthosis,tibial Fx Orthosis,rigid Prefab,fitting/Adjustment Kafo,fx Orthosis,femoral Rx Cast Orthosis,thermoplastic,custom Fab Kafo,fx Orthosis,femoral Fx Cast Orthosis,custom Fabricated Kafo Fx Orthosis,femoral Fx Cast Orthosis,soft,prefab,includes Fit/Adjustment Kafo,fx Orthosis,femoral Fx Cast Orthosis,semi-Rigid,prefab,fit/Adjust Kafo,fx Orthosis,femoral Rx Cast Orthosis,rigid Prefab,fit/Adjust Addition To Lower Extremity,molded Inner Boot Addition To Lower Extremity,prosthetic Type(Bk),socket,molded To Pt Model Addition To Lower Extremity,thigh/Wt Bearing,gluteal/Ischial Wt Bearing,ring Addition To Lower Extremity,thigh/Wt Bearing,quadri-Lat Brim,mold To Pt Model Addition To Lower Extremity,thigh/Weight Bearing,ischial Containemnt Addition To Lower Ext,thigh/Wt Bearing,ischial Contain,custom Molded Addition To Lower Extremity,pelvic Control,pelvic Sling Addition To Lower Extremity,pelvic Control,plastic,molded To Pt Model Addition To Lower Extremity,pelvic Control,metal Frame,recip Hip Joint/Cables Addition To Lower Extremity,thoracic Control,paraspinal Uprights Addition Lower Extremity Joint, Knee Or Ankle, Concentric Adjust Torsion Lower Extremity Orthoses,nos Foot, Adjustable Shoe-Styled Positioning Device Shoulder Orthotic, Joint Design, Custom Fabricated, Inc Fitting And Adjustment Shoulder Orthotic, Joint Design, Prefabricated, Inc Fitting And Adjustment Eo,double Upright W Forearem/Arm Cuffs,free Motion,custom Fab Eo,dbl Uprt Forearm/Cuffs Exte Eo,dbl Uprt/Forearm/Cuffs Adj Elbow Wrist Hand Orthosis, Rigid, Without Joints, May Include Soft Interface, Elbow Wrist Hand Orthosis, Includes One Or More Nontorsion Joints, Elastic Elbow Wrist Hand Finger Orthosis, Rigid, Without Joints,may Include Soft Elbow Wrist Hand Finger Orthosis, Includes One Or More Nontorsion Joints, Addition To Upper Extremity Joint, Wrist Or Elbow, Concentric Adjustable Whfo,dyn Flex Hige.Wr Ext/Wr D Whfo,dynamic Flexor Hinge,reciprocal Wrist Ext/Flex,finger Flex/Ext,custom Fab Whfo,external Powered,electric,custom Fabricated Wrist Hand Orthosis, Includes One Or More Nontorsion Joints, Elastic Bands, Sewho,abduction Positioning,airplane Design,prefab,includes Fit/Adjust Shoulder Elbow Wrist Hand Orthosis, Shoulder Cap Design, Without Joints,may Sewho,abduction Positioning,erb's Palsy Design,prefab,includes Fit/Adjust Shoulder Elbow Wrist Hand Orthosis, Shoulder Cap Design, Includes One Or More Shoulder Elbow Wrist Hand Orthosis, Abduction Positioning (Airplane Design), Upper Limb Orthosis,nos CC32013443

August 1, 2013 L4000 L4010 L4020 L4030 L4040 L4045 L4050 L4055 L4210 L4394 L4631 L8320 S8451 S8452 69300 70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496 70498 71250 71260 71270 71275 72125 72126 72127 72128 72129 72130 72131 72132 72133 72191 72192 72193 72194 73200

Replace Girdle For Spinal Orthosis(Ctlso Or So) Repl Trilateral Socket Brim Replace Quadrilateral Socket Brim,molded To Patient Model Replace Quadrilateral Socket Brim,custom Fitted Replace Molded Thigh Lacer,for Custom Fabricated Orthosis Only Replace Non-Molded Thigh Lacer, For Custom Fabricated Orthosis Only Replace Molded Calf Lacer,for Custom Fabricated Orthosis Only Replace Non-Molded Calf Lacer,for Custom Fabricated Orthosis Only Repair Of Orthotic Device, Repair Or Replace Minor Parts Replace Soft Interface Mat, Foot Drop Splint Ankle Foot Orthosis, Walking Boot Type, Varus/Valgus Correction, Rocker Bottom Truss,addition To Standard Pad,water Pad Splint,prefabricated,wrist Or Ankle Splint,prefabricated,elbow Otoplasty Protr Ear W Or W/O Size Reduction Computed Tomography, Head Or Brain, W/O Contract Material Computed Tomography, Head Or Brain, With Contrast Material Computed Tomography,head Or Brain,w/O Contr Foll By Contr W/Further Sections Computed Tomography,orbit,sella,fossa Or Outer,middle,inner Ear W/O Contrast Computed Tomography,orbit,sella,fossa Or Outer,middle,inner Ear W/Contrast Computed Tomography,orbit,sella,fossa, Ear W/O Contr Foll By Contrast Computed Tomography, Maxillofacial, W/O Contrast Computed Tomography, Maxillofacial,w/Contrast Computed Tomography, Maxillofacial W/O Contr Follow By Contrast Computed Tomography Soft Tissue Neck W/O Contrast Computed Tomography Soft Tissue Neck W/Contrast Computed Tomography Soft Tissue Neck W/O Contr Follow By Contrast Computed Tomographic Angiography,head W/Contrast Incl Noncontr Images Computed Tomographic Angiography,neck W/Contrast Incl Noncontr Images Computed Tomography,thorax, W/O Contrast Computed Tomography,thorax, W/Contrast Computed Tomography,thorax, W/O Contr Follow By Contrast Computed Tomographic Angiography,chest W/Contrst Incl Noncontr Images Computed Tomography Cervical Spine W/O Contrast Computed Tomography Cervical Spine W/Contrast Computed Tomography Cervical Spine W/O Contr Follow By Contrast Computed Tomography, Thoracic Spine, W/O Contrast Computed Tomography Thoracic Spine With Contrast Material Computed Tomography,thoracic Spine, W/O Contrast Follow By Contrast Computed Tomography, Lumbar Spine, W/O Contrast Computed Tomography, Lumbar Spine W/Contrast Computed Tomgraphy Lumbar Spine Wo Contrast Material Foll By Contrast Material Computed Tomographic Angiography,pelvis W/Contr Incl Noncontr Images Computed Tomography, Pelvis, W/O Contrast Computed Tomography, Pelvis, W/Contrast Computed Tomography,pelvis W/O Contr Follow By Contrast Cat Scan Upper Extremity W/O Contrast CC32013443

August 1, 2013 73201 73202 73206 73700 73701 73702 73706 74150 74160 74170 74174 74175 74176 74177 74178 74261 74262 74263 75571 75572 75573 75574 76380 91035 93025 93228 93350 93351 93352 95800 95801 95805 95806 95807 95808 95810 95811 95951 95971 95972 95978 95980 G0398 G0399 G0400 A4600 A8004

Cat Scan Upper Extremity W/Contrast Cat Upper Extremity W/O Contr Follow W/Contr Computed Tomographic Angiography,upper Extrem W/Cont Incl Noncon Images Cat Scan Lower Extremity W/O Contrast Cat Scan Lower Extremity With Contrast Cat Scan Lower Extremity W/O Contrast Follow By Contrast Computed Tomographic Angiography,lower Extrem W/Cont Incl Noncon Images Cat Scan Abdomen Without Contrast Cat Scan Abdomen With Contrast Cat Scan Abdomen W/O Contr Follow W/Contr Ct Angio Abd&plvis Cntrst Mtrl W/Wo Cntrst Imges Computed Tomographic Angiography,abdomen W/Contr Incl Noncontr Images Computed Tomography, Abdomen And Pelvis Without Contrast Material Computed Tomography, Abdomen And Pelvis With Contrast Material(S) Ct Abd & Pelvis W/O Contrast,1 Or More Regions, Followed By Contrast Ct Colonogrphy Dx Image Postprocess No Contrast Ct Colonogrphy Dx Image Postprocess W/Contrast Ct Colonography Screening Image Postprocessing Ct Heart No Contrast Quant Eval Coronry Calcium Ct Heart Contrast Eval Cardiac Structure&morph Ct Hrt Contrst Cardiac Struct&morph Cong Hrt Dx Cta Hrt Cornry Art/Bypass Grfts Contrst 3d Post Computerized Tomography Limited, Follow Up Esophagus, Gastroesphogeal Reflux Test - W Nasal Catheter Ph Microvolt T Wave Alternans For Assess Of Ventricular Arrhythmias External Mobile Cv Telemetry W/Phys R&i W/Report Echo Transthoracic R-T Incl /M-Mode Using Equip W/I&r Echo Tthrc R-T 2d -Plus M-Mode Rest&strs Cont Ecg Use Of Echo Contrast Agent During Stress Echo Slp Study, Unattended Sim Recording Heart Rate O2 Sat Resp Analy & Slp Time Sleep Study, Unattended, Sim Recording Min Of Heart Rate O2 Sat & Resp Analysis Multiple Sleep Latency Test Sleep Study, Unattended Simult Record Heart Rate,o2, Respir Airflow/Effort Sleep Study, Attended Polysomnography, 1-3 Polysomnography, 4 Or More Polysomnography W/Cpap Monitor,eeg&videorecording,24h Elec Analy Implant Neur Pulse Gen - Sim Neuro Pulse Gen W/Intra Or Sub Prog Elec Anal Imp Neuro Pul Gen Complex Spinal Cord First Hour Electronic Analysis Of Implanted Neurostimulator Pulse Generated Electronic Analysis Nstim Pulse Generator Gastric Intraop W/Prgrmg Home Sleep Test/Type Ii Porta Home Sleep Test/Type Iii Porta Home Sleep Test W/Type Iv Portable Monitor, Unattended, Min 3 Channels Sleeve For Intermittent Limb Compression Device, Replacement Only, Each Soft Interface For Helmet, Replacement Only CC32013443

August 1, 2013 A9277 A9278 B9002 B9004 E0170 E0171 E0172 E0187 E0194 E0198 E0200 E0205 E0250 E0251 E0255 E0256 E0260 E0261 E0265 E0266 E0270 E0271 E0272 E0277 E0280 E0290 E0291 E0292 E0293 E0294 E0295 E0296 E0297 E0300 E0301 E0302 E0303 E0304 E0329 E0371 E0372 E0373 E0457 E0459 E0460 E0461 E0462

Transmitter, External, For Use W/ Interstitial Continuous Glucose Monitor Receiver (Monitor) External, For Use With Interstitial Continuous Glucose Enteral Nutrition Infusion Pump, With Alarm Parenteral Nutrition Infusion Pump, Portable Commode Chair With Integrated Seat Lift Mechanism, Electric, Any Type Commode Chair With Integrated Seat Lift Mechanism, Non-Electric, Any Type Seat Lift Mechanism Placed Over Or On Top Of Toilet, Any Type Water Pressure Mattress Air Fluidized Bed Water Pressure Pad For Mattress, Standard Mattress Length And Width Heat Lamp,w/O Stand(Table Model) Includes Bulb, Or Infrared Element Heat Lamp,with Stand, Includes Bulb, Or Infrared Element Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress Hospital Bed,variable Height,hi-Lo,with Any Type Side Rails W/O Mattress Hospital Bed,semi-Elec(Head/Foot Adj) With Any Type Side Rails,with Mattress Hospital Bed,semi-Elec(Head/Foot Adj) With Any Type Side Rails,w/O Mattress Hospital Bed,total Elec (Head,ft,ht Adj) With Any Type Side Rails,w/Mattress Hospital Bed,total Elec (Head,ft,ht Adj) With Any Type Side Rails,w/O Mattress Hosp Bed,institutional Type (Oscil,circ,stryker Frame) W/Mattress Mattress, Innerspring Mattress, Foam Rubber Powered Pressure-Reducing Air Mattress Bed Cradle, Any Type Hospital Bed, Fixed Height, Without Side Rails, With Mattress Hospital Bed,fixed Height,without Side Rails,without Mattress Hospital Bed, Variable Height, Hi-Lo,without Side Rails With Mattress Hospital Bed, Variable Height, Hi-Lo,without Side Rails Without Mattress Hospital Bed, Semi-Elec(Head/Foot Adjustments) W/O Side Rails,with Mattress Hospital Bed, Semi-Elec(Head/Foot Adjustments) W/O Side Rails,w/O Mattress Hospital Bed,total Elec(Head/Ft/Ht Adjustment)w/O Side Rails,with Mattress Hospital Bed,total Elec(Head/Ft/Ht Adjustment)w/O Side Rails,w/O Mattress Pediatric Crib, Hospital Grade, Fully Enclosed Hospital Bed, Heavy Duty, Xtra Wide, W Weight Capac Greater Than 350 Hosp Bed,xtra Heavy,xtra Wide,greater 600 Lbs Side Rails W/O Mattress Hosp Bed,heavy Duty,xtra Wide,wt Grtr Than 350 Less Thn 600,side Rails W/O Matt Hosp Bed,xtra Heavy Duty,xtra Wide,wt Grtr Than 600,side Rails W Mattress Pediatric Hospital Bed, Electric Or Semi Electric Nonpowered Advanced Pressure Reducing Overlay For Mattress,stnd Lngth/Wdth Powered Air Overlay For Mattress,standard Length/Width Nonpowered Advanced Pressure Reducing Mattress Chest Shell (Cuirass) Chest Wrap Negative Pressure Ventilator,portable Or Stationary Volume Control Ventilator,w/O Pressure Support Mode,may Include Pressure Cont Rocking Bed, With Or W/O Side Rails CC32013443

August 1, 2013 E0463 E0464 E0470 E0471 E0472 E0480 E0481 E0482 E0483 E0484 E0485 E0487 E0574 E0585 E0600 E0601 E0606 E0617 E0618 E0619 E0630 E0635 E0636 E0637 E0638 E0640 E0641 E0642 E0650 E0651 E0652 E0656 E0657 E0660 E0665 E0667 E0675 E0676 E0691 E0692 E0693 E0694 E0700 E0740 E0744 E0745 E0747

Pressure Support Ventilator W/Volume Control Mode,used With Invasieve Interface Pressure Support Ventilator W/Volume Control Mode,used W/Non-Invasive Interface Respiratory Assist Device,bi-Level Pressure Capability W/O Backup Rate Feature Respiratory Assist Device,bi-Level Pressure Capa,w/Back Up,noninvasive Inter Respiratory Assist Device,bi-Level Pressure Cap.W/Backup,w/Invasive Interface Percussor,electric Or Pneumatic, Home Model Intrapulmonary Percussive Ventilation System And Related Acces Cough Stimulating Device,alternating Positive And Negative Airway Pressure High Frequency Chest Wall Oscillation Air-Pulse Generator System Oscillatory Positive Expiratory Pressure Device,non Electric,any Type,each Oral Device/Appliance Used To Reduce Upper Airway Collapsibility,prefabricated Spirometer, Electronic, Includes All Accessories Ultrasonic/Electronic Aerosol Generator With Small Volume Nebulizer Nebulizer, W/Compressor & Heater Respiratory Suction Pump,home Model,portable Or Stationary, Electric Continuous Airway Pressure (Cpap) Device Postural Drainage Board External Defibrillator With Integrated Electrocardiogram Analysis Apnea Monitor, Without Recording Feature Apnea Monitor, With Recording Feature Patient Lift, Hydraulic Or Mechanical W/Seat, Sling, Strap Or Pads Patient Lift, Electric, With Seat Or Sling Multipositional Patient Support System,integrated Lift,pt Accessible Controls Combination Sit To Stand System,any Size Including Pediatric,w/Seatlift Feature Standing Frame System,1 Position Any Size Including Peds, W-W/O Wheels Patient Lift, Fixed System, Includes All Components/Accessories Standing Frame System, Multi-Position (E.G. Three-Way Stander), Any Size Standing Frame System, Mobile (Dynamic Stander), Any Size Including Pediatric Pneumatic Compressor, Nonsegmental Home Model Pneumatic Compressor,segmental Home Model W/O Calibrated Gradient Pressure Pneumatic Compressor,segmental Home Model W/Calibrated Gradient Pressure Segmental Pneumatic Trunk Segmental Pneumatic Chest Nonsegmental Pneumatic Appliance,use With Pneumatic Compressor,full Leg Nonsegmental Pneumatic Appliance/Use With Pneumatic Compressor,full Arm Segmental Pneumatic Appliance/Use With Pneumatic Compressor,full Leg Pneumatic Compression Device,hi Pressure,rapid Inflation/Deflation Cycle Intermittent Limb Compression Device (Includes All Accessories) Nos Ultraviolet Light Therapy System Panel,treatment Area 2 Sq Feet Or Less Ultraviolet Light Therapy System Panel(Bulbs,lamp,timer,eye Pro) 4 Ft Panel Ultraviolet Light Therapy System Panel(Bulbs,lamp,timer,eye Pro) 6ft Panel Ultraviolet Multidirectional Light Therapy System In 6ft Cabinet Safety Equipment, Device Or Accessory, Any Type Incontinence Trmt System, Pelvic Floor Stimulator,monitor,sensor/Trainer Neuromuscular Stimulator For Scoliosis Neuromuscular Stimulator,electronic Shock Unit Osteogenesis Stimulator,electrical Noninvasive,other Than Spinal Applications CC32013443

August 1, 2013 E0748 E0749 E0760 E0762 E0764 E0769 E0770 E0779 E0781 E0782 E0783 E0784 E0791 E0840 E0855 E0880 E0890 E0910 E0911 E0912 E0930 E0935 E0936 E0940 E0941 E0945 E0946 E0947 E0948 E0958 E0968 E0969 E0970 E0980 E0985 E0986 E1002 E1003 E1004 E1005 E1006 E1007 E1008 E1009 E1010 E1011 E1018

Osteogenesis Stimulator,electrical,noninvasive,spinal Applications Osteogenesis Stimulator, Electrical,surgically Implanted Osteogenesis Stimulator,low Intensity Ultrasound, Non Invasive Transcutaneous Electrical Joint Stimulation Device System, Includes All Functonl Neuromusc Stim, Transcutans Stimulation Sequential Muscles Electrical Stimulation Or Electromagnetic Wound Treatment Device Functional Electric Stim Nos Ambulatory Infusion Pump Mechanical Reusable For Infusion 8hr Or Greater Ambulatory Infusion Pump, Sgl/Mult, With Admin Equip Infusion Pump, Implantable,non-Programable Infusion Pump System,implantable,programmable(Includes All Components) External Ambulatory Infusion Pump, Insulin Parenteral Infusion Pump,stationary,single Or Multichannel Traction Frame,attached To Headboard,cervical Traction Cervical Traction Equipment Not Requiring Additional Stand Or Frame Traction Stand,freestanding,extremity Traction Traction Frame,attached To Footboard,pelvic Traction Trapeze Bars, Aka Patient Helper,attached To Bed,with Grab Bar Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Fracture Frame,freestanding,includes Weights Continuous Passive Motion Exercise Device For Use On Knee Only Continuous Passive Motion Exercise Device For Use Other Than Knee Trapeze Bar,freestanding,complete With Grab Bar Gravity Assisted Traction Device,any Type Extrm Belt/Harness Fracture, Frame, Dual W/ Cross Bars, Attached To Bed (E.G. Balken 4 Poster) Fracture Frame,attachments For Complex Pelvic Traction Fracture Frame,attachments For Complex Cervical Traction Manual Wheelchair Accessory,one-Arm Drive Attachment,each Commode Seat, Wheelchair Narrowing Device, Wheelchair No.2 Footplates,except For Elevating Legrest Safety Vest, Wheelchair Wheelchair. Accessory, Seat Lift Mechanism Manual Wheelchair Accessory,push Activated Power Assist,each Wheelchair. Accessry, Power Seating System, Tilt Only Wheelchair. Accessory, Power Seating Sys, Recline Only, Wo Shear Wheelchair Accessory,power Seating System,recline,mechanical Shear Reduction Wheelchair Accessory,power Seating System,recline,w/Power Shear Reduction Wheelchair Accessory,power Seat System,combine Tilt/Recline,w/O Shear Reduction Wheelchair Accessory,power Seating System,combo Tilt/Recline,mech Shear Reduc. Wheelchair Accessory,power Seating System,combo Tilt/Recline,power Shear Reduc. Wheelchair. Accessory, Add To Power Seating Sys, Mechan Linked Leg Wheelchair. Accessory, Add To Power Seating Sys, Power Leg Elevation Modification To Pediatric Size Wheelchair,width Adjustment Package Heavy Duty Shock Absorber For Heavy Duty/Extra Heavy Duty Power W/Chair,ea CC32013443

August 1, 2013 E1030 E1031 E1035 E1037 E1038 E1039 E1050 E1060 E1070 E1083 E1084 E1085 E1086 E1088 E1090 E1092 E1093 E1100 E1110 E1130 E1140 E1150 E1160 E1161 E1170 E1171 E1172 E1180 E1190 E1200 E1220 E1221 E1222 E1223 E1224 E1225 E1226 E1227 E1228 E1229 E1230 E1232 E1233 E1234 E1235 E1236 E1237

Wheelchair. Accessory, Ventilator Tray, Gimbaled Rollabout Chair,any And All Types With Casters Five In.Or Greater Multi-Positional Pt Trnsfr Sys,integrtd Seat,operated By Careg-Up To 300 Pounds Transprt Chair, Pediatric Size Transport Chair,adult Size,patient Wt Capacity Up To/Including 300lbs Transport Chair,adult Size, Heavy Duty,patient Wt Greater Than 300lbs Fully Reclining Wheelchair, Fixed Arms, Swing Away Leg Rests Fully Reclining Wheelchair,detachable Arms,desk/Full-Length Elevating Legrests Fully Reclining Wheelchair,detach Arms,desk/Full-Length,detachable Footrests Hemi-Wheelchair, Fixed Arms, Swing-Away, Detachable Elevating Legrest Hemi-Wheelchair,detachable Arms,desk/Full Length,swing Away,elev Legrests Hemi-Wheelchair,fixed Full-Length Arms,swing Away,detachable Footrests Hemi-Wheelchair Detach Arms,desk/Full Length,swing Away,detach Footrests High-Strength Lightweight Wheelchair,detach Arms,desk/Full Length,swing Away High-Strength Lightweight Wheelchair,detach Arms,desk/Full-Length,swing-Away Wide,heavy-Duty Wheelchair,detach Arms,desk/Full-Length,detach/Elevate Legrest Wide,heavy-Duty Wheelchair,detach Arms,desk/Full-Lngth,swing Away,detach Foot Semi-Reclining Wheelchair,fixed Full-Length Arms,swing-Away Detach/Elev Legrest Semi-Reclining Wheelchair,detachable Arms,desk/Full Length,elev Legrests Standard Wheelchair,fixed Full-Length Arms,fixed/Swing-Away,detach Footrests Wheelchair,detach Arms,desk/Full-Length,swing-Away,detach Ftrests Wheelchair,detach Arms,desk/Full-Length,swing-Away,detach,elevate Legrests Wheelchair,fixed Full-Length Arms,swing-Away,detach/Elevating Legrests Manual Adult Size Wheelchair, Includes Tilt In Space Amputee Wheelchair,fixed Full-Length Arms,swing-Away,detach/Elevate Legrests Amputee Wheelchair,fixed Full-Length Arms,w/O Footrests Or Legrests Amputee Wheelchair,detachable Arms,desk/Full Length,w/O Footrests-Legrests Amputee Wheelchair,detach Arms,desk/Full Length,swing-Away,detach Footrests Amputee Wheelchair-Detach Arms,desk/Full-Length,swing-Away,detach-Elev Legrests Amputee Wheelchair,fixed Full-Length Arms,swing-Away,detach Footrests Wheelchair, Specially Sized Or Constructed Wheelchair W/Fixed Arm, Footrests Wheelchair W/Fixed Arm, Legrests Wheelchair W/Det Arms, Footrests Wheelchair W/Det Arms, Legrests Wheelchair Accessory,manual Semi-Reclining Back Wheelchair Accessory,manual Fully Reclining Back(Recline Greater 80 Degrees) Special Height Arms Wheelchair Special Back Height Wheelchair Wheelchair, Pediatric Size, Not Otherwise Specified Power Operated Vehicle Wheelchair,pediatric Size,tilt-In-Space,folding,adjust W/Seating System Wheelchair,pediatric Size,tilt-In-Space,rigid,adj W/O Seating System Wheelchair,pediatric Size,tilt-In-Space,folding,adj W/O Seating System Wheelchair, Pedia Tric Size, Rigid, Adjustable, With Seating System Wheelchair Pediatric Size,folding,adjustable,with Seating System Wheelchair,pediatricc Size,rigid,adjustable,w/O Seating System CC32013443

August 1, 2013 E1238 E1240 E1250 E1260 E1270 E1280 E1290 E1295 E1296 E1354 E1356 E1800 E1801 E1802 E1805 E1806 E1810 E1811 E1816 E1818 E1840 E1902 E2000 E2100 E2120 E2203 E2204 E2218 E2227 E2228 E2291 E2292 E2293 E2294 E2295 E2300 E2301 E2310 E2311 E2312 E2321 E2322 E2324 E2325 E2327 E2328 E2329

Wheelchair,pediatric Size,folding,adjustable,w/O Seating System Lightweight Wheelchair,detach Arms,desk/Full-Length,swing-Away,detach/Elev Leg Lightweight Wheelchair,fixed Full-Length Arms,swing-Away,detach Footrests Lightweight Wheelchair,detach Arms,desk/Full-Length,swing-Away,detach Footrests Lightweight Wheelchair,fixed Full-Length Arms,swing-Away,detach/Elev Legrest Heavy-Duty Wheelchair,detach Arms,desk/Full Length,elev Legrests Heavy-Duty Wheelchair,detach Arms,desk/Full Length,swing-Away,detach Footrests Heavy-Duty Wheelchair,fixed Full-Length Arms Elevating Legrests Special Wheelchair Seat Height From Floor Wheeled Cart, Port Cyl/Conc Battery Pack/Cart, Portable Concentrator Dynamic Adjustable Elbow Extension/Flexion Device Static Progressive Stretch Elbow Device, Ext/Flex W Or W/O Motion W/Accessories Dynamic Adjustable Forearm Pronation/Supination Device Dynamic Adjustable Wrist Extension/Flexion Device Static Progressive Stretch Wrist Device, Ext/Flex W Or W/O Motion W/Accessories Dynamic Adjustable Knee Extension/Flexion Device Static Progressive Stretch Knee Device, Ext/Flex W Or W/O Motion W/Accessories Static Progressive Stretch Ankle Device, Ext/Flex W Or W/O Motion W/Accessories Static Progressive Stretch Forearm Pro/Sup Device W Or W/O Motion W/Accessories Dynamic Adjustable Shoulder Flexion / Abduction / Rotation Communication Board, Non-Electronic Augmentative Or Gastric Suction Pump, Home Model, Portable Or Stationary Blood Glucose Monitor With Integrated Voice Synthesizer Pulse Generator Sys For Tympanic Treatmnt Inner Ear Endolymph Fluid Manual Wheelchair Accessory,nonstandard Seat Frame Depth,20 L/Than 22 Manual Wchair Accessory, Nonstandard Seat Frame Depth, 22 To 25 In Manual Wheelchair Accessory, Foam Propulsion Tire, Any Size, Each Manual Wheelchair Accessory, Gear Reduction Drive Wheel, Each Manual Wheelchair Accessory, Wheel Braking System And Lock, Complete, Each Back, Planar, For Pediatric Size Wheelchair Including Fixed Attaching Seat, Planar, For Pediatric Size Wheelchair Including Fixed Attaching Back, Contoured, For Pediatric Size Wheelchair Including Fixed Attaching Seat, Contoured, For Pediatric Size Wheelchair Including Fixed Attaching Manual Wc Accessory, For Ped Size Wc Dynamic Seating Frame Power Wheelchair Acces Sory, Power Seat Elevation System Power Wheelchair Acces Sory, Power Standing System Power Wheelchair Accessory,elec Conn/Wchair Controller And 1 Power Seat Syst Power Wchair Access, Elec Connection Betw Wheelchair Controller Pwc Mini-Prop Remote Joystick Power Wheelchair Accessory,hand Control Interface,remote Joystick Power Wheelchair Accessory,hand Control Interface,multiple Mechanical Switches Power Wheelchair Accessory, Chin Cup For Chin Control Interface Power Wheelchair Access, Sip And Puff Interface, Nonproportional Power Wheelchair Accessory,head Control Interface,mech/Proportional Power Wheelchair Accesory,head Control Or Extremity Control Interface Power Wheelchair Accessory,head Control Interface,contact Switch Mechanism CC32013443

August 1, 2013 E2330 E2331 E2341 E2343 E2351 E2362 E2368 E2369 E2370 E2371 E2373 E2375 E2376 E2389 E2390 E2402 E2502 E2506 E2508 E2510 E2512 E2599 E2609 E2610 E2616 E2617 E2621 E2622 E2623 E2624 E2625 E8000 E8001 E8002

Power Wheelchair Accessory,head Control Interface,proximity Switch Mechanism Power Wheelchair Accessory,attendent Control,porportional Power Wheelchair Accessory,nonstandard Seat Frame Width, 24-27 In Power W Chair Access, Nonstand Seat Frame Depth, 22-25 Inches Power W Chair Access, Elect Interface To Operate Speech Generating Power Wchair Accessory, Group 24 Non-Sealed Lead Acid Battery, Each Power Wheelchair Component,motor,replacement Only Power Wheelchair Component, Gear Box, Replacement Only Power Wheelchair Component,motor And Gear Box Combination,replacement Only. Power Wheelchair Accessory, Group 27 Sealed Lead Acid Battery, (E.G. Gel Cell, Power Wc Accessory,hand/Chin Control,remove Joystick Proportional, Replace Only Non-Expandable Controller Expandable Controller, Replacement Power Wheelchair Access, Foam Caster Tire, Any Size, Replacement Only, Ea Power Wheelchair Access, Solid Drv Wheel Tire, Any Size,replace Only, Ea Negative Pressure Wound Therapy Elec Pump, Stationary Or Portable Speech Generatine Device,digitized Speech,using Pre-Recorded Mess.8-20min Speech Generating Device,digitized Speech,pre-Recorded Msg,more Than 40 Min Speech Generating Device,synthesized Speech,msg Form By Spelling Access By Phys Speech Generating Device,synthesized Speech,multiple Methos Of Msg Accessory, For Speech Generating Device, Mounting System Accessory, For Speech Generting Device, Not Otherwise Classified Custom Fabricated Wheelchair Seat Cushion, Any Size Wheelchair Seat Cushion, Powered Positioning Wheelchair Back Cushion,posterior-Lateral Width 22in Or Greater Custom Fabricated Wheelchair Back Cush, Any Size, Including Any Type Positioning Wheelchair Back Cushion,planar Back W/Lat Support 22in/Greater Skin Protection Wheelchair Seat Cushion, Adjustable, Width Less Than 22 Inches Skin Protection Wheelchair Seat Cushion, Adjustable, Width 22 Inches Skin Protection & Positioning Wheelchair Seat Cushion, Adjustable, Width Less Skin Protection And Positioning Wheelchair Seat Cushion, Adjustable, Width 22 Gait Trainer, Pediatric Size, Posterior Support, Includes All Accessories Gait Trainer, Pediatric Size, Upright Support, Includes All Accessories Gait Trainer, Pediatric Size, Anterior Support, Includes All Accessories

G0457

Negative pressure wound therapy, (e. G. Vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters Negative pressure wound therapy, (e. G. Vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters

K0001 K0002 K0003

Standard Wheelchair Standard Hemi [low Seat] Wheelchair Lightwgt Wheelchair

G0456

CC32013443

August 1, 2013 K0004 K0005 K0006 K0007 K0009 K0010 K0011 K0012 K0014 K0018 K0050 K0073 K0098 K0108 K0195 K0455 K0462 K0606 K0609 K0669 K0730 K0800 K0801 K0802 K0806 K0807 K0808 K0812 K0813 K0814 K0815 K0816 K0820 K0821 K0822 K0823 K0824 K0825 K0826 K0827 K0828 K0829 K0830 K0831 K0835 K0836 K0837

High Strength, Lightwgt Wheelchair Ultralightwgt Wheelchair Heavy Duty Wheelchair 5 Extra Heavy Duty Wheelchair Other Manual Wheelchair/Base Standard-Weight Frame Motorized/Power Wheelchair Standard-Weight Frame Motorized/Power Wheelchair W/Programmable Control Para Lightweight Portable Motorized/Power Wheelchair Other Motorized/Power Wheelchair Base Detachable,adjustable Height Armrest,upper Portion, Each Ratchet Assembly Caster Pin Lock,each Drive Belt For Power Wheelchair Wheelchair Component Or Accessory, Nos Elevating Legrest,pair(For Use With Capped Rental Wheelchair Base) Infusion Pump Used For Uninterrupted Parenteral Admin.Of Meds Temporary Replacement For Patient Owned Equipment Being Repaired Any Type Auto External Defibrillator,w/Integrated Electrocardio Analy,garment Type Replacement Electrodes For Use W/Automated External Defibrillator,each Seat/Back Cus No Dmepdac Ver Controlled Dose Inhalation Drug Delivery System Power Operate Vehicle,grp1 Std.Pt.Wt.Cap Up To Incl 300 Lb Power Operate Vehicle,grp,1 Hd,ptl.Wt.Cap 301 To 450 Lbs Power Operated Vehicle,grp 1, Very Hd.Pt.Wt.Cap 451 To 600 Lbs Power Operated Vehicle, Grp 2 Std,pt.Wt.Cap Up To Incl 300 Lbs Power Operated Vehicle, Grp 2 Hd.Pt.Wt.Cap 301 To 450 Lbs Power Operated Vehicle,grp 2 Very Hd.Pt.Wt.Cap 451 To 600 Lbs Power Operated Vehicle, Not Otherwise Classified Power Chair, Grp 1 Std, Port, Sling/Solid Seat/Back Pt Wt.Cap Incl 300 Lbs Power Chair,grp 1 Std.Port, Captains Chair, Pt.Wt.Cap And Incl 300 Lbs Power Chair, Grp 1 Std. Sling/Sold Seat/Back, Pt.Wt.Cap Incl 300 Lbs Power Chair,grp 1 Std.Captains Chair,pt Wt.Up To And Incl 300 Lbs Power Chair,grp 2 Std.Port, Sling/Solid Seat/Back,pt.Wt.Cap Incl 300 Lbs Power Chair,grp 2 Std,port, Captains Chair, Pt Wt.Cap Incl 300 Lbs Power Chair,grp 2 Std, Sling/Solid Seat/Back Pt.Wt.Cap Incl 300 Lbs Power Chair,grp 2 Std,captains,chair Pt.Wt Up To Including 300 Lbs Power Chair,grp 2 Hd. Sling/Solid Seat/Back Pt Wt 301 To 450 Lbs Power Chair,grp 2 Hd. Captains Chair, Pt Wt. 301 To 450 Lbs Power Chair, Grp 2 Very Hd.Sling/Solid Seat/Back, Pt.Wt.Cap 451 To 600 Lbs Power Chair,grp 2 Very Hd. Captains Chair Pt Wt Cap 451 To 600 Lbs Power Chair, Grp 2 Extra Hd. Sling/Solid Seat/Back Pt Wt.Cap 601 Lbs More Power Chair,grp 2 Extra Hd, Captains Chair Pt Wt Cap 601 Lbs Or More Power Chair, Grp 2 Std, Seat Elevator, Sssb, Pt Wt Cap Incl 300 Lbs Power Chair,grp 2 Std.Seat Elevator,capt Chair Wt Cap Incl 300 Lbs Power Chair,grp 2 Std,single Power Opt, Sssb, Pt Wt Cap Incl 300 Lbs Power Chair,2 Std, Single Power Opt, Capt Chair Pt Wt Cap Incl 300 Lbs Power Chair, Grp 2 Hd.Single Power Opt, Sssb, Pt Wt.Cap 301 To 450 Lbs CC32013443

August 1, 2013 K0838 K0839 K0840 K0841 K0842 K0843 K0848 K0849 K0850 K0851 K0852 K0853 K0854 K0855 K0856 K0857 K0858 K0859 K0860 K0861 K0862 K0863 K0864 K0868 K0869 K0870 K0871 K0877 K0878 K0879 K0880 K0884 K0885 K0886 K0890 K0891 K0898 K0899 L8689 S1002 S9001

Power Chair,grp 2 Hd, Single Power Opt Capt Chair,pt Wt Cap 301 To 450 Lbs Power Chair,grp 2 Very Hd. Single Power Opt,sssb, Pt Wt Cap 451 To 600 Lbs Power Chair,grp 2 Extra Hd, Single Power Opt,sssb, Cap 601 Lbs Or More Power Chair,grp 2 Std, Mult Power Opt, Sssb, Pt Wt.Cap Up Incl 300 Lbs Power Chair,grp 2 Std,mult Power Opt,capt Chair.Wt Cap Up Incl 300 Lbs Power Chair,grp 2 Hd, Mult Power Opt,sssb, Pt Wt Cap 301 To 450 Lbs Power Chair, Grp 3 Std, Sssb, Pt Wt.Cap Up To And Incl 300 Lbs Power Chair, Grp 3 Std, Captains Chair, Pt Wt Cap Up To And Incl 300 Lbs Power Chair,grp 3 Hd, Sling/Solid Seat/Back, Pt.Wt. Cap 301 To 450 Lbs Power Chair,grp 3 Hd, Captains Chair, Pt Wt Cap 301 To 450 Lbs Power Chair, Grp 3 Very Hd, Sssb, Pt Wt Cap 451 To 600 Lbs Power Chair,grp 3 Very Hd, Captains Chair, Pt Wt Cap 451 To 600 Lbs Power Chair, Grp 3 Extra Hd, Sssb, Pt Wt Cap 601 Lbs Or More Power Chair,grp 3 Extra Hd, Captains Chair, Pt Wt.Cap 601 Lbs Or More Power Chair,grp 3 Std.Single Power Opt, Sssb, Wt. Cap Incl 300 Lbs Power Chair, Grp 3 Std,single Power Opt, Capt Chair Wt Cap Incl 300 Lbs Power Chair, Grp 3 Hd.Single Power Opt, Sssb, Pt Wt.Cap 301 To 450 Lbs Power Chair, Grp 3 Hd, Single Power Opt, Capt Chair, Wt Cap 301 To 450 Lbs Power Chair,grp 3 Very Hd, Single Power Opt, Sssb, Wt Cap 451 To 600 Lbs Power Chair,grp 3 Std,mult Power Opt, Sssb, Pt Cap Incl 300 Lbs Power Chair, Grp 3 Hd, Mult Power Opt, Sssb, Pt Wt Cap 301 To 450 Lbs Power Chair, Grp 3 Very Hd, Mult Power Opt, Sssb, Wt Cap 451 To 600 Lbs Power Chair, Grp 3 Extra Hd, Mult Power Opt,sssb, Cap 601 Lbs Or More Power Chair,grp 4 Std, Sssb, Pt.Wt.Cap Up To And Incl 300 Lbs Power Chair, Grp 4 Std, Captains Chair,pt Wt.Cap Up And Incl 300 Lbs Power Chair,grp 4 Hd. Sling/Solid Seat/Back. Pt Wt Cap 301 To 450 Lbs Power Chair, Grp 4 Very Hd, Sssb, Pt Wt Cap 451 To 600 Lbs Power Chair, Grp 4 Std. Single Power Opt, Sssb, Pt Wt Cap 300 Lbs Power Chair,grp 4 Std.Siingle Power Opt, Capt Chair.Wt Cap Incl 300 Lbs Power Chair, Grp 4 Hd. Single Power Opt, Sssb, Pt Wt Cap 301 To 450 Lbs Power Chair, Grp 4 Very Hd, Single Power Opt, Sssb, Wt 451 To 600 Lbs Power Chair, Grp 4 Std. Mult Power Opt, Sssb, Pt Wt Cap Incl 300 Lbs Power Chair, Grp 4 Std. Mult Power Opt, Capt Chair, Wt Cap Incl 300 Lbs Power Chair, Grp 4 Hd.Mult Power Opt, Sssb, Pt Wt Cap 301 To 450 Lbs Power Chair, Grp 5 Ped, Single Power Opt,sssb, Pt Wt Cap Incl 125 Lbs Power Chair, Grp 5 Ped, Mult Power, Sssb, Pt.Wt.Cap And Incl.125 Lbs Power Chair, Not Otherwise Classified Pow Mobil Dev No Dme Pdac Ext Rechrge Syst Int Battery Use W/Implantable Neurostimulator-Replace Only Customized Item(List In Addition To Code For Basic Item) Home Uterine Monitor W Or W/O Associated Nursing Services

S9110

Telemonitoring of patient in their home, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month

L3330 98960 98961

Lift Elevation Metal Extension Educa Train For Pt Self Mangmt By Qual Nonphys W Patient Each 30 Min Educa Train For Pt Self Mangmt By Qual Nonphy With 2 To 4 Patients CC32013443

August 1, 2013 98962 S9140 S9460 S9465 L8690 L8691 L8693 V5014 V5020 V5030 V5040 V5050 V5060 V5120 V5130 V5140 V5160 V5170 V5180 V5210 V5220 V5261 V5264 V5266 V5267 99500 99501 99502 99503 99504 99505 99506 99507 99509 99510 99511 99512 99601 99602 G0154 G0155 G0156 G0162 G0163 G0164 S0281 S5108

Educa Train For Pt Self Mangmt By Qual Nonphy With 5 To 8 Patients Diabetic Management Program Follow-Up Visit To Non-Md Provider Diabetic Management Program,nurse Visit Diabetic Mamagement Program,dietitian Visit Auditory Osseointegrated Device, Includes All Internal And External Components Auditory Osseointegrated Device, External Sound Processor, Replace Auditory Osseointegrated Device Abutment, Any Length, Replacement Only Repair/Modification Of A Hearing Aid Conformity Evaluation Hearing Aid,monaural,body Worn,air Conduction Hearing Aid,monaural,body Worn,bone Conduction Hearing Aid - Monaural - In The Ear Hearing Aid - Monaural - Behind Ear Binaural - Body Binaural - In The Ear Binaural - Behind The Ear Dispensing Fee - Binaural Hearing Aid - Cros - In The Ear Hearing Aid - Cros - Behind The Ear Hearing Aid - Bicros - In The Ear Hearing Aid - Bicros - Behind Ear Hearing Aid, Digit, Bin, Bte Ear Mold/Insert Battery For Hearing Device Hearing Aid Supply/Accessory Home Visit For Prenantal Assessment Home Visit For Postnatal Assessment And Follow-Up Care Home Visit For Newborn Care Assessment Home Visit For Respiratory Therapy Care Home Visit For Patients Receiving Mechanical Ventilation Home Visit For Stoma Care And Maint Incl Colostomy And Cystostomy Home Visit For Intramuscular Injections Home Visit For Catheter Maintenance Home Visit For Assistance With Activities Of Daily Living Home Visit For Individual,family Or Marrige Counseling Home Visit For Fecal Impaction Mgmt And Enema Admin Home Visit For Hemodialysis Home Infusion Specialty Drug Admin Per Visit Up To 2 Hrs Home Infus Spec Drug Admin Per Visit Each Add'l Hour Direct Skilled Nursing Services Of Lpn/Rn In Home Health/Hospice, Ea 15 Mins Services Of Clinical Social Worker In Home Health Or Hospice Setting Ea 15 Min Services Of Home Health Aide In Home Health Or Hospice Setting Each 15 Min Skilled Services By A Registered Nurse (Rn) In The Delivery Of Management & Skilled Services Of A Licensed Nurse (Lpn Or Rn) In The Delivery Of Observation Skilled Services Of A Licensed Nurse, In The Training And/Or Education Of A Medical Home Program, Comprehensive Care Coordination/Plan, Maintenance Home Care Training To Home Care Client, Per 15 Minutes CC32013443

August 1, 2013 S5109 S5110 S5111 S5115 S5116 S5180 S5181 S9061 S9097 S9098 S9122 S9123 S9124 S9127 S9128 S9129 S9131 S9208 S9209 S9211 S9212 S9213 S9214 S9430 S9474 S9529 T1000 T1001 T1002 T1003 T1004 T1005 T1019 T1020 T1021 Q5001 Q5002 Q5003 Q5004 Q5005 Q5006 Q5007 Q5008 Q5009 Q5010 S0255 S9125

Home Care Training To Home Care Client, Per Session Home Care Training Family Per 15 Minutes Home Care Training Family Per Session Home Care Training Non Family Per 15 Minutes Home Care Training Non Family Per Session Home Health Respratory Therapy, Initial Evaluation Home Health Respirtory Therapy Nos Per Diem Home Administration Of Aerosolized Drug Therapy (Eg Pentamidine) Per Diem Home Visit For Wound Care Home Visit,phtotherapy Services,equip Rental,nurse Ser,blood Draw,per Diem Home Health Aide Or Certified Nurse Assistant Care In Home Per Hour Nursing Care In The Home By Registered Nurse Per Hour Nursing Care,in Home,by Licensed Practical Nurse,per Hour Social Work Visit In The Home Per Diem Speech Therapy In The Home Per Diem Occupational Therapy In The Home Per Diem Physical Therapy,in The Home,per Diem Home Mgmt Preterm Labor,including Admin Services Home Mgmt Of Preterm Premature Rupture Of Membranes,including Admin Serv Home Mgmt Of Gestational Hypertension,includes Admin Services Home Mgmt Of Postpartum Hypertension, Includes Admin Services,prof Rx Serv Home Mgmt Of Preeclampsia,includes Admin Services,prof Rx Services Home Mgmt Of Gestational Diabetes,includes Admin Services,prof Rx Services Pharmacy Compounding And Dispensing Services Enterostomal Therapy By A Rn Certified In Enterostomal Therapy Per Diem Routine Venipuncture For Collection Of Specimen,home Bound,nursing Hm,snf Private Duty/Independent Nursing Services-Licensed,up To 15 Min Nursing Assessment/Evaluation Rn Services, Up To 15 Minutes Lpn/Lvn Services, Up To 15 Minutes Services Of A Qualified Nursing Aide, Up To 15 Minutes Respite Care Services, Up To 15 Minutes Personal Care Services,per 15 Min,not For Inpt Or Resident Of Hospital Personal Care Services,per Diem,not For Inpt Or Resident Of Hosp,nurse Fac Home Health Aide Or Certified Nurse Assistant, Per Visit Hospice Care Provided In Patient's Home/Residence Hospice Care Provided In Assisted Living Facility Hospice Care Nursing Long Term Care Facility Or Non-Skillednurse Facility Hospice Care Provided In Skilled Nursing Facility Hospice Care Provided In Inpatient Hospital Hospice Care Provided In Inpatient Hospice Facility Hospice Care Provided In Long Term Care Facility Hospice Care Provided In Inpatient Psychiatric Facility Hospice Care Provided In Place Not Otherwise Specified Hospice Home Care Provided In Hospice Facility Hospice Referral Visit Performed By Nurse,social Worker,designated Staff Respite Care In The Home Per Diem CC32013443

August 1, 2013 S9126 G0378 G0379 91111 95803 0019T 0030T 0042T 0071T 0072T 0075T 0076T 0078T 0079T 0080T 0081T 0085T 0092T 0095T 0098T 0100T 0101T 0102T 0103T 0106T 0107T 0108T 0109T 0110T 0111T 0123T 0124T 0163T 0164T 0165T 0169T 0171T 0172T 0178T 0179T 0180T 0181T 0182T 0183T 0185T 0186T 0190T

Hospice Care In The Home Per Diem Hospital Observation Service, Per Hour Direct Admission Of Patient For Hospital Observation Care Gi Tract Imaging Intraluminal Esophagus W/Phy I&r Actigraphy Testing Recording Analysis I&r Extracorporeal Shock Wave Involving Musculoskeletal System Antiprothrombin Phospholipid Cofactor Antibody Each Lg Class Cereb Perf Anal Using Tomog W Contr Incl Post Proc Of Parametric Maps Focus Ultrasnd Ablat Of Uter Leiomyomata Inc Mr Guid Less 200 Cc Tissue Focus Ultrasnd Ablat Uter Leiomyomata Inc Mr Guid 200 Cc Of Tissue Transcath Extracranial Or Intrathoracic Stents, Initial Vessel Transcath Extracranial Or Intrathoracic Stents, Ea Addl Vessel Endo Vascular Repair Of Abdominal Aortic Aneurysm, Pseduoaneurysm Placement Of Visceral Extension Prosthesis For Endovascular Repair Endo Vasc Repair Of Abdominal Aortic Aneurysm, Pseduoaneurysm Placement Of Visceral Extension Prosthesis For Endovascular Repair Breath Test, Heart Transplant Rejection Tot Disc Arthroplasty Ant W/Diskectomy W/End Prep Ea Addl Interspace Remove Total Disc Arthro Anterior Single Ea.Addl Interspace Rev W/Replace Total Disc Arthro Anterior, Ea Addl Interspace,cervical Placement Of Subconjunctival Retinal Prosthesis Rec And Pulse Gen Extracorporeal Shock Wave Musculoskeletal Nos High Energy Extracorporeal Performed By Physician Req Anesth Other Than Local Holotranscobalamin Quantitative Qst Using Touch Pressure To Assess Lg Dia Sensation Qst Testing Interpretation Per Extremity Using Vibration Lg Dia Qst Per Extremity Using Cooling To Assess Small Nerve Fiber Sensation Qst Using Heat Pain To Assess Small Nerve Fiber Sensation Qst Using Other Stimuli To Assess Sensation Long Chain Omega 3 Fatty Acids In Red Blood Cell Membranes Fistulization Of Sclera For Glaucoma Thru Ciliary Body Conjuctival Inc W Post Extrascleral Place Pharmacological Agent Tot Disc Arthro, Anterior Incl Prepare Interspace Ea.Addl. Lumbar Remove Total Disc Arthroplasty, Ant, Ea. Addl Interspace Lumbar Revise Total Disc Arthroplasty, Ant, Ea. Addl Interspace Lumbar Stereotactic Place Cath Brain For Dely Therap Agents Lumbar Spine Process Distraction Device, Single Level Lumbar Spine Process Distraction Device Ea.Addl.Level 64 Lead Ecg W/Interpretation And Report 64 Lead Ecg With Tracing 64 Lead Ecg With Intrepretation And Review Only Corneal Hysteresis By Ais, Bilateral W/Interprt And Report High Dose Rate Electronic Brachyterhapy, Per Fraction Low Frequency Wound Ultrasound On Going Care Per Day Multivariate Analysis Pt Findings W/Assessment Suprachoroidal Delivery Of Pharmacoligic Agent/Not Medication Placement Of Intraocular Radiation Source Applicator CC32013443

August 1, 2013 0191T 0195T 0196T 0198T 0199T 0200T 0201T 0202T 0205T 0206T 0207T 0208T 0209T 0210T 0211T 0212T 0219T 0220T 0221T 0222T 0223T 0224T 0225T 0226T 0227T 0228T 0229T 0230T 0231T 0232T 0233T 0234T 0235T 0236T 0237T 0238T 0239T 0240T 0241T 0242T 0243T 0244T 0253T 0262T 0263T 0264T 0265T

Insert Anterior Segment Drain Device Internal Into Trabecular Mesh Arthrodesis Presacral Interbody Arthrodesis Presacral Interbody Ea Interspace Measure Ocular Blood Flow By Repetitive Intraoc Press Sample W/I&r Physlgc Rcdg Tremor Using Accelmtr(S) And Gyrosc(S) Incl Freq And Amp Incl I&r Percut Sacr Augmentation Unilat Inc Balloon Or Mech Dev 1 Or More Needles Percut Sacr Augmentation Bilat Incl Balloon Or Mech Dev 2 Or More Needles Post Vert Jt Arthroplasty W Wo Cement Incl Fluors Sngl Lvl Lumbar Spine Iv Cth C Vsl/Grf Spct Eval Plus Or Minus Invtj W/Rsi Vsl Rmt Algrthmc Alys Ecg W/Cptr Prblty Assmt Evac Meibomian Glnds Auto Ht& Intmt Press Uni Automated Audiometry Air Automated Audiometry Air And Bone Speech Auditory Threshold, Automated Speech Auditory Threshold, Automated W/Speech Recognition Comprehensive Auto Audiometry Fuse Spine Facet Jt Cervical Fuse Spine Facet Jt Thoracic Fuse Spine Facet Jt Lumbar Fuse Spine Facet Jt Add Segment Acoustic Cardiography W/Analys Combine Acoustic/Electic Intervals, Single Acoustic Cardiography W/Analys Combine Acoustic/Elect Intervals, Multiple Acoustic Cardiography W/Analys Combine Acoustic/Electrl Inter Mult Delays Anoscopy, Hra Diag, W/Specimens Brushing Or Washing Anoscopy, Hra Diag, W/Specimens Brushing Or Washing With Biopsies Inj Anesth Agent/Or Steroid, Transf Epidral,us Guid, Cerv/Thorac, Single Inj Anesth Agnt/Or Steroid, Transf Epidural,us Guid, Cerv/Thorac, Ea Add Inj Anesth Agent/Or Sterd, Transf Epidural,us Guid, Lumbr/ Sacral,single Inj Anesth Agent/Or Sterd, Transf Epidural,us Guid, Lumbr/ Sacral,ed Add Inj Platelet Rich Plasma, Any Tissue W/Image Guide Harvest/Preparation Skin Adv Glycation Endprod Mult-Wavelength Fluorescnt Spectroscopy Trnsluminal Peripheral Atherectomy W/Radio Spervsion & Interp Renal Artery Trnsluminal Peripheral Atherectomy W/Radio Spervsion & Interp Visceral Artery Trnsluminal Peripheral Atherectomy W/Radio Spervsion & Interp Abdominal Aorta Trnsluminal Peripheral Atherectomy W/Radio Spervsion & Interp Brachio Trunk Trnsluminal Peripheral Atherectomy W/Radio Spervsion & Interp Iliac Artery Bioimpedance Spectroscpy 100 Frequncies Or More, Measurmnt Extracellular Fluid Esophageal Motility High Resolution Esophageal Pressure Topography W/I&r Esoph/Gastroesoph Motility W/Stimulant Acid Or Alkali Perfusion W/I&r Gi Tract Transit & Pressure Measment Stomach Thru Colon, Wireless Cap W/I&p Intermit Measment Of Wheeze Rate For Bronchodilator Or Bronchial Challenge Dx Continuous Measurement Wheeze Rate Bronchodil During Sleep 3-24 Hrs W/I&p Insert Ant Segment Aqueous Drain Device, W/Out Extraocular Reservoir,internal Implant Catheter-Dlvd Prosthetic Pulmonary Valve, Endovascular Approach Intramuscular Autologous Bone Marrow Cell Therapy-Complete Intramuscular Autologous Bone Marrow Cell Therapy-Exclude Harvest Intramuscular Autologous Bone Marrow Cell Therapy W/Prep Of Cells One Leg CC32013443

August 1, 2013 0266T 0267T 0268T 0269T 0270T 0271T 0272T 0273T 0274T 0275T 0276T 0277T 0278T 0279T 0280T 0281T 0282T 0283T 0284T 0285T 0286T 0288T 0291T 0292T 0293T 0294T 0295T 0296T 0297T 0298T 0299T 0300T 0301T A4575 A4639 E0175 E0217 E0221 E0225 E0239 E1700 E1701 E1702 E1815 E1830 E1831

Activation Device, Total System Activation Device, Lead Only Activation Device, Pulse Generator Only Revision Or Removal Carotid Sinus Baroreflex Activation Device Total System Revision Or Removal Carotid Sinus Baroreflex Activation Device Lead Only Revis/Removal Carotid Sinus Baroreflex Activation Device Pulse Generator Only Interrogation Device Eval.Carotid Sinus Baroreflex Interrogation Device Eval Carotid Sinus Baroreflex With Programming Percut Laminotomy/Ectomy Decompression Cervical Or Thoracic Percutaneous Laminotomy/Laminectomy For Decomp Of Neural Elements Bronchscpy Fluoro W/Bronchial Thermplasty 1 Lobe Bronchscpy Fluoro W/Brnchial Thermplasty 2 Or More Lobes Trnscut Elect Modlation Pain Reproces Ea Tx Sess Cell Enumrtion W/Immun Selxn & Id Fluid Specimn Cell Enumration W/Immun Selxn Id Fluid Spec I&r Perc Transcth Closr Lt Atrial Appndge Implnt S&i Perc/Open Implnt Neurostim Electrode Subq Trial Perc/Open Implnt Neurostim Electrode Subq Perm Rev/Remvl Pg/Elctrodes Imagng Addn New Elctrodes Elec Anlys Implant Subq Field Stim Pg Reprogramm Near Infrared Spectroscpy Studies Low Ext Wounds Anscpy W/Delvry Thermal Energy Muscle Anal Canal Intravascular Optical Coherence Tomography During Eval, Initial Vessel Intravascular Optical Coherence Tomography Durng Eval Ea.Additionalvessel Insert Left Atrial Hemodynamic Monitor, Complete And Assoc.Injection Procedures Pressure Sensor Lead At Time Of Insert Pacing Cvd Pulse Generator Ext Ecg Recording More Than 48 Hrs To 21 Days Ext Ecg Recording W/Connection And Initial Recording Ext Ecg Scanning Analysis With Report Ext Ecg Review And Interpretation Extracorporeal Shock Wave For Integ Wound Healing, Initial Wound Extracorporeal Shock Wave For Integ Wound Healing, Each Additional Wound D&r Malig Breast Tumor W/Microwave Under Us Thermotherapy Guidance Topical Hyperbaric Oxygen Chamber, Disposable Replacement Pad For Infrared Heating Pad System Each Foot Rest, Use W/Commode Chair Water Circulating Heat Pad W Pump Infrared Heating Pad System Hydrocollator Unit, Includes Pads Hydrocollator Unit, Portable Jaw Motion Rehabilitation System Replacement Cushions For Jaw Motion Rehabilitation System,pkg Of 6 Replacement Measuring Scales For Jaw Motion Rehab System,pkg Of 200 Dynamic Adjustable Ankle Extension/Flexion Device Dynamic Adjustable Toe Extension/Flexion Device Static Progressive Stretch Toe Device, Extension And/Or Flexion, With Or

CC32013443

August 1, 2013

G0455

Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen

G9143 G9147

Warfarin Response Genetic Test Outpatient Intravenous Insulin Treatment

L8605

Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies

L8621 L8622 L8623 L8624 L8627 L8628 L8629 M0300 Q3031 Q4107 Q4113 Q4124 Q4130

Zinc Air Battery For Cochlear Implant Device,replacement,ea Alkaline Battery For Cochlear Implant Device,any Size,replacement,ea Lithium Ion Battery For Use With Cochlear Implant Device Speech Processor Lithium Ion Battery For Use With Cochlear Implant Device Speech Processor, Ear Cochlear Implant, External Speech Processor, Component, Replace Cochlear Implant, External Controller Component, Replacement Transmitting Coil And Cable, Integrated, Use W/ Cochlear Implant Device, Iv Chelation Therapy (Chemical Endarterectomy) Collagen Skin Test Graftjacket, Per Sq Cm Graft Jacket Express, Injectable, 1 Cc Oasis Ultra Tri-Layer Wound Matrix, Per Square Centimeter Strattice Tm, Per Square Centimeter

Q4132 Q4133

Grafix core, per square centimeter Grafix prime, per square centimeter

S0122 S0126 S0128 S1030 S1031 S1040 S2083 S2117 S2300 S2400 S2404 S2409 S3650 S3652 S3722 S4990 S4991 S4995 S8130 S8131 S8262 S8948 S9055 S9090 S9455 T1503

Injection, Menotropins, 75 Iu Injection, Follitropin Alfa, 75 Iu Injection, Follitropin Beta, 75 Iu Continuous Noninvasive Glucose Monitoring Device,purchase Continuouse Noninvasive Glucose Monitoring Device,rental,including Sensor Cranial Remold Orthosis,pediatric Rigit W/Soft Matl Custom Fab W/Fitting/Adj Adjustment Of Gastric Band Diameter Via Subcutaneous Port By Injection Or Aspi Arthroereisis Subtalar Arthroscopy Shoulder Surgical W/Thermally-Induced Capsulorrhaphy Repair,congenital Diaphragmatic Hernia In Fetus Using Temp Tracheal Occlus Repair,myelomeningocele In Fetus, Performed In Utero Repair,congenital Malformation Of Fetus,performed In Utero, Noc Saliva Test Hormone Level During Menopause Saliva Test,hormone Level,to Assess Preterm Labor Risk Dose Optimizatn By Area Undr Curve (Auc) Analysis, Infusional 5-Fluorouracil Nicotine Patch Legend Nicotine Patch Nonlegend Smoking Cessation Gum Interferential Current Stimulator, 2 Channel Interferential Current Stimulator, 4 Channel Mandibular Orthopedic Repositioning Device, Each Application Of A Modality To One Or More Areas,low-Level Laser,ea 15 Min Procuren Or Other Growth Factor Preparation To Promote Wound Healing Vetebral Axial Decompression Per Session Diabetic Mamagement Program,group Session Admin Of Med, Other Than Oral And/Or Injectable By Agency/Prof Per Visit

CC32013443

August 1, 2013 B4178 B4180 B4185 B4189 B4193 B4197 B4199 B5000 S5497 S5498 S5501 S5502 S5517 S5518 S5520 S5521 S5522 S5523 S9325 S9326 S9327 S9328 S9329 S9330 S9331 S9336 S9338 S9339 S9340 S9341 S9342 S9343 S9345 S9346 S9347 S9348 S9349 S9351 S9353 S9355 S9357 S9359 S9361 S9363 S9364 S9365 S9366

Parenteral Nutrition Solution, Amino Acid, Greater Than 8.5%, Home Mix Parenteral Nutrition Solution,carbohydrates(Dextrose)greater Than 50%,home Mix Parenteral Nutrition Solution, Per 10 Grams Lipids Parenteral Nutrition Solution,compd Amino Acid And Carbs W Electr,10-51 Gr Pro Parenteral Nutrition Solution,compd Amino Acid And Carbs W Elect,52-73 Gm Prot Parenteral Nutrition Solution,compd Amino Acid And Carbs W Elect,74-100 Gr Prot Parenteral Nutrition Solution,compd Amino Acid And Carbs W Elect,over 100 Grms Parenteral Nutrition Solution,compound Amino Acid/Carb W Electrolytes Home Infusion Therapy,cath Care/Maint,noc, Admin Serv, Prof Rx Serv,care Coor Home Infusion Therapy, Cath Care/Maintenance,simple(Single Lumen),admin Sv Home Infusion Therapy,cath Care/Maint,complex(More Than One Lumen),admin Sv Home Infusion Therapy,cath Care/Maint,implanted Access Device,admin Serv Home Infusion Therapy,all Supplies Nec For Restoration Of Cath Patency/Dec Home Infusion Therapy,all Supplies Necessary For Catheter Repair Home Infusion Therapy,all Supplies Nec For Picc Line Insertion Home Infusion Therapy,all Supplies Nec For Midline Catheter Insertion Home Infusion Therapy,insertion Of Picc,nursing Services Only Home Infusion, Insert Midline Venous Cath, Nursing Services Only Home Infusion Therapy,pain Mgmt Infusion,admin Services,prof Rx Services Home Infusion Therapy,continuous(24hrs/More)pain Mgmt Infusion,admin Serv Home Infusion Therapy,intermittent(Less Than 24hrs) Pain Mgmt Infusion Home Infusion Therapy,implanted Pump Pain Mgmt Infusion,admin Services Home Infusion Therapy,chemotherapy Infusion,admin Services,prof Rx Serv. Home Infusion Therapy,continuous(24hr Or More) Chemotherapy Infusion,admin Home Infusion Therapy,intermittent(Less Than 24 Hrs) Chemotherapy Infusion Home Infusion Therapy,continuous Anticoagulant Infusion Therapy,admin Serv Home Infusion Therapy,immunotherapy,admin Serv,prof Rx Services,care Coor Home Therapy,peritoneal Dialysis,admin Serv,professional Rx Serv,care Coor Home Therapy,enteral Nutrition,admin Services,prof Rx Services,care Coor Home Therapy,enteral Nutrition Via Gravity,admin Serv,prof Rx Service Home Therapy,enteral Nutrition Via Pump,admin Serv,prof Rx Serv,care Coor Home Therapy,enteral Nutrition Via Bolus,admin Serv,prof Rx Serv,care Coor Home Infusion Therapy,anti-Hemophilic Agent Infusion Therapy (Factor Viii) Home Infusion Therapy,alpha-1-Proteinase Inhibitor (Prolastin) Admin Serv Home Infusion Therapy,uninterrupted,long-Term,controlled Rate Intravenous Home Infusion Therapy,sympathomimetic/Inotropic Agent Infusion Therapy Home Infusion Therapy, Tocolytic, Admin Per Diem Hit, Continue Or Intermitt Anti-Emetic Infusion Tx And All Supply And Equip Home Infusion Therapy,continuous Insulin Infusion Therapy,admin Services Home Infusion Therapy,chelation Therapy,admin Serv,per Diem Home Infusion Therapy,enzyme Replacement Intravenous Therapy(Imiglucerase) Home Infusion Therapy,anti-Tumor Necrosis Factor Intravenous Therapy Home Infusion Therapy,diuretic Intravenous Therapy,admin Ser,per Diem Home Infusion Therapy,anti-Spasmotic Therapy,admin Services,per Diem Home Infusion Therapy,total Parenteral Nutrition(Tpn) Admin Ser, Per Diem Home Infusion Therapy,total Parenteral Nutrition(Tpn) 1 Ltr Per Day,admin Home Infusion Therapy,total Parenteral Nutrition(Tpn) Greater Than 1 < 2lt CC32013443

August 1, 2013 S9367 S9368 S9370 S9372 S9373 S9374 S9375 S9376 S9377 S9379 S9490 S9494 S9497 S9500 S9501 S9502 S9503 S9504 S9537 S9538 S9542 S9558 S9559 S9560 S9562 S9590 G0237 G0238 G0239 G0424 S9473 81200 81205 81206 81207 81208 81209 81210 81211 81212 81213 81214 81215 81216 81217 81225 81226

Home Infusion Therapy,total Parenteral Nutrition,more Than 2 < 3 Ltr Per Day Home Infusion Therapy,total Parenteral Nutrition, More Than 3 Ltrs Per Day Home Therapy,intermittent Anti-Emetic Injection Therapy,admin Services Home Therapy,intermittent Anticoagulant Injection Therapy(Heparin) Admin Home Infusion Therapy,hydration Therapy,admin Serv, Prof Rx Serv,per Diem Home Infusion Therapy,hydration Therapy,1 Lt Per Day,admin Services. Home Infusion Therapy,hydration Therapy,more Than 1 Ltr < 2 Liters Per Day Home Infusion Therapy,hydration Therapy,more Than 2 Ltrs < 3 Ltrs Per Day Home Infusion Therapy,hydration Therapy,more Than 3 Liters Per Day,pr Diem Home Infusion Therapy,infusion Therapy, Noc, Admin Services,per Diem Home Infusion Therapy,corticosteroid Infusion,admin Services,per Diem Home Infusion Therapy,antibiotic,antiviral,antifungal Therapy,admin Serv Home Infusion Therapy,antibiotic,antiviral/Antifungal Therapy,1 Every 3hrs Home Infusion Therapy,antibiotic,antiviral,antifungal Therapy Every 24 Hrs Home Infusion Therapy,antibiotic,antiviral,antifungal Therapy Every 12 Hrs Home Infusion Therapy,antibiotic,antiviral,antifungal Therapy Every 8 Hrs Home Infusion Therapy,antibiotic,antiviral,antifungal Therapy Every 6 Hrs Home Infusion Therapy,antibiotic,antiviral,antifungal,every 5 Hrs,per Diem Home Therapy,hematopoietic Hormone Injection Therapy,admin Serv, Per Diem Home Infusion Of Blood Products,admin Services,per Diem Home Injectable Therapy,noc,administrative Services,per Diem Home Injectable Therapy,growth Hormone,administrative Services,per Diem Home Injectable Therapy,interferon,including Admin Services,per Diem Home Injectable Therapy,hormonal Therapy,administrative Services,per Diem Home Injectable Therapy,palivizumab,administrative Services,per Diem Home Therapy,irrigation Therapy,admin Services,per Diem Therap Px Increase Strength Or Respira Muscles F-To-F 1 On 1 Per 15 Min Therapeutic Px Improve Respira Function 1 On 1 F-To-F Per 15 Min Therapeut Px Improve Respira Or Increase Strength 2 Or More Pulmonary Rehab, Inc Exercise & Monitoring, One Hr Per Session Up To 2/Day Pulmonary Rehab Program Non-Physician Provider Per Diem Aspa Gene Analysis Common Variants Bckdhb Gene Analysis Common Variants Bcr/Abl1 Major Breakpnt Qualitative/Quantitative Bcr/Abl1 Minor Breakpnt Qualitative/Quantitative Bcr/Abl1 Other Breakpnt Qualitative/Quantitative Blm Gene Analysis 2281del6ins7 Variant Braf Gene Analysis V600e Variant Brca1&brca2 Full Seq Analys/Comm Dup/Del Brca1 Brca1&brca2 Anal 185delag5385insc/6174delt Brca1&brca2 Anal Uncommon Dup/Del Variants Brca1 Full Seq Anal&common Dup/Del Variants Brca1 Gene Analysis Known Familial Variant Brca2 Gene Analysis Full Sequence Analysis Brca2 Gene Analysis Known Familial Variant Cyp2c19 Gene Analysis Common Variants Cyp2d6 Gene Analysis Common Variants CC32013443

August 1, 2013 81227 81228 81229 81240 81241 81242 81243 81244 81245 81250 81251 81255 81256 81257 81260 81261 81262 81263 81264 81265 81266 81267 81268 81270 81275 81280 81281 81282 81290 81291 81292 81293 81294 81295 81296 81297 81298 81299 81300 81301 81302 81303 81304 81310 81315 81316 81317

Cyp2c9 Gene Analysis Common Variants Cytogenom Const Microarray Copy Number Variants Cytogenom Const Microarray Copy Number&snp Var F2 Gene Analysis 20210g More Than A Variant F5 Coagulation Factor V Anal Leiden Variant Fancc Gene Analysis Common Variant Fmr1 Analysis Eval To Detect Abnormal Alleles Fmr1 Gene Analysis Characterization Of Alleles Flt3 Gene Analysis Internal Tandem Dup Variants G6pc Gene Analysis Common Variants Gba Glucosidase/Beta/Acid Anal Comm Variants Hexa Gene Analysis Common Variants Hfe Hemochromatosis Gene Anal Common Variants Hba1/Hba2 Analysis For Common Deletions/Variant Ikbkap Gene Analysis Common Variants Igh@ Rearrange Abnormal Clonal Pop Amplified Igh@ Rearrange Abnormal Clonal Pop Direct Probe Igh@ Variable Region Somatic Mutation Analysis Igk@ Gene Rearrange Detect Abnormal Clonal Pop Comparative Anal Str Markers Patient&comp Spec Comparative Anal Str Markers Ea Addl Specimen Chimerism W/Comp To Baseline W/O Cell Selection Chimerism W/Comp To Baseline W/Cell Selection Ea Jak2 Gene Analysis P.Val617phe Variant Kras Gene Analysis Variants In Codons 12 And 13 Long Qt Syndrome Full Sequence Analysis Long Qt Syndrome Anal Known Familial Sequence Long Qt Syndrome Gene Anal Dup/Del Variants Mcoln1 Mucolipin1 Gene Analysis Common Variants Mthfr Gene Analysis Common Variants Mlh1 Gene Analysis Full Sequence Analysis Mlh1 Gene Analysis Known Familial Variants Mlh1 Gene Analysis Duplication/Deletion Variants Msh2 Gene Analysis Full Sequence Analysis Msh2 Gene Analysis Known Familial Variants Msh2 Gene Analysis Duplication/Deletion Variants Msh6 Gene Analysis Full Sequence Analysis Msh6 Gene Analysis Known Familial Variants Msh6 Gene Analysis Duplication/Deletion Varia Microsatellite Instab Anal Mismatch Repair Def Mecp2 Gene Analysis Full Sequence Mecp2 Gene Analysis Known Familial Variant Mecp2 Gene Analysis Duplication/Deletion Variant Npm1 Nucleophosmin Gene Anal Exon 12 Variants Pml/Raralpha Common Breakpoints Qual/Quant Pml/Raralpha Single Breakpoint Qual/Quan Pms2 Gene Analysis Full Sequence CC32013443

August 1, 2013 81318 81319 81330 81331 81332 81340 81341 81342 81350 81355

Pms2 Gene Analysis Known Familial Variants Pms2 Gene Analysis Duplication/Deletion Variants Smpd1 Gene Analysis Common Variants Nrpn/Ube3a Methylation Analysis Serpina1 Gene Analysis Common Variants Trb@ Rearrangement Anal Amplification Method Trb@ Rearrangement Anal Direct Probe Methodology Trg@ Gene Rearrangement Analysis Ugt1a1 Gene Analysis Common Variants Vkorc1 Gene Analysis Common Variants

G0452

Molecular pathology procedure; physician interpretation and report

S3721 A4233 A4234 A4235 A4236 A4466 A6010 A6011 A6021 A6022 A6023 A6024 A6196 A6197 A6198 A6199 A6206 A6207 A6208 A6209 A6210 A6211 A6217 A6252 A7506 K0605 L7360 L7362 L7364 L7367 A6505 A6506 B4149 B4150 B4152 B4153

Prostate Cancer Antigen 3 (Pca3) Testing Replacement Battery, Alkaline (Other Than J Cell), For Use With Medically Replacement Battery, Alkaline, J Cell, For Use With Medically Necessary Home Replacement Battery, Lithium, For Use With Medically Necessary Home Blood Replacement Battery, Silver Oxide, For Use With Medically Necessary Home Blood Garment, Belt, Sleeve Or Other Covering, Elastic Or Similar Stretchable Collagen Based Wound Filler, Dry Form, Sterile, Per G Of Collagen Collagen Based Wound Filler, Gel/Paste, Per G Of Collagen Collagen Dressing Sterile Pad Size 16 Sq. In. Or Less, Each Collagen Dressing, Sterile Pad Size More Than 16 Sq. In.Less Or Equal 48 Collagen Dressing:sterile Pad Size More Than 48 Sq. In., Each Collagen Dressing Wound Filler,sterile Per 6 Inches Alginate Or Othr Fiber Gelling Dress,wound Cover,sterile Pad Size 16in Or Less Alginate Or Othr Fiber Gelling Dress,wound Cover, Sterilepad Size 16 Sq In Alginate Or Othr Fiber Gelling Dressing,wound Cover,sterilemore Than 48 Sq In Alginate Or Other Fiber Gelling Dressing,wound Filler,sterile Per 6 In Contact Layer, Sterile 16 Sqin Or Less, Each Contact Layer, Sterile More Than 16 Sqin But Less Than Or Equl To 48 Sqin, Each Contact Layer, Sterile None Than 48 Sq Inches, Each Dressing Foam Dress,wound Cover, Sterile Pad Size 16 Sq In Less W/O Adhesive Border,ea Foam Dress,sterile More Than 16 Sqin/Less Or Equal To 48 Sqin, W/O Adhesive Ea Foam Dressing,wound Cover,sterile More Than 48 Sq In W/O Adhesive Border Gauze, Nonimpreg/Nonster, More Than 16 Sqin/Less Than Or Equal To 48 Sqin Special Absorptive Dress, Sterile Over 16 Sqin Up To/Equl 48 Sqin, W/O Adhes Adhesive Disc For Use In A Heat And Moisture Exchange System And/Or With Replacement Battery For External Infusion Pump, Lithium, 4.5 Volt Each Six Volt Battery, Each Battery Charger, Six Volt Each Twelve Volt Battery, Each Lithium Ion Battery, Replacement Compression Burn Garment, Glove To Elbow, Custom Fabricat Comprssion Burn Garment, Glove To Axilla, Custom Fabricat Enteral Formula, Blenderized Natural Foods With Intact Nutrients Enteral Formula, Blenderized Natural Foods With Intact Nutrients,thru Feed Tube Enteral Formula,nutritionally Complete,calorically Dense,with Intact Nutrients Enteral Formula, Nutritionally Complete, Hydrolyzed Proteins CC32013443

August 1, 2013 B4154 B4155 B4157 B4158 B4159 B4160 B4161 B4162 C9366 J7310 J7311 L8514 L8600 L8603 L8606 L8609 L8610 L8612 L8613 Q4118 Q4119 Q4120

Enteral Formula,nutritionally Complete,for Special Metabolic Needs Enteral Formula,nutritionally Incomplete/Mod Nutrients,includes Spec Nutrients Enteral Formula, Nutritionally Complete, For Special Metabolic Needs Enteral Formula For Pediatrics Nutritionally Complete With Intact Nutrients Enteral Formula,for Peds,nutritionally Complete Soy Based W/Intact Nutrients Enteral Formula,for Peds,nutritionally Complete Caloricall Dense W/Intact Nutr Enteral Formula, For Pediatrics, Hydrolyzed/Amino Acids And Peptide Enteral Formula,for Peds,special Metabolic Needs For Inherited Disease Of Metab Epifix, Per Square Centimeter Ganciclovir, 4.5 Mg, Long Acting Implant Fluocinolone Acetonide, Intravitreal Implant Tracheoesophageal Puncture Dilator, Replacement Only, Each Implantable Breast Prosthesis,silicone Or Equal Injectable Bulking Agent,collagen Implant,urinary Tract,2.5ml Syringe Injectable Bulking Agent, Synthetic Implant, Urinary Tract, 1 Ml Syringe, Artificial Cornea Ocular Implant Aqueous Shunt Ossicular Implant Matristem Micromatrix, 1 Mg Matristem Wound Matrix, Per Square Centimeter Matristem Burn Matrix, Per Square Centimeter

Q4131 Q4134 Q4135 Q4136

Epifix, per square centimeter Hmatrix, per square centimeter Mediskin, per square centimeter Ez-derm, per square centimeter

S0189 93464 95250 95251 96125 96920 96921 96922 98966 99183 C1300 G0248 G0250 G0409

Testosterone Pellet 75 Mg Physiologic Exercise Study & Hemodynamic Measure Before And After Ambulatory Continuous Glucose Monitoring Min,.72 Hrs Ambulatory Continuous Glucose Monitoring Min,.72 Hrs W/ I&r Standardized Cognitive Performance Testing Per Hour Laser Treatment For Inflam Skin Disease Less Than 250 Sq Cm Laser Treatment For Inflammatory Skin Disease Psoriasis 250 To 500 Sq Cm Laser Treat Ment Inflammatory Skin Disease Psoriasis Over 500 Sq Cm Nonphysician Telephone Assessment 5-10 Min Physician Attendance And Supervision Of Hyberbaric Oxygen Therapy, Per Session Hyperbaric Oxygen Under Pressure, Full Body Chamber, Per 30 Minute Interval Demo Initial, Home Inr Monitor Pt W/Mech Heart Or Venous Thromboembol W/Face Phys Rev Interp W/Pt Mgmt Home Inr Testing Or Venous Thromboembo-No Freq.Test Corf Related Service 15 Min. Each

J7315

Mitomycin, opthalmic, 0. 2 mg

M0075 M0076 S9988 S9989 S9990 L8604

Cellular Therapy Prolotherapy Services Provided As Part Of A Phase 1 Clinical Trial Services Outside Us Services Provided As Part Of A Phase Ii Clinical Trial Dextranomer/Hyaluronic Acid CC32013443

August 1, 2013 Q4100 Q4101 Q4102 Q4103 Q4104 Q4105 Q4106 Q4108 Q4110 Q4111 Q4112 Q4114 Q4115 Q4116 Q4122 Q4123 Q4125 Q4126 Q4127 Q4128 Q4129 96101 96102 96103 96116 96118 96119 96120 83890 83891 83892 83893 83894 83896 83897 83898 83900 83901 83902 83903 83904 83905 83906 83907 83908 83909 83912

Skin Substitute, Not Otherwise Specified Apligraf, Per Sq Cm Oasis Wound Matrix, Per Sq Cm Oasis Burn Matrix, Per Sq Cm Integra Bilayer Matrix Wound Dressing (Bmwd), Per Sq Cm Integra Dermal Regeneration Template (Drt), Per Sq Cm Dermagraft, Per Sq Cm Integra Matrix, Per Sq Cm Primatrix, Per Sq Cm Gammagraft, Per Sq Cm Cymetra, Injectable, 1 Cc Integra Flowable Wound Matrix, Injectable, 1cc Alloskin, Per Sq Cm Alloderm, Per Sq Cm Dermacell, Per Square Centimeter Alloskin Rt, Per Square Centimeter Arthroflex, Per Square Centimeter Memoderm, Per Square Centimeter Talymed, Per Square Centimeter Flexhd Or Allopatch Hd, Per Square Centimeter Unite Biomatrix, Per Square Centimeter Psycho Testing Per Hr Both Face To Face And Time Intrept Test And Report Psycho Testing W Qualif Pro Interprt Admin By Tech Per Hour Psycho Testing Admin By Computer W Healthcare Pro Intrept And Report Neurobehavioral Status Exam Per Hr W Intrept And Report Neuropsychological Testing Per Hour W Intrept And Report Neuropsychological Testing With Hc Pro Intrept And Report Neuropsychological Test Admin By Computer With Hc Pro Intrept And Report Molecular Diag, Molecular Isolate Or Extract Each Nucleic Acid Type Molecular Diag - Isolate Or Extract Of Highly Purified Nucleic Acid, Ea. Molecular Diag-Enzymatic Digestion, Each Treatment Molecular Diag - Dot/Slot Blot Production Each Nucleic Acid Prep Molecular Diagnostics, Separation By Gel Electrophoresis Molecular Diagnostics, Nucleic Acid Probe, Each Molecular Diag - Nucleic Acid Transfer Each Nucleic Acid Prep Molecular Diagnostics, Amplification Target Ea.Nucleic Acid Sequence Molecular Diagnostics, Amplification Target Multiplex 1st 2 Acid Sequences Molecular Diagnostics, Amplification Target Multiplex Ea.Add Seq Beyond 2 Molecular Diag, Reverse Transcription Molec Diag - Mutation Scanning, By Physical Properties, Single Each Molec Diag - Mutation Id By Sequencing, Single, Each Molec Diags - Mutation Id By Allele Specific Transcription, Single,each Molec Diag - Mutation Id By Allele Specific Translation,single,each Molecular Diag-Lysis Of Cells Prior Acid Extraction Each Specimen Molecular Diagnostics, Amplification Signal Each Nucleic Acid Sequence Molecular Diag-Separate And Id High Resolution Tech, Each Acid Prep Molecular Diag, Interpretation And Report CC32013443

August 1, 2013 83913 83914 88230 88233 88235 88237 88239 88240 88241 88245 88248 88249 88271 88272 88273 88274 88275 88280 88283 88285 88289 88291 88299 S3833 S3834 S3840 S3842 S3844 S3845 S3852 S3853 S3854 S3855 S3861 S3865 S3866 S3870 70336 70540 70542 70543 70544 70545 70546 70547 70548 70549

Molecular Diagnostics, Rna Stabilization Mutation Id Enzymatic Ligation Or Primer Ext, Single Segment/Base Tissue Culture Non-Neoplastic Disorders, Lymphocyte Tissue Culture Non-Neoplastic Disorders,skin Or Other Solid Tissue Biopsy Tissue Culture Non-Neoplastic Disorders,amniotic Or Villus Cells Tissue Culture Neoplastic Disorders,bone Marrow,blood Cells Tissue Culture Neoplastic Disorders, Solid Tumor Cryopreservation,freezing Storage Of Cells,each Cell Line Thawing And Expansion Of Frozen Cells, Each Aliquot Chromosome Analysis For Breakage Syndromes Baseline Sce 20-25 Cells Chromosome Analy Breakage Syndromes 50-100 Cells,count 20 Cells 2 Karyotypes Chromosome Analysis For Breakage Syndromes - Score 100 Cells,clastogen Stres Molecular Cytogenics - Dna Probe, Each Molecular Cytogenics - 3-5 Cells, Chromosomal In Situ Hybridization Molecular Cytogenics 10-30 Cells, Chromosomal In Situ Hybridization Molecular Cytogenics 25-99 Cells,interphase In Situ Sybridizatioin Molecular Cytogenics 100-300 Cells, Interphase In Situ Hybridization Chromosome Analysis,addl Karyotypes,ea.Study Chromosome Analysis Additional Specialized Banding Technique Chromosome Analysis, Addl Cells Count,ea Study Chromosome Analysis,addl High Resolution Study Cytogenetic & Molecular Cytogenetics, Interp And Report Unlisted Cytogenetic Study Complete Apc Gene Sequence Analysis For Adenomatous Polyposis & Atten Fap Single-Mutation Analy For Suscept To Familial Adenomatous Polyposis-Fap Dna Analysis For Germline Mutations Of The Ret Proto-Oncogene For Suscepti Genetic Testing For Von Hippel-Landau Disease Dna Analy Of The Connexin 26 Gene-Gjb2 For Suscept To Congenital,profound Deaf Genetic Testing For Alpha-Thalssemia Dna Analysis For Apoe Epsilon 4 Allele For Suscept To Alzheimer's Disease Genetic Testing For Myotonic Muscular Dystrophy Gene Expression Profiling Panel For Use In The Management Of Breast Cancer Genetic Testing For Detection Of Mutations In The Presenilin - 1 Gene Genetic Testing Brugada Syndrome Comprehensive Gene Sequence Analysis For Hypertrophic Cardiomyopathy Specific Gene Analysis For Indiv W/Known Hcm Mutation In The Family Cgh Test Developmental Delay Mri Temporomandibular Joint Magnetic Resonance Imaging, Orbit,face And/Or Neck W/O Contrast Matls Magnetic Resonance Imaging Orbit, Face And Neck W Contrast Material Magnetic Resonance Imaging Face, Orbit And Neck W/O Contrast Material Magnetic Resonance Angiography, Head W/O Contrast Magnetic Resonance Angiography Head W Contrast Magnetic Resonance Angiography - Head W/O Contrast Further Sequence Magnetic Resonance Angiography-Neck W/O Contrast Magnetic Resonance Angiography Neck W Contrast Magnetic Resonance Angiography Neck W/O Contrast Further Sequences CC32013443

August 1, 2013 70551 70552 70553 70554 70555 70557 70558 70559 71550 71551 71552 71555 72141 72142 72146 72147 72148 72149 72156 72157 72158 72159 72195 72196 72197 72198 73218 73219 73220 73221 73222 73223 73225 73718 73719 73720 73721 73722 73723 73725 74181 74182 74183 74185 75557 75559 75561

Mri Brain W/O Contrast Mri Brain W/Contrast Mri Brain W/O Contrast Foll By Contrast/Sequences Mri Brain Functional W/O Physician Admnistration Mri Brain Functional W/Physician Admnistration Mribrain During Intracranial Proced Wo Contrast Matl Mri Brain During Intracranial Proced W Contrast Matls Mri Brain During Intracran Proc Wo Contrst Matls Then W Contrst Matls Furt Mri Chest W/O Contrast Mri Chest W/Contrast Materials Mri Chest W/O Contrast And Further Seq Mra Chest Exc.Myocardium W Or W/O Contrast Mri Spinal Canal Cervical W/O Contrast Mri Spinal Canal Cervical With Contrast Mri Spinal Canal Thoracic W/O Contrast Mri Spinal Canal Thoracic With Contrast Mri Spinal Canal Lumbar W/O Contrast Mri Spinal Canal Lumbar With Contrast Mri Spinal Canal W/O Contrast Follow By Contrast/Further Seq, Cervical Mri Spinal Canal W/O Contrast Follow By Contrast/Further Seq,thoracic Mri Spinal Canal W/O Contrast Follow By Contrast/Further Seq,lumbar Mra, Spinal Canal And Contents W Or W/O Contrast Magnetic Resonance Imaging Pelvis W/O Contrast Magnetic Resonance Imaging, Pelvis With Contrast Materials Magnetic Resonance Imaging Pelvis W/O Contrast Further Sequences Mra Pelvis W Or W/O Contrast Magnetic Resonance Imaging Upper Extremities W/O Contrast Magnetic Resonance Imaging-Upper Extremities W/ Contrast Mri W/O Contrast Follow W/Contrast Mri Any Joint Upper Extremity W/O Contrast Magnetic Resonance Imaging Any Joint Upper Extremity W Contrast Magnetic Resonacne Imaging Any Joint Upr Extremity W/O Contrast Further Seq Mra Upper Extremity W Or W/O Contrast Mri Lower Extrem Other Than Joint W/O Contrast Mri Lower Extrem Other Than Joint W/Contrast Mri Lower Extrem Other Than Joint W/O Contrast Follow By Contrast Mri Any Joint Lower Extremity W/O Contrast Mri Any Joint Lower Extremity W/Contrast Mri Any Jnt Low Extrem W/O Contrast Follow By Contrast And Further Sequence Mra Lower Extremity W Or W/O Contrast Materials Mri Abdomen W/O Contrast Mri Abdomen With Contrast Mri Abdomen W/O Contrast Mat Followed By W/Contrast Mat And Further Seq Mra Abdomen W Or W/O Contrast Matl Cardiac Mri Morphology & Function W/O Contrast Cardiac Mri W/O Contrast With Stress Imaging Cardiac Mri W/W/O Contrast & Further Sequences CC32013443

August 1, 2013 75563 76390 76498 77021 77022 77058 77059 77084 C8900 C8901 C8902 C8903 C8904 C8905 C8906 C8907 C8908 C8909 C8910 C8911 C8912 C8913 C8914 C8918 C8919 C8920 72292 75635 78320 78445 78451 78452 78453 78454 78466 78468 78469 78472 78473 78481 78483 78494 78496 78499 78607 78647 78710

Cardiac Mri W/W/O Contrast With Stress Imaging Mr Spectroscopy Unlisted Magnetic Resonance Procedure Diagnostic Interventional Mr Guidance Needle Placement Mr Guidance & Monitor Parenchymal Tissue Ablation Mri Breast Unilateral Mri Breast Bilateral Mri Bone Marrow Blood Supply Magnetic Resonance Angio Graphy With Contrast, Abdomen Magnetic Resonance Angiography W/O Contrast, Abdomen Magnetic Resonance Angiography W/O Contrast Followed By W/Contrast,abdomen Magnetic Resonance Imaging With Contrast, Breast, Unilateral Magnet Resonance Imaging Without Contrast, Breast, Unilateral Magnetic Resonance Imaging W/O Cont Followed By W/Contrast,breast,unilateral Mri With Contrast, Breast: Bilateral Mri Without Contrast, Breast: Bilateral Mri W/O Contrast Followed By With Contrast, Breast: Bilateral Mra With Contrast, Chest (Excluding Myocardium) Mra W/O Contrast, Chest (Excluding Myocardium) Mra, W/O Contrast Followed By With Contrast,chest (Excluding Myocardium) Mra W/Contrast, Lower Extremity Mra W/O Contrast, Lower Extremity Mra W/O Contrast Followed By With Contrast, Lower Extremity Mra W Contrast Pelvis Mra W O Contrast Pelvis Mra W/O Contrast Followed By With Contrast, Pelvis Rad S&i Perq Vertebroplasty Per Vertebral Body Or Sacral Fluor Ct Guide Ct Angiography Abdominal Aorta And Bilateral Iliofemoral Lwr Extrem Runoff Nuclear,diag, Bone/Joint, Tomographic (Spect) Nuclear,diag, Non-Cardiac Vascular Flow Imaging Nuclear,diag,myocardial Spect Single Study At Rest Or Stress Nuclear,diag,myocardial Spect Multiple Studies Nuclear,diag,myocardial Perfusion Planar 1 Study Rest/Stress Nuclear,diag,myocardial Perfusion Planar Multiple Studies Nuclear,diag, Myocardial, Infarct/Planar Nuclear,diag, W/Ejection Fraction By 1st Pass Nuclear,diag, Spect W Or W/O Quantification Nuclear,diag, Cardiac Blood Pool, Single Nuclear,diag, Cardiac Blood Pool, Multiple Nuclear,diag,cardiac Blood Pool Image,first Pass, Single Nuclear,diag,cardiac Blood Pool Image, First Pass Tech Multiple Nuclear,diag,cardiac Blood Pool Image At Rest,wall Motion Nuclear,diag,cardiac Blood Pool 1st Pass Tech Nuclear, Diag, Unlisted Cardiovasc Procedure Nuclear, Diag, Brain Image, Tomographic (Spect) Nuclear, Diag, Cerebral, Spect Nuclear,diag,kidney Image Morphology, Tomographic CC32013443

August 1, 2013 78807 0159T S8035 S8037 S8042 S8092 90911 38204 38205 38206 38207 38208 38209 38210 38211 38212 38213 38214 38215 G0341 G0342 G0343 J0480 J2562 S2053 S2054 S2055 S2060 S2061 S2065 S2102 S2103 S2140 S2142 S2150 S2152 S9975 A4611 A4612 A4613 E0424 E0430 E0431 E0433 E0434 E0435 E0439

Nuclear, Diag, Inflammatory, Spect Computer Breast Mri For Lesion Detect Add-On Magnetic Source Imaging Magnetic Resonance Cholanglopancreatography (Mrcp) Magnetic Resonance Imaging (Mri) Low-Field Electron Beam Computed Tomography Biofeedback Train, Perineal, Anorectal Or Sphincter W/Emg Or Manometry Managmnt Of Recipient Hematopoietic Progenitor Cell Donor Search Blood Derived Hematopoietic Progenitor Cell Harvesting For Transplant Blood Derived Hematop Progenitor Cell Harvesting For Transplant Transplant Prep Hematopoietic Progenitor Cells Cyropreserve And Storage Transplant Prep Hematopoietic Progenitor Cells Thawing W/O Washing Per Donor Transplant Prep Hematopoietic Progenitor Cells Thawing W/Washing Per Donor Transplant Prep Hemat Progen Cells Spec Cell Deplet Win Harv Cell Depl Transplant Prepar Hematopoietic Progenitor Cells Tumor Cell Depletion Transplnt Preparation Hematopoietic Progenitor Cells Red Blood Remov Transplant Prep Of Hematopoietic Progenitor Cells Platelet Depletion Transplnt Prep Hematopoietic Progenitor Cells Plasma Volume Depletion Transplant Preparation Hematopoietic Progenitor Cells Cell Conc Percutaneous Islet Cell Transplant Inc Portal Vein Cath And Infus Laparoscopy For Islet Cell Transplant Inc Portal Vein Cath And Infus Laparotomy For Islet Cell Transplant Inc Portal Vein Cath And Infus Injection, Basiliximab, 20 Mg Injection, Plerixafor, 1 Mg Transplantation Of Small Intestine,and Liver Allografts Transplantation Of Multivisceral Organs Harvesting Of Donor Multivisceral Organs W/Prep,main Of Allografts Cadaver Lobar Lung Transplantation Donor Lobectomy (Lung) For Transplantation, Living Donor Simultaneous Pancreas Kidney Transplantation Islet Cell Tissue Transplant For Pancreas-Allogeneic Adrenal Tissue Transplant To Brain Cord Blood Harvesting For Transplantation, Allogeneic Cord Blood-Derived Stem-Cell Transplantation, Allogeneic Bone Marrow Or Blood-Derived Stem Cells,allogeneic/Autologous,harvesting Solid Organ,complete/Segmental,single-Combo Of Organs,deceased/Living Donor Transplant Related Lodging Meals And Transport Per Diem Battery,heavyduty, Replacement For Patient-Owned Ventilator Battery Cables, Replacement For Patient-Owned Ventilator Battery Charger, Replacement For Patient-Owned Ventilator Stationary Compressed Gaseous Oxygen System,rental(Cont,content,regul,flowmtr) Portable Gaseous Oxygen System,purchase(Regul,flowmtr Humidifier,etc) Portable Gaseous Oxygen System,rental( Prot Container, Rug, Flowmtr Etc) Portable Liquid Oxygen System, Rental Home Liquefier Used To Fill Portable Portable Liquid Oxygen System,rental,(Port Cont,supply Reservoir,flowmtr Etc) Portable Liquid Oxygen System,purchase,(Port Contr,supply Resv,flowmtr,etc) Stationary Liquid Oxygen System,rental,(Container,contents,regulator,etc) CC32013443

August 1, 2013 E0440 E0441 E0442 E0443 E0444 E0445 E0446 E0450 E0455 E1390 E1391 E1392 E1399 E1405 E1406 K0738 K0739 78459 78491 78492 78608 78609 78811 78812 78813 78814 78815 78816 G0219 G0235 97005 97006 97010 97012 97014 97016 97018 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039

Stationary Liquid Oxygen System,purchase,contents Indic,regulator,flowmtr Etc Stationary Oxygen Contents, Gaseous, 1 Month's Supply=1 Unit Stationary Oxygen Contents, Liquid, 1 Months Supply= 1 Unit Portable Oxygen Contents, Gaseous , 1 Months Supply= 1 Unit Portable Oxygen Contents, Liquid, 1 Months Supply= 1 Unit Oximeter Device For Measuring Blood Oxygen Levels Non-Invasively Topical Oxygen Delivery System, Not Otherwise Specified, Includes All Supplies Volume Control Ventilator,w/O Pressure Support Mode,include Pressure Control Oxygen Tent, Excluding Croup Or Pediatric Tents Oxygen Concentrator,single Dely.Post 85%/Grt 02 Concentration Oxygen Concentrator,dual Delivery Port,85%-Greater O2 Concentration Portable Oxygen Concentrator, Rental Durable Medical Equipment, Misc Oxygen And Water Vapor Enriching System With Heated Delivery Oxygen And Water Vapor Enriching System Without Heated Delivery Port Gas Oxyg Sys,rent,home,compress,reg,flow,humid,cannula,mask Repair/Svc Dme Non-Oxygen Eq Per 15 Minutes Nuclear Scan Myocardial, Pet Eval Nuclear, Diag, Pet Scan Single Study At Rest Or Stress Nuclear,diag, Pet Scan Multiple Studies At Rest And/Or Stress Nuclear,diag, Brain (Pet) Metabolic Eval Nuclear, Diag. Brain, Perfusion Eval Nuclear, Diag, Tumor Imaging Pet Limited Area Nuclear, Diag, Tumor Imaging Pet, Skull Base To Mid-Thigh Nuclear, Diag, Pet Tumor Imaging, Whole Body Nuclear, Diag Pet W/Acq Ct For Attenuation Correct/Imaging, Limited Area Nuclear, Diag Pet W/Acq Ct Attenuation Correct/Imaging,skull Base To Mid Thigh Nuclear, Diag Pet W/Acq Ct For Attenuation Correct And Imaging, Whole Body Pet Imaging Whole Body Melanoma For Non Covered Indications Pet Imaging, Any Site, Not Otherwise Specified Athletic Training Evaluation Athletic Training Re-Evaluation Hot/Cold Packs Treatment Mechanical Traction Therapy Electric Stimulation Therapy Vasopneumatic Device Therapy Paraffin Bath Therapy Whirlpool Therapy Application Modality To One Or More Areas: Diathermy Infrared Therapy Ultraviolet Therapy Electrical Stimulation, 1 Or More Areas Electrical Stimulation, Iontophoresis, Each 15 Minutes Application Of Modality, Contrast Baths, Ea. 15 Minutes Application Of Modality, Ultrasound, Ea. 15 Minutes Application Of Modality, Hubbard Tank, Ea. 15 Minutes Unlisted Modality For Pt CC32013443

August 1, 2013 97110 97112 97113 97116 97124 97139 97140 97150 97530 97532 97533 97535 97542 97545 97546 97605 97606 97750 97755 97760 97761 97762 97799 97802 97803 97804 G0129 G0151 G0152 G0157 G0158 G0159 G0160 G0282 G0283 G0295 G0329 S9476 J2793 J7525

Therap Proc Ea.15 Min, For Strength, Range, Flex Therap Proc Ea.15 Min, Neuromuscular Reeducation Therapeutic Procedure, Aquatic Therapy W/Exercise Therap Proce Ea.15 Min, Gait Training Massage, Including Efleurage, Pertissage And/Or Tapotement Unlisted Therapeutic Procedure Manual Therapy Tech, One Or More Regions, Each 15 Minutes Therapeutic Procedure, Group (2 Or More Persons) Therap Activities, Direct Ea.15 Min Develop Of Cognitive Skills To Improve Attention Memory Prob Solving Sensory Integration Tech To Enhance Sensory Processing Self-Care/Home Mgmt Training Direct Ea.15 Min Wheelchair Mgmt Each 15 Min Working Hardening/Conditioning Initial 2 Hrs Work Hardening,each Add'l Negative Pressure Wound Therapy Vacuum Assist Drainage Collection Negative Pressure Wound Therapy (Vacuum Assisted Drainage Collect Physical Performance/Measurement W/Written Report,each 15 Min Assis Tive Technology Assessment Direct Contact W Report Ea 15 Min Ortho Mangmt And Training Of Lower Extremities And Or Trunk Ea 15 Min Prosthetic Training Upper Or Lower Extremities Each 15 Min Checkout For Orthotic Prosthetic Use Est Patient Each 15 Min Unlisted Physical Med/Rehab Serv/Proc Medical Nutrition Therapy Inital Assessment And Intervention Med Nutrition Therapy Re Assessment And Intervention Indiv Medical Nutrition Therap Group 30 Mins Ot Require Skills Of Qualified Ot As Part Of Partial Hospital 45 Min Or More Services Performed By Pt In Home Health/Hospice Setting, Each 15 Minutes Services Performed By Ot In Home Health/Hospice Setting, Each 15 Minutes Services Performed By A Qualified Physical Therapist Assistant In The Home , Services Performed By A Qualified Occupational Therapist Assistant In The Home Services Performed By A Qualified Physical Therapist, In The Home Health Services Performed By A Qualified Occupational Therapist, In The Home Health Electrical Stimulation,to 1/More Areas,for Wound Care Other Than G0281 Electrical Stimulation,1 Or More Areas For Indication Other Than Wound C Care Electromagnetic Therapy,to One/More Areas,for Wound Care Other Than G0329 Electromagnetic Therapy, To One-More Areas For Chronic Stage Iii And Stage Iv Vestibular Rehabilitation Program Non Physician Provider Per Diem Injection, Rilonacept, 1 Mg Tacrolimus, Parenteral, 5 Mg

J7527

Everolimus, oral, 0. 25 mg

J7686 J8561 J8562 J8705 S0145 S0148

Treprostinil, Inhalation Solution, Fda-Approved Final Product, Non-Compounded Everolimus, Oral, 0.25 Mg Fludarabine Phosphate, Oral, 10 Mg Topotecan, Oral, 0.25 Mg Injection Pegylated Interferon Alfa 2a 180 Mcg Per Ml Injection, Pegylated Interferon Alfa-2b, 10 Mcg CC32013443

August 1, 2013 S0156 L5000 L5010 L5020 L5050 L5060 L5100 L5105 L5150 L5160 L5200 L5210 L5220 L5230 L5250 L5270 L5280 L5301 L5321 L5331 L5341 L5400 L5410 L5420 L5430 L5460 L5500 L5505 L5510 L5520 L5530 L5535 L5540 L5560 L5570 L5580 L5585 L5590 L5595 L5600 L5610 L5611 L5613 L5614 L5616 L5617 L5622

Exemestane, 25 Mg Partial Foot,shoe Insert With Longitudinal Arch,toe Filler Partial Foot,molded Socket,ankle Height,with Toe Filler Partial Foot,milded Socket,tibial Tubercle Height,with Toe Filler Ankle, Symes, Mold Socket, Sach Foo Ankle,symes,metal Frame,molded Leather Socket,articulated Ankle/Foot Below Knee,molded Socket,shin,sach Foot Below Knee,plastic Socket,joints And Thigh Lacer,sach Foot Knee Disarticulation,molded Socket,external Knee Joints,shin,sach Foot Knee Disarticulation,molded Socket,bent Knee Configuration,ext Knee Joints Above Knee,molded Socket,single Axis Constant Friction Knee,shin,sach Ft Above Knee,short Prostheses,no Knee Joint,w Foot Blocks,no Ankle Joints Above Knee,short Prosthesis,no Knee Joint,w Articulated Ankle/Foot,ea Above Knee,for Proximal Femoral Focal Deficiency,constant Friction Knee Hip Disarticulation,canadian Type,molded Socket,hip Joint,single Axis Cons Hip Disarticulation,tilt Table Type,molded Socket,lock Hip Joint Single Axis Hemipelvectomy,canadian Type,molded Socket,hip Joint,single Axis Constant Below Knee, Molded Socket, Shin, Sach Foot, Endoskeletal System Above Knee,molded Socket,open End,sach Foot,endoskeletal System,single Axs Hip Disarticulation,canadian Type,molded Socket,endoskeletal Sys,hip Joint Hemipelvectomy,canadian Type,molded Socket,endoskeletal System,hip Joint Immed Post Surg/Early Fitting,application,initial Rigid Dressing,1 Cast Chg Immediate Post Surg/Early Fit,application Rigid Dressing,additional Cast Chg Ipsf Above Knee Ipsf Above Knee Cast Change Immediate Postsurg/Early Fitting,application Nonweight Bearing Rigid Dres Initial,below Knee Ptb Type Socket,non-Alignable System,pylon,no Cover,sach Initial,above Knee-Kneedisarticulation,ischial Level Socket,non-Alignable Preparatory,below Knee Ptb Type Socket,nonalignable System,pylon,no Cover Preparatory,below Knee Ptb Type Socket,non-Alignable System,pylon,no Covr Preparatory,below Knee Ptb Type Socket,termoplastic Or Equal,mold To Model Preparatory, Below Knee Ptb Type Socket, Prefabricated, Open End Socket Preparatory,below Knee Ptb Type Socket,laminated Socket,molded To Model Preparatory,above Knee-Knee Disarticulation,plaster Socket,molded To Model Preparatory,above Knee-Knee Disarticulation,thermoplastic/Equal,direct Form Preparatory,above Knee-Knee Disartiuclation,thermoplastic/Equal,molded To Model Preparatory,above Knee-Knee Disarticulation,prefab Adj Open End Socket Preparatory,above Knee,knee Disarticulation,laminated Socket,molded To Model Preparatory,hip Disarticulation-Hemipelvectomy,thermoplastic/Equal,molded Preparatory,hip Disarticulation-Hemipelvectormy,laminated Socked,molded Addition To Lower Extremity,endoskel System,above Knee,hydracadence Addition To Lower Extrem,endoskel Syst,above Knee,4 Bar Linkage W/Frc Swing Addition To Lwr Extrm,endoskeltal Syst,above Knee,w/Hydraulic Swing Phase Addition Lwr Ext,endoskeletal Sys,above Knee,pneumatic Swing Phase Control Addition Lwr Ext,endoskeletal Sys,above Knee,universal Multiplex System Addition Lwr Ext,quick Chg Self-Aligning Unit,above/Below Knee,ea Addition To Lower Extremity,test Socket,knee Disarticulation CC32013443

August 1, 2013 L5626 L5628 L5630 L5631 L5638 L5639 L5640 L5642 L5643 L5644 L5645 L5646 L5647 L5648 L5649 L5650 L5651 L5652 L5653 L5661 L5665 L5671 L5673 L5677 L5679 L5681 L5682 L5683 L5700 L5701 L5702 L5704 L5705 L5706 L5707 L5711 L5712 L5714 L5716 L5718 L5722 L5724 L5726 L5728 L5780 L5781 L5782

Addition To Lower Extremity,test Socket,hip Disarticulation Addition To Lower Extremity,test Socket,hemipelvectomy Addition To Lower Extremity,symes Type,expandable Wall Socket Addition To Lower Ext,above Knee/Knee Disarticulation,acrylic Socket Addition To Lower Extremity,below Knee,leather Socket Addition To Lower Extremity,below Knee,wood Socket Addition To Lower Extremity,knee Disarticulation,leather Socket Addition To Lower Extremity,above Knee,leather Socket Addition To Lower Ext,hip Disarticulation,flexible Inner Socket,ext Frame Addition To Lower Extremity,above Knee,wood Socket Addition To Lower Ext,below Knee,flexible,inner Socket,external Frame Addition To Lower Ext,below Knee,air,fluid,gel,or Equal,cushion Socket Addition To Lower Extremity,below Knee,suction Socket Addition To Lower Ext,above Knee,air,fluid,gel,or Equal,cushion Socket Addition To Lower Extremity,ischial Containment/Narrow M-L Socket Addition To Lower Ext,total Contact,above Knee/Knee Disarticulation Socket Addition To Lower Extremity,above Knee,flexible Inner Socket,ext Frame Addition To Lower Ext,suction Suspension,above Knee/Knee Disarticulation Socket Addition To Lower Extremity,knee Disarticulation,expandable Wall Socket Addition To Lower Extremity,socket Insert,multidurometer,symes Addition To Lower Extremity,socket Insert,multidurometer,below Knee Addition To Lower Ext,below Knee/Above Knee Suspension Locking Mechanism Addition To Lower Ext,below/Above Knee,custom Fab From Existing Mold Or Pr Addition To Lower Extremity,below Knee,knee Joints,polycentric,pair Addition To Lower Ext,below/Above Knee,custom Fab,not For Use With Lock Mech Addition To Lower Ext,below/Above Knee,custom Fab Socket Insert,w/Wo Lock Addition To Lower Extremity,below Knee,thigh Lacer,gluteal/Ischial,molded Addition To Lower Ext,below/Above Knee,custom Fab Socket Insert Not Gongen Replacement,socket,below Knee,molded To Patient Model Replacement,socket,above Knee/Knee Disarticulation,include Attachmnt Plate Replacement,socket,hip Disarticulation,include Hip Jnt,molded To Pt Model Custom Shaped Protective Cover,below Knee Custom Shaped Protective Cover,above Knee Custom Shaped Protective Cover,knee Disarticulation Custom Shaped Protective Cover,hip Disartculation Addition,exoskeletal Knee-Shin System,single Axis Manual Lock,ultra-Light Addition,exoskeletal Knee-Shin System,single Axis,friction Swing/Stance Addition,exoskeletal Knee-Shin System,single Axis,var Friction Swing Phase Addition,exoskeletal Knee-Shin Syste,polycentric,mech Stance Phase Lock Addition,exoskeletal Knee-Shin System,polycentric Friction Swing/Stance Addition,exoskeletal Knee-Shin System,single Axis Pneumatic Swing,friction Addition,exoskeletal Knee-Shin Sys,single Axis,fluid Swing Phase Control Addition,exoskeletal Knee-Shinn System,single Axis Ext Joints,fluid Swing Addition,exoskeletal Knee-Shin System,single Axis,fluid Swing/Stance Phase Addition,exoskeletal Knee-Shin System,single Axis Pneumatic/Hydra Pneumatic Addition To Lower Limb Prosthesis,vacuum Pump,residual Limb Vol Mgmt Addition To Lower Limb Prosthesis,vacuum Pump,resid Limb Vol Mgmt,hvy Duty CC32013443

August 1, 2013 L5785 L5790 L5795 L5810 L5811 L5812 L5814 L5816 L5818 L5822 L5824 L5826 L5828 L5830 L5840 L5845 L5848 L5855 L5856 L5857 L5858 L5920 L5930 L5940 L5950 L5960 L5962 L5964 L5966 L5968 L5973 L5975 L5976 L5979 L5980 L5981 L5982 L5984 L5986 L5987 L5988 L5990 L5999 L6000 L6010 L6020 L6050

Addition,exoskeletal Sys,below Knee,ultra-Light Material Addition,exoskeletal System,above Knee,ultra-Light Material Addition,exoskeletal System,hip Disarticulation,ultra-Light Material Addition,endoskeletal Knee-Shin System,single Axis,manual Lock Addition,endoskeletal Knee-Shin System,single Asix Manual Lock,ultra-Light Addition,endoskeletal Knee-Shin System,single Axis Friction Swing/Stance Add'l Endoskeletal Knee-Shin System,polycentric,hydraulic Swing Phase Cntl Add, Endo Knee-Shin Sys, Mech Stanc Addition,endoskeletal Knee-Shin System,polycentric,friction Swing/Stance Addition,endoskeletal Knee-Shin System,single Axis,pneumatic Swing,frictio Addition,endoskeletal Knee-Shin System,single Axis,fluidswing Phase Contrl Addition,endoskeletal Knee-Shin System,single Axis,hydraulic Swing Phase Addition,endoskeletal Knee-Shin Syst,single Axis,fluid Swing/Stance Phase Cntrl Addition,endoskeletal Knee-Shin System,single Axis,pneumatic/Swing Phase Addition,endoskeletal Knee-Shin System,4-Bar Linkage/Multiaxial,pneumatic Addition,endoskeletal Knee-Shin System,stance Flexion Feature,adjustable Add Endoskeletal Knee-Shin Fluid Ext,dampen W Or Wo Adjust Addition,endoskeletal System,hip Disarticulation,mech Hip Extension Assist Addition To Lower Ext Prosthesis,endoskeletal Knee-Shin Sys,swing/Stance Phase Addition To Lower Ext Prosthesis,endoskeletal Knee-Shin Sys,swing Phase Only Addition To Lower Extremity Prosthesis, Endoskeletal Knee Shin System, Addition,endoskeletal Sys,above Knee/Hip Disarticulation,alignable Sys Addition, Endoskeletal System, High Activity Knee Control Fram Addition,endoskeletal Sys,below Knee,ultralight Material Addition,endoskeletal System,above Knee,ultra-Light Material Addition,endoskeletal System,hip Disarticulation,ultra-Light Material Addition,endoskeletal Sys,below Knee,flexible Protective Outer Surface Cov Addition,endoskeletal Sys,above Knee,flexible Protective Outer Surface Cov Addition,endoskeletal Sys,hip Disarticulation,flex Protective Outer Cover Addition To Lower Limb Prosthesis,multiaxial Ankle W Swing Phase Dorsiflex Endoskeletal Ankle Foot Syst, Microprocessor Control Feature, Dorsiflexion All Low Extremity Prosthesis,combine Single Axis Ankle & Flex Keel Foot All Lower Extremity Prostheses,energy Storing Foot(Seattle Carbon Copy Ii) All Lower Extremity Prosthese,multi-Axial Ankle,dynamic Response Ft,1 Pc All Lower Extremity Prostheses,flex-Foot System All Lwr Extremity Prostheses,flex-Walk System Or Equal All Exoskeletal Lower Extremity Prostheses,axial Rotation Unit All Endoskeletal Lwr Extremity Prosthesis,axial Rotation Unit,w/Wo Ajustbl All Lower Extremity Prostheses,multi-Axial Rotation Unit (Mcp Or Equal) All Lower Extremity Prosthesis,shank Foot System W/Vertical Loading Pylon Addition To Lwr Limb Prosthesis,vertical Shock Reducing Pylon Feature Addition To Lower Extremity Prosthesis, User Adjustable Heel Lower Extremity Prosthesis,not Otherwise Specified Partial Hand,robin-Aids,thumb Remaining(Or Equal) Partial Hand,robin-Aids,little /Ring Finger Remaining(Or Equal) Partial Hand,robin-Aids,no Finger Remaining (Or Equal) Wrist Disarticulation,molded Socket,flexible Elbow Hinges,triceps Pad CC32013443

August 1, 2013 L6055 L6100 L6110 L6120 L6130 L6200 L6205 L6250 L6300 L6310 L6320 L6350 L6360 L6370 L6380 L6382 L6384 L6386 L6388 L6400 L6450 L6500 L6550 L6570 L6580 L6582 L6584 L6586 L6588 L6590 L6600 L6605 L6623 L6624 L6625 L6628 L6638 L6642 L6650 L6655 L6686 L6687 L6688 L6689 L6690 L6692 L6693

Wrist Disarticulation,molded Socket,w Expandable Interface,flex Elbow Hngs... Below Elbow,molded Socket,flexible Elbow Hinge,triceps Pad Below Elbow,molded Socket(Muenster Or Northwestern Suspension Types) Below Elbow,molded Double Wall Split Socket,step-Up Hinges,half Cuff Below Elbow,molded Double Wall Split Socket,activated Locking Hinge Elbow Disarticulation,molded Socket,outside Locking Hinge,forearm Elbow Disarticulation,molded Socket W Expandable Interface,outside Hinges, Above Elbow,molded Double Wall Socket,internal Locking Elbow,forearm Shoulder Disarticulation,molded Socket,shoulder Bulkhead,humeral Section, Shoulder Disarticulation,passive Restoration(Complete Prosthesis) Shoulder Disarticulation,passive Restoration(Shoulder Cap Only) Interscapular Thoracic,molded Socket,shoulder Bulkhead,humeral Section, Interscapular Thoracic,passive Restoration(Complete Prosthesis) Interscapular Thoracic,passive Restoration(Shoulder Cap Only) Immediate Postsurg/Early Fit,application Initial Rigid Dressing,wrist Disart. Immediate Postsurg/Early Fit,application Of Initial Rigid Dressing,above Elbow Immediate Postsurg/Early Fit,application Of Initial Rigid Dressng,shoulder Immediate Postsurgical/Early Fitting,ea Additional Cast Change/Realignmnt Immediate Postsurgical/Early Fitting,application Of Rigid Dressing Only Below Elbow,molded Socket,endoskeletal System,soft Prosthetic Tissue Shape Elbow Disarticulation,molded Socket,endoskeletal System,soft Pros Tissue Above Elbow Endoskeletal Syste Shoulder Disarticulation,molded Socket,endoskeletal System,tissue Shaping Intrascapular Thoracic,molded Socket,endoskeletal Sys,soft Prosth Tissue Preparatory,wrist Disarticulation/Below Elbow,molded To Patient Model Preparatory,wrist Disarticulation/Below Elbow,single Wall Skt,direct Form Preparatory,elbow Disarticulation/Above Elbow,single Wall Skt,molded To Pt Preparatory,elbow Disarticulation/Above Elbow,single Wall Skt,direct Form Preparatory,shoulder Disarticulation/Interscapular Thoracic,molded To Pt Preparatory,shoulder Disarticulation/Interscapular Thoracic,direct Formed Upper Extremity Additions,polycentric Hinge,pair Upper Extremity Additions,single Pivot Hinge,pair Upper Extremity Addition,spring Assist Rotational Wrist Unit/Latch Release Upper Extremity Addition, Flexion/Extension And Rotation Wrist Unit Upper Extremity Addition,rotation Wrist Unit With Cable Lock Upper Extremity Addition,quick Disconnect Hook Adapter,otto Bock Or Equal Upper Extremity Addition To Prosthesis,elec Lock Featrue,w Manual Pwr Arm Upper Extremity Addition,excursion Amplifier,lever Type Upper Extremity Addition,shoulder Universal Joint,each Upper Extremity Addition,standard Control Cable,extra Upper Extremity Addition,suction Socket Upper Extremity Addition,frame Type Socket,below Elbow/Wrist Disarticulat Upper Extremity Addition,frame Type Socket,above Elbow/Elbow Disarticulati Upper Extremity Addition,frame Type Socket,shoulder Disarticulation Upper Extremity Addition,frame Type Socket,interscapular-Thoracic Upper Extremity Addition,silicone Get Insert Or Equal,each Upper Extremity Addl External Locking Elbow, Forearm Counter Balance CC32013443

August 1, 2013 L6694 L6695 L6696 L6697 L6698 L6704 L6707 L6708 L6709 L6711 L6712 L6713 L6714 L6721 L6722 L6805 L6810 L6881 L6882 L6895 L6900 L6905 L6910 L6915 L6920 L6925 L6930 L6935 L6940 L6945 L6950 L6955 L6960 L6965 L6970 L6975 L7007 L7008 L7009 L7040 L7045 L7170 L7180 L7181 L7185 L7186 L7190

Addition To Upper Extremity Prosthesis,below/Above Elbow,use W Locking Mech Addition To Upper Extrem Prosthesis,below/Above Elbow,not For Use W Lock Addition To Upper Extremity Prosthesis,below/Above Elbow,for Congenital Addition To Upper Extremity Prosthesis,below/Above Elbow,other Than Congen Addition To Upper Extremity Prosthesis,below/Above Elbow,lock Mehcanism Terminal Device, Sport/Recreational/Work Attach, Any Material, Any Size Terminal Device,hook, Mech, Voluntary Close, Any Matl/Size,lined/Unlined Terminal Device, Hand, Mech, Voluntary Opening, Any Material, Any Size Terminal Device, Hand, Mech, Voluntary Closing, Any Material, Any Size Ped Term Dev, Hook, Vol Open Ped Term Dev, Hook, Vol Closed Ped Term Dev, Hand, Vol Open Ped Term Dev, Hand, Vol Closed Hookhand, Heavy Duty, Vol Open Hookhand, Heavy Duty, Vol Closed Addition To Terminal Device, Modifier Wrist Unit Addition To Terminal Device, Precision Pinch Device Auto Grasp Feature,add To Upper Limb Electric Prosthetic Terminal Device Microprocessor Control Feature,add To Upper Limb Prosthetic Terminal Device Addition To Upper Extremity Prosthesis,glove For Terminal Device,custom Fab Hand Restoration,partial Hand,w Glove,thumb Or One Finger Remaining Hand Restoration,partial Hand,w Glove,multiple Fingers Remaining Hand Restoration,partial Hand,w Glove,no Fingers Remaining Hand Restoration,replacement Glove For L6910 Wrist Disart,external Power,inner Socket,otto Bock/Equal Switch,cables.. Wrist Disart,external Pwr,self-Suspended Inner Socket,otto Bock/Equal Elec Below Elbow,ext Power,self-Suspended Inner Socket,otto Bock Or Equal Swtch Below Elbow,ext Pwr,self-Suspended Inner Socket,otto Bock/Equal Electrodes Elbow Disart,ext Pwr,molded Inner Socket,forearm,otto Bock/Equal Switch Elbow Disart,ext Pwr,molded Inner Socket,otto Bock Or Equal Electrodes, Above Elbow,ext Pwr,molded Inner Socket,remvble Shell,otto Bock Or Equal Switch Above Elbow,ext Pwr,molded Inner Socket,otto Bock Or Equal Electrodes Shoulder Disarticulation,ext Pwr,molded Inner Socket,otto Bock/Equal Switch Shoulder Disarticulation,ext Pwr,molded Socket,otto Bock/Equal Electrodes Interscapular-Thoracic,ext Pwr,molded Socket,otto Bock Or Equal Switch, Interscapular-Thoracic,ext Pwr,molded Socket,otto Bock Or Equal Electrodes Electric Hand, Switch Or Myoelectric Controlled, Adult Electric Hand, Switch Or Myoelectric, Controlled, Pediatric Electric Hook, Switch Or Myoelectric Controlled, Adult Prehensile Actuator, Switch Controlled Electric Hook,switch Or Myoelectric Controlled, Pediatric Electronic Elbow,hosmer Or Equal,switch Controlled Electronic Elbow,microprocessor Sequential Cntrl Of Elbow/Terminal Device Electronic Elbow,microprocessor Simultaneous Cntrlof Elbow/Terminal Device Electronic Elbow,adolescent,variety Village Or Equal,switch Controlled Electronic Elbow,child Variety Village Or Equal,switch Controlled Electronic Elbow,adolescent,variety Village/Equal,myoelectronically Cntl CC32013443

August 1, 2013 L7191 L7260 L7261 L7401 L7404 L7499 L8035 L8040 L8041 L8042 L8043 L8044 L8045 L8046 L8047 L8048 L8049 L8500 L8614 L8619 V2623 V2627 V2629 77295 77301 77371 77372 77373 77418 77422 77423 77424 77425 77432 77435 77469 77520 77522 77523 77525 77600 77605 77610 77615 77620 0073T G0173

Electronic Elbow,child,variety Villagee/Equal,myoeletronically Controlled Electronic Wrist Rotator,otto Bock Or Equal Electronic Wrist Rotator,for Utah Arm Addition To Upper Extremity Prosthesis, Above Elbow Disarticulation, Ultralight Addition To Upper Extremity Prosthesis, Above Elbow Disarticulation, Acrylic Upper Extremity Prosthesis,nos Custom Breast Prosthesis,post Mastectomy,molded To Patient Model Nasal Prosthesis, Provided By A Non-Physician Midfacial Prosthesis, Provided By A Non-Physician Orbital Prosthesis, Provided By A Non-Physician Upper Facial Prosthesis, Provided By A Non-Physician Hemi-Facial Prosthesis, Provided By A Non-Physician Auricular Prosthesis, Provided By A Non-Physician Partial Facial Prosthesis, Provided By A Non-Physician Nasal Septal Prosthesis, Provided By A Non-Physician Unspecified Maxillofacial Prosthesis,by Report,provided By A Nonphysician Repair/Modification Of Maxillofacial Prosthesis,labor Component,15 Min Incr Artificial Larynx, Any Type Cochlear Device Incl All Internal And External Components Cochlear Implant External Speech Processor And Controller , Replacement Prosthetic Eye Plastic Custom Scleral Cover Shell Prosthetic Eye - Other Type Therapeutic Rad,3-D Reconstruc Intensity Modulated Radiotherapy Plan Rad Tx Delvy, Srs Complete Tx Cranial Lesions Multi-Source Cobalt 60 Bases Rad Tx Delvy, Srs Complete Tx Cranial Lesions Linear Accelerator Bases Stereotactic Body Radiation Delivery Intensity Mod Tx Delvy, Single Or Mult Per Tx Session Hi Energy Neutron Rad Tx Single Tx Using Singl Port Or Parallel Opposed Ports Hi Energy Neutron Rad Tx 1 Or More Isocenters W Block Wedge Or Compensator Intraop Radiaj Tx Deliver Xray Single Tx Session Intraop Radiaj Tx Deliver Electrons Sngl Tx Sess=recycled Stereotactic Rad Tx Mgmt Of Cranial Lesions One Or More Sessions Stereotactic Body Radiation Management Intraoperative Radiation Treatment Management Proton Beam Delivery,simple, W/O Compensation Proton Beam Delivery, Simple, W/Compensation Proton Treatment Delivery, Intermediate Proton Treatment Delivery Complex Hyperthermia, External Generated, Superficial Hyperthermia, External Generated, Deep Hyperthermia, Interstitial Probes 5 Or Less Hyperthermia, Interstitial More Than 5 Probes Hyperthermia Generated By Intracavitary Probes Compensator Based Beam Modul Tx Using 3 Or More High Res Beam Linear Accelerator Based Stereotactic Radiosurgery,complete Course 1 Session CC32013443

August 1, 2013 75565 C8931 C8932 C8933 C8934 C8935 C8936 G0288 S8080 92507 92508 92526 92606 92607 92608 92609 G0153 G0161 V5362 V5363 33140 33141 33254 33255 33256 33265 33266 33930 33935 33940 33945 36468 36470 36471 36475 36476 36478 36479 36513 36514 36516 37204 37650 37660 37700 37718 37722

Cardiac Mri For Velocity Flow Mapping Mra W/Out Contrast Followed By W/Contrast, Spinal Canal & Contents Magnetic Resonance Angiography W/Out Contrast, Spinal Canal & Contents Mra W/Out Contrast Followed By W/ Contrast, Spinal Canal & Contents Magnetic Resonance Angiography With Contrast, Upper Extremity Magnetic Resonance Angiography Without Contrast, Upper Mra W/Out Contrast Followed By W/Contrast, Upper Extremity Reconstruction,computed Tomographic Antiography Of Aorta For Surg Plan Scintimammography (Radioimmunoscintigraphy Of The Breast), Unilateral, Treatment Speech, Language,voice,communication And/Or Auditory Processing-Indiv Treatment Speech, Language,voice,communication And/Or Auditory Process -Group Treat Swallowing Dysfunction And/Or Oral Function For Feeding Therapeutic Service Use Non-Speech-Generate Device Incl Prog/Modification Eval Rx Speech-Generate Augmt/Altern Communicate Dev Face To Face 1st Hr. Eval Rx Speech-Gen Augmt/Alter/Communic Dev Face To Face Ea.Addl 30 Min Therap Serv Use Speech-Gen Device Incl Program/Modification Services Performed By Speech Path In Home Health/Hospice Setting, Ea 15 Mins Services Performed By A Qualified Speech-Language Pathologist, In The Home Speech Screening Language Screening Transmyocardial Laser Revascularization Transmyocardial Revascularization - Laser Performed W Other Open Cardiac Proc Operative Tissue Ablation And Reconstruction Of Atria, Limited Oper Tissue Ablation And Reconstr Atria, Extensive W/O C-P Bypass Oper Tissue Ablation And Reconstr Atria, Extensive With C-P Bypass Endoscopy,surg Oper Tiss Ablation Recon Atria Ltd W/O C-P Bypass Endoscopy,surg Oper Tiss Ablation Recon Atria Ext W/O C-P Bypass Removal Of Donor Heart/Lung Heart-Lung Transplant W/Recipient Cardiectomy-Pneumonectomy Removal Of Donor Heart Heart Transplant W Or W/O Recipient Cardiectomy Single/Mult Injects Sclerosing Solutions,spider Veins, Limb Or Trunk Inject Sclerosing Agent 1 Vein Injection Sclerosing Agent Multiple Veins Endovenous Ablation Incomp Vein Extrem,inclusive Imaging 1st Vein Treated Endovenous Ablation Incomp Vein Extrem,inclu Image 2nd And Subseq Veins Enovenous Ablation Therapy Of Incompetent Vein, Extremity, 1st Vein Enovenous Ablation Therapy Of Incompetent Vein, Extremity Separate Therapeutic Aphers For Platelets Thera Apheresis For Plasma Pheresis Extracorporeal Selective Adsorption Or Selective Filtration And Plasma Transcath Occlus/Emboliz,percutaneous,any Method Non Central,non-Head Or Neck Ligation Of Femoral Vein Ligation Of Common Iliac Vein Ligation/Division Vein At Junction Or Distal Interrupt Ligation Division And Stripping Short Saphenous Vein Ligation Division And Stripping Long Saphenous Veins From Knee Or Below CC32013443

August 1, 2013 37735 37760 37761 37765 37766 37780 37785 37788 37790 41010 41019 41512 41530 41821 41850 41899 42140 42145 42820 42821 42825 42826 42830 42831 42835 42836 42890 42894 42950 43257 43283 43644 43645 43647 43648 43770 43771 43772 43773 43774 43775 43842 43843 43845 43846 43847 43848

Ligation/Division Stripping Veins/Exc Ulcer , Graft W/Excision Ligation Veins, Subfacial,radical Skin Graft, Open Lig Prfratr Vein Subfscal Open Incl Us Gid 1 Leg Stab Phlebectomy Varicose Veins 1 Extremity Less Than 20 Incisions Stab Phlebectomy Varicose Veins 1 Extremitygreater Than 20 Incisions Ligat/Div Short Saphenous Vein At Saphenopopliteal Junction Ligation,division, Excision Varicose Vein Cluster, One Leg Penile Revascularization, Artery, W Or W/O Graft Penile Venous Occlusive Proc Incision Of Lingual Frenum Placement Needle/Cath/Devices Head/Neck Radioelement Application Tongue Base Suspension Permanent Suture Technique Submucosal Ablation Tongue Rf 1/Grtr Sites Per Session Operculectomy, Excision Pericoronal Tissues Destruct Lesion, Dentoalveolar Structures Unlisted Proced Dentoalveolar Uvulectomy, Excision Of Uvula Repair,palate,pharynx/Uvula Tonsillectomy And Adenoidectomy, Under Age 12 T&a, Age 12 Or Over Tonsillectomy, Primary Or Secondary, Under Age 12 Tonsillectomy, Primary Or Secondary,over Age 12 Adenoidectomy, Primary Under Age 12 Adenoidectomy,primary Age 12 And Over Adenoidectomy, Secondary, Under Age 12 Adenoidectomy,secondary, Over Age 12 Limited Pharyngectomy Resect Pharyngeal Wall Req Close W/Myo Or Fascio Flag W/Anastamosis Pharyngoplasty Upper Gastrointestinal Endoscopy Including Esophagus, Stomach Laparoscopy Surgical Esoph Lengthening Procedure Eg Collis Or Wedge Gastro Laparoscopic Gastric Restrictive Px, W/Gastric Bypass/ Roux-En-Y Laparoscopy,gastric Restrict Px W/Bypass/Small Intestine Recon For Absorption Laparoscopy Implant/Replace Gastric Neurostim Eltrd Antrum Laparoscopy Revision/Removal Gastric Neurostim Eltrd Antrum Laparoscopy Surg Gastric Restrict Px Placement Of Adj Gastric Device Laparoscopy Surg Gastric Restrict Px Rev Adj Device Component Only Laparoscopy Surg Gastric Restrict Px Rem Adj Gast Restric Device Comp Only Laparoscopy Surg Gastric Remove/Replace Gastric Device Component Only Laparoscopy Surg Gastric Remove Of Adj Gast Device And Sub Port Component Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy Gastric Restrict Px W/O Bypass,morbid Obesity,vertical Banded Gastroplasty Gastric Restrict Px W/O Bypass,morbid Obesity, Other Than Vertical Banded Gastric Restrictive Px W Part Gastrectomy Duodenoileostomy Gastric Restrict W/Gastric Bypass,morbid Obesity W/Short Limp Roux-En-Y Gastric Restrict W/Gastric Bypass,morbid Obesity, Small Intestine Limit Absorpt Revise,open Gastric Restrict Px Morbid Obesity Other Than Adj Device CC32013443

August 1, 2013 43881 43882 43886 43887 43888 44133 44135 44136 44137 46707 47133 47135 47136 47140 47141 47142 47382 47562 47563 47564 47600 47605 47610 47612 47620 48554 49320 65125 65756 65757 65760 65765 65767 65770 65771 65772 65775 65778 65779 65780 66985 66986 67028 67220 67221 67900 67901

Implant/Replace Gastric Neurostim Electrodes Antrum Open Revision/Removal Gastric Neurostim Electrodes Antrum Open Gastric Restrict Px Open Revision Subcutaneous Port Component Only Gastric Restrict Px Removal Of Subcutaneous Port Component Only Gastric Restrict Px Removal And Replmt Of Subcut Port Component Only Donor Enterctomy, Open Partial, From Living Donor Intestinal Allotransplantation From Cadaver Donor Intestinal Allotransplantation From Living Donor Complete Transplanted Intestinal Allograft Removal Rpr Anorectal Fistula W/ Plug Donor Hepatectomy From Cadaver Donor Liver Allotransplantation, Orthotopic Part/Whole From Cadaver Or Living Donor Liver Allotransplantation, Heterotopic, Part/Whole Cadaver Or Living Donor Hepatectomy Living Donor Lt Lat Segment Donor Hepatect W Prep Maint Allograft Living Don Ttl Lt Lobectomy Don Or Hepatec W Prep Mainte Allograft Living Donor Total Rt Lobectomy Ablation 1 Or More Liver Tumors Percutaneous, Radiofrequence Laparoscopy Surgical Cholecystectomy Laparoscopy Surgical W Cholecystectomy W Cholangiography Lap Surgical W Cholecystectomy W Exploration Of Common Duct Cholecystectomy Cholecystect W Cholangiography Cholecystectomy W/Explore Of Common Duct Cholecystectomy W/Choledochoenterostomy Cholecystectomy W/Expl Common Duct,w/Transduodenal W Or W/O Cholangiography Transplant - Pancreatic Allogrft Laparoscopy Surgical Abdomen/Peritoneum/Omentum Diagnostic W Or W/O Spe Modification Of Ocular Implant Keratoplasty Endothelial Backbench Prep Corneal Endothelial Allograft Keratomeleusis Keratophakia Epikeratoplasty Keratoprosthesis Radial Keratotomy Corneal Incision To Correct Astigmatism Corneal Wedge Resection To Correct Astigmatism Place Of Amniotic Membrane On Ocular Surface For Wound Healing Self-Retaining Place Of Amniotic Membrne On Ocular Surface For Wound Healing, 1 Layer Sutured Ocular Surface Reconstruction Amniotic Membrane Trans, Mult Layers Insert Intraocular Lens Prosthesis Not W/Cataract Removal Exchange Of Intraocular Lens Intravitreal Inj Pharmacologic Agent Destruct Localized Lesion Of Choroid,one Or More Session,photocoagulation Destruct Local Lesion Choroid One Or More Sessions Photodynamic Therapy Repair Brow Ptosis Repair Blepharoptosis, Frontalis Muscle Tech W/Suture Or Other Material CC32013443

August 1, 2013 67902 67903 67904 67906 67908 67909 67911 67912 67914 67915 67916 67917 67921 67922 67923 67924 67950 67961 67966 67971 67973 67974 67975 V2630 V2631 V2632 56800 56810 57295 57335 57426 58140 58145 58146 58150 58152 58180 58200 58210 58240 58260 58262 58263 58267 58270 58275 58280

Rep Blepharoptosis Frontalis Muscle Tech W/Fascial Sling Repair Blepharoptosis, Levator Resection Or Advancement, Internal Approach Repair Blepharoptosis, Levator Resection Or Advancement, External Approach Repair Blepharoptosis, Superior Rectus Technique W/ Fascial Sling Repair Blepharoptosis, Conjunctivo-Tarso-Muller's Muscle Levator Resection Reduce Ptosis Overcorrection Correction Of Lid Retraction Correction Lagophthalmos W Implant Upper Eyelid Lid Load Rep Ectropion W Suture Rep Ectropion W Thermocautery Repair Ectropion,tarsal Wedge Excision Rep Ectropion Extensive Rep Entropion W Suture Rep Entropion W Thermocautery Repair Entropion Tarsal Wedge Excision Repair Entropion, Extensive Canthoplasty (Reconstruction Of Canthus) Exc/Repair Eyelid Invl Lid W/Prep Skin Grft Or Pedicle Flap Up To 1/4 Margin Exc/Repair Eyelid Invl Lid W/Prep Skin Grft Or Pedicle Flap Over 1/4 Margin Reconstruct Eyelid, Full From Opposing Eyelid Up To 2/3, 1 Or 1st Stage Reconstruct Eyelid, Full From Opposing Eyelid Total Lower 1st Or 1st Stage Reconstruct Eyelid, Full From Opposing Eyelid Total Upper 1 Stage Or 1st Stage Reconstruct Eyelid, Full From Opposing Eyelid, Second Stage Anterior Chamber Intraocular Lens Iris Supported Intraocular Lens Posterior Chamber Intraocular Lens Plastic Repair Of Introitus Perineoplasty, Repair Of Perineum, Nonobstetrical Revision With Removal Of Prosthetic Vaginal Graft Vaginal Approach Vaginoplasty For Intersex State Revision Prosthetic Vaginal Graft Laparoscopic Myomectomy, Single/Multi, Abdominal Approach Myomectomy, Single/Multi, Vaginal Approach Myom Exc Of Fibroid Tumors Of Uterus 5 Or More Intramural Myomas Total Ab Hysterectomy, W Or W/O Tube Removal, W Or W/O Ovary Removal Total Ab Hysterectomy,w Wo Tube Or Ovary Removal, W/Colpo-Urethrocystopexy Supracervical Ab Hysterectomy W Or W/O Tube Remove W Or W/O Ovary Removal Hysterectomy,total Abdomin Inclpart Vaginectomy W Wo Tube Or Ovary Removal Hysterectomy Radical, Abdom Incl Bilat Lymphaden W Wo Tube Or Ovary Removal Pelvic Exenter Malig Tot Abdom Hysterect/Cervicect W Wo Tube Or Ovary Remove Vaginal Hysterectomy For Uterus 250 Grams Or Less Vaginal Hysterectomy Uters 250 Gr Or Less W/Tube Ovary Removal Vaginal Hysterectomy Uterus W/Tube/Ovary Removal W/Repair Enterocele Vaginal Hysterectomy W/Colpo-Urethrocystopexy W Or W/O Endo Control Hysterect Vag W Rep Enterocele Hysterectomy Vag W Total Or Partial Vaginectomy Hyster Vag W Colpect Rep Enter CC32013443

August 1, 2013 58285 58290 58291 58292 58293 58294 58340 58345 58353 58356 58541 58542 58543 58544 58545 58546 58548 58550 58552 58553 58554 58555 58558 58559 58560 58561 58562 58563 58565 58570 58571 58572 58573 58600 58605 58611 58615 58660 58661 58662 58670 58671 58672 58673 58740 58750 58752

Hysterectomy Vaginal Radical Vaginal Hysterectmy For Uterus Greater Than 250 Grams Vag Hysterectomy For Uterus Greater Than 250 Grams With Remov Of Tubes Vaginl Hysterctmy Uterus Greater Than 250 Grams Removal Of Tubes Vaginal Hyst For Uterus Greater Than 250 Grams With Colpo Urethrocyst Vaginal Hysterectomy For Uterus Greater Than 250 Grams Repair Of Enter Cath For Saline Infusion Sonohysterography Or Hysterosalpingography Transcervical Fallopian Cath For Dx Patency W Or W/O Hysterosalpingography Endometrial Thermal Ablation W/O Hysteroscopic Guidance Endometrial Cryoablation W/Us, W/Endometrial Curettage, Laparoscopy Supracrv Hysterectomy 250 Grams Or Less Laparoscopy Supracrv Hyst 250 Gram Or Less W/Rmvl Tube/Ovary Laparoscopy Supracrv Hystectomy Grtr Than 250 Gram Laparoscopy Supracrv Hyst Grtr Than 250 G W/Rmvl Tube/Ovary Laproscopy Surgicl Myomectomy Excision 1 To 4 Intramural Myomas With Laparoscpy Surg Myomectmy Excision 5 Or More Intramural Myomas Laparoscopy W/Rad Hyst W/Bilat Lmphadec Rmvl Tube/Ovary Laparoscopy Surgical W Vaginal Hysterectomy W Or W/O Removal Of Tubes Laparscpy Surg W Vag Hysterect For Uter 250 Grams Less Remov Of Tubes Laparoscpy Surg W Vag Hysterectomy For Uter Great Than 250 Grams Laparo Surgical W Vaginal Hysterectomy For Uterus Great Than 250 Grams Hysteroscopy Diagnostic Hysteroscopy Surgical W Biospy Of Endometruim &/Or Polypectomy W Or W/O Hysteroscopy W Lysis Of Intrauterine Adhesions Any Method Hysteroscopy W Division Or Resection Of Intrauterine Septum Any Method Hysteroscopy W Removal Of Leiomyomata Hysteroscopy W Removal Of Impacted Foreign Body Hysteroscopy W Endometrial Ablation Any Method Hysteroscopy, Surgical - With Bilateral Fallopian Tube Cannulation Laparoscopy W Total Hysterectomy Uterus 250 G Or Less Laps,surg W/Total Hysterectomy Uterus Less 250 G W/Remove Tube/Ovary Laparoscopy,surg W/Total Hysterectomy Uterus Grtr Than 250 G Laparoscopy Tot Hysterectomy Grtr Than 250 G W Tube/Ovary Ligation/Transection Fallopian Tubes, Abdom Or Vag Appr, Uni Or Bilateral Ligate/Transect Fallopian,abd Or Vag, Postpartum, Uni Or Bilateral Same Hosp Ligation Fallopian Tube At Cesar. Deliv/Intra Abdom. Surgery Occlusion Fallopian Tubes By Device,vaginal Or Suprapubic Approach Laparoscopy Surgical W Lysis Of Adhesions Laparoscopy W Removal Of Adnexal Structures Laparoscopy Fulguration/Excision Of Lesions Of Ovary Pelvic Viscera Or Laparoscopy Fulguration Of Oviducts Laparoscopy Of Occlusion Of Oviducts By Device Laparoscopy Fimbrioplasty Laparoscopy Salpinostomy Lysis Of Adhesions (Tubes, Ovaries) Tubotubal Anastomosis Implantation Tubouterine CC32013443

August 1, 2013 58760 58770 58920 58953 58954 11420 11421 11422 11423 11424 11426 11442 11443 11954 11980 11981 11983 15271 15272 15273 15274 15732 15734 15780 15781 15782 15783 15786 15787 15788 15789 15792 15793 15819 15820 15821 15822 15823 15824 15825 15826 15828 15829 15832 15833 15834 15835

Fimbrioplasty Salpingostomy Wedge Resect Or Bisect Ovary, Uni Or Bilateral Hysterectomy/Removal Of Tubes/Ovaries W/ Radical Dissection Hysterectomy/Removal Of Tubes/ Ovaries W/Radical Dissection/Lymphadenectomy Exc Ben Les Scalp Hands