HCPCS Index 2017

Abatacept,   J0129
Abciximab,   J0130
dressing holderbinder,   A446
pad, low profile,   L1270
Abduction control, each,   L2624
Abduction rotation bar, foot,   L3140 - L3170
Foot, abduction rotation bar, including shoes   L3140
Foot, abduction rotation bar, without shoes   L3150
Foot, adjustable shoe-styled positioning device   L3160
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each   L3170
AbobotulinumtoxintypeA,   J0586
Absorption dressing,   A6251 - A6256
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6251
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6252
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6253
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6254
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6255
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6256
Access system,   A4301
ambulation devices,   E0153 - E0159
Platform attachment, forearm crutch, each   E0153
Platform attachment, walker, each   E0154
Wheel attachment, rigid pick-up walker, per pair   E0155
Seat attachment, walker   E0156
Crutch attachment, walker, each   E0157
Leg extensions for walker, per set of four (4)   E0158
Brake attachment for wheeled walker, replacement, each   E0159
artificial kidney and machine (see also ESRD),   E1510 - E1699
Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, iv poles, pressure gauge, concentrate container   E1510
Heparin infusion pump for hemodialysis   E1520
Air bubble detector for hemodialysis, each, replacement   E1530
Pressure alarm for hemodialysis, each, replacement   E1540
Bath conductivity meter for hemodialysis, each   E1550
Blood leak detector for hemodialysis, each, replacement   E1560
Adjustable chair, for esrd patients   E1570
Transducer protectorsfluid barriers, for hemodialysis, any size, per 10   E1575
Unipuncture control system for hemodialysis   E1580
Hemodialysis machine   E1590
Automatic intermittent peritoneal dialysis system   E1592
Cycler dialysis machine for peritoneal dialysis   E1594
Delivery andor installation charges for hemodialysis equipment   E1600
Reverse osmosis water purification system, for hemodialysis   E1610
Deionizer water purification system, for hemodialysis   E1615
Blood pump for hemodialysis, replacement   E1620
Water softening system, for hemodialysis   E1625
Reciprocating peritoneal dialysis system   E1630
Wearable artificial kidney, each   E1632
Peritoneal dialysis clamps, each   E1634
Compact (portable) travel hemodialyzer system   E1635
Sorbent cartridges, for hemodialysis, per 10   E1636
Hemostats, each   E1637
Scale, each   E1639
Dialysis equipment, not otherwise specified   E1699
beds,   E0271 - E0280 , E0300 - E0326
Mattress, innerspring   E0271
Mattress, foam rubber   E0272
Bed board   E0273
Over-bed table   E0274
Bed pan, standard, metal or plastic   E0275
Bed pan, fracture, metal or plastic   E0276
Powered pressure-reducing air mattress   E0277
Bed cradle, any type   E0280
Pediatric crib, hospital grade, fully enclosed, with or without top enclosure   E0300
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress   E0301
Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress   E0302
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress   E0303
Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress   E0304
Bed side rails, half length   E0305
Bed side rails, full length   E0310
Bed accessory board, table, or support device, any type   E0315
Safety enclosure framecanopy for use with hospital bed, any type   E0316
Urinal male, jug-type, any material   E0325
Urinal female, jug-type, any material   E0326
wheelchairs,   E0950 - E1030 , E1050 - E1298 , E2300 - E2399 , K0001 - K0109
Wheelchair accessory, tray, each   E0950
Heel loopholder, any type, with or without ankle strap, each   E0951
Toe loopholder, any type, each   E0952
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each   E0955
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each   E0956
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each   E0957
Manual wheelchair accessory, one-arm drive attachment, each   E0958
Manual wheelchair accessory, adapter for amputee, each   E0959
Wheelchair accessory, shoulder harnessstraps or chest strap, including any type mounting hardware   E0960
Manual wheelchair accessory, wheel lock brake extension (handle), each   E0961
Manual wheelchair accessory, headrest extension, each   E0966
Manual wheelchair accessory, hand rim with projections, any type, replacement only, each   E0967
Commode seat, wheelchair   E0968
Narrowing device, wheelchair   E0969
No 2 footplates, except for elevating leg rest   E0970
Manual wheelchair accessory, anti-tipping device, each   E0971
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each   E0973
Manual wheelchair accessory, anti-rollback device, each   E0974
Wheelchair accessory, positioning beltsafety beltpelvic strap, each   E0978
Safety vest, wheelchair   E0980
Wheelchair accessory, seat upholstery, replacement only, each   E0981
Wheelchair accessory, back upholstery, replacement only, each   E0982
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control   E0983
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control   E0984
Wheelchair accessory, seat lift mechanism   E0985
Manual wheelchair accessory, push-rim activated power assist system   E0986
Manual wheelchair accessory, lever-activated, wheel drive, pair   E0988
Wheelchair accessory, elevating leg rest, complete assembly, each   E0990
Manual wheelchair accessory, solid seat insert   E0992
Arm rest, each   E0994
Wheelchair accessory, calf restpad, replacement only, each   E0995
Wheelchair accessory, power seating system, tilt only   E1002
Wheelchair accessory, power seating system, recline only, without shear reduction   E1003
Wheelchair accessory, power seating system, recline only, with mechanical shear reduction   E1004
Wheelchair accessory, power seatng system, recline only, with power shear reduction   E1005
Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction   E1006
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction   E1007
Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction   E1008
Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each   E1009
Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair   E1010
Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)   E1011
Wheelchair accessory, addition to power seating system, center mount power elevating leg restplatform, complete system, any type, each   E1012
Reclining back, addition to pediatric size wheelchair   E1014
Shock absorber for manual wheelchair, each   E1015
Shock absorber for power wheelchair, each   E1016
Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each   E1017
Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each   E1018
Residual limb support system for wheelchair, any type   E1020
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory   E1028
Wheelchair accessory, ventilator tray, fixed   E1029
Wheelchair accessory, ventilator tray, gimbaled   E1030
Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests   E1280
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests   E1130
Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1100
Wheelchair specially sized or constructed, (indicate brand name, model number, if any) and justification   E1220
Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1050
Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests   E1170
Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest   E1240
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests   E1060
Wheelchair with fixed arm, footrests   E1221
Amputee wheelchair, fixed full length arms, without footrests or legrest   E1171
Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest   E1110
Lightweight wheelchair, fixed full length arms, swing away detachable footrest   E1250
Heavy duty wheelchair, fixed full length arms, swing away detachable footrest   E1285
Wheelchair, detachable arms, desk or full length, swing away detachable footrests   E1140
Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest   E1172
Wheelchair with fixed arm, elevating legrests   E1222
Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1070
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests   E1150
Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1290
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1260
Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests   E1270
Wheelchair, fixed full length arms, swing away detachable elevating legrests   E1160
Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests   E1180
Heavy duty wheelchair, fixed full length arms, elevating legrest   E1295
Wheelchair with detachable arms, footrests   E1223
Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest   E1083
Special wheelchair seat height from floor   E1296
Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests   E1190
Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests   E1084
Manual adult size wheelchair, includes tilt in space   E1161
Wheelchair with detachable arms, elevating legrests   E1224
Special wheelchair seat depth, by upholstery   E1297
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each   E1225
Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests   E1195
Hemi-wheelchair, fixed full length arms, swing away detachable foot rests   E1085
Special wheelchair seat depth andor width, by construction   E1298
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each   E1226
Amputee wheelchair, fixed full length arms, swing away detachable footrest   E1200
Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests   E1086
High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1087
Special height arms for wheelchair   E1227
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests   E1088
Special back height for wheelchair   E1228
Wheelchair, pediatric size, not otherwise specified   E1229
High strength lightweight wheelchair, fixed length arms, swing away detachable footrest   E1089
Power operated vehicle (three or four wheel nonhighway) specify brand name and model number   E1230
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests   E1090
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system   E1231
Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests   E1092
Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests   E1093
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system   E1232
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system   E1233
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system   E1234
Wheelchair, pediatric size, rigid, adjustable, with seating system   E1235
Wheelchair, pediatric size, folding, adjustable, with seating system   E1236
Wheelchair, pediatric size, rigid, adjustable, without seating system   E1237
Wheelchair, pediatric size, folding, adjustable, without seating system   E1238
Power wheelchair, pediatric size, not otherwise specified   E1239
Wheelchair accessory, power seat elevation system, any type   E2300
Wheelchair accessory, power standing system, any type   E2301
Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware   E2310
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware   E2311
Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware   E2312
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each   E2313
Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware   E2321
Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware   E2322
Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated   E2323
Power wheelchair accessory, chin cup for chin control interface   E2324
Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware   E2325
Power wheelchair accessory, breath tube kit for sip and puff interface   E2326
Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware   E2327
Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware   E2328
Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware   E2329
Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware   E2330
Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware   E2331
Power wheelchair accessory, nonstandard seat frame width, 20-23 inches   E2340
Power wheelchair accessory, nonstandard seat frame width, 24-27 inches   E2341
Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches   E2342
Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches   E2343
Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface   E2351
Power wheelchair accessory, group 34 non-sealed lead acid battery, each   E2358
Power wheelchair accessory, group 34 sealed lead acid battery, each (eg, gel cell, absorbed glassmat)   E2359
Power wheelchair accessory, 22nf non-sealed lead acid battery, each   E2360
Power wheelchair accessory, 22nf sealed lead acid battery, each, (eg, gel cell, absorbed glassmat)   E2361
Power wheelchair accessory, group 24 non-sealed lead acid battery, each   E2362
Power wheelchair accessory, group 24 sealed lead acid battery, each (eg, gel cell, absorbed glassmat)   E2363
Power wheelchair accessory, u-1 non-sealed lead acid battery, each   E2364
Power wheelchair accessory, u-1 sealed lead acid battery, each (eg, gel cell, absorbed glassmat)   E2365
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each   E2366
Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each   E2367
Power wheelchair component, drive wheel motor, replacement only   E2368
Power wheelchair component, drive wheel gear box, replacement only   E2369
Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only   E2370
Power wheelchair accessory, group 27 sealed lead acid battery, (eg, gel cell, absorbed glassmat), each   E2371
Power wheelchair accessory, group 27 non-sealed lead acid battery, each   E2372
Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware   E2373
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only   E2374
Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only   E2375
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only   E2376
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue   E2377
Power wheelchair component, actuator, replacement only   E2378
Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each   E2381
Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each   E2382
Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each   E2383
Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each   E2384
Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each   E2385
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each   E2386
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each   E2387
Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each   E2388
Power wheelchair accessory, foam caster tire, any size, replacement only, each   E2389
Power wheelchair accessory, solid (rubberplastic) drive wheel tire, any size, replacement only, each   E2390
Power wheelchair accessory, solid (rubberplastic) caster tire (removable), any size, replacement only, each   E2391
Power wheelchair accessory, solid (rubberplastic) caster tire with integrated wheel, any size, replacement only, each   E2392
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each   E2394
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each   E2395
Power wheelchair accessory, caster fork, any size, replacement only, each   E2396
Power wheelchair accessory, lithium-based battery, each   E2397
Standard wheelchair   K0001
Standard hemi (low seat) wheelchair   K0002
Lightweight wheelchair   K0003
High strength, lightweight wheelchair   K0004
Ultralightweight wheelchair   K0005
Heavy duty wheelchair   K0006
Extra heavy duty wheelchair   K0007
Custom manual wheelchairbase   K0008
Other manual wheelchairbase   K0009
Standard - weight frame motorizedpower wheelchair   K0010
Standard - weight frame motorizedpower wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking   K0011
Lightweight portable motorizedpower wheelchair   K0012
Custom motorizedpower wheelchair base   K0013
Other motorizedpower wheelchair base   K0014
Detachable, non-adjustable height armrest, replacement only, each   K0015
Detachable, adjustable height armrest, base, replacement only, each   K0017
Detachable, adjustable height armrest, upper portion, replacement only, each   K0018
Arm pad, replacement only, each   K0019
Fixed, adjustable height armrest, pair   K0020
High mount flip-up footrest, replacement only, each   K0037
Leg strap, each   K0038
Leg strap, h style, each   K0039
Adjustable angle footplate, each   K0040
Large size footplate, each   K0041
Standard size footplate, replacement only, each   K0042
Footrest, lower extension tube, replacement only, each   K0043
Footrest, upper hanger bracket, replacement only, each   K0044
Footrest, complete assembly, replacement only, each   K0045
Elevating legrest, lower extension tube, replacement only, each   K0046
Elevating legrest, upper hanger bracket, replacement only, each   K0047
Ratchet assembly, replacement only   K0050
Cam release assembly, footrest or legrest, replacement only, each   K0051
Swingaway, detachable footrests, replacement only, each   K0052
Elevating footrests, articulating (telescoping), each   K0053
Seat height less than 17 or equal to or greater than 21 for a high strength, lightweight, or ultralightweight wheelchair   K0056
Spoke protectors, each   K0065
Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each   K0069
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each   K0070
Front caster assembly, complete, with pneumatic tire, replacement only, each   K0071
Front caster assembly, complete, with semi-pneumatic tire, replacement only, each   K0072
Caster pin lock, each   K0073
Front caster assembly, complete, with solid tire, replacement only, each   K0077
Drive belt for power wheelchair, replacement only   K0098
Iv hanger, each   K0105
Wheelchair component or accessory, not otherwise specified   K0108
Antithrombin III,   J7197
Acetaminophen,   J0131
Acetazolamide sodium,   J1120
Acetylcysteine, inhalation solution,   J7604, J7608
Acetylcysteine, injection,   J0132
Acyclovir,   J0133
Adalimumab,   J0135
Adenosine,   J0151, J0153
Adhesive,   A4364
bandage,   A6413
disc or foam pad,   A5126
remover,   A4455, A4456
support, breast prosthesis,   A4280
Administrative, Miscellaneous and Investigational,   A9000 - A9999
Hygienic item or device, disposable or non-disposable, any type, each   A9286
Gallium ga-68, dotatate, diagnostic, 01 millicurie   A9587
Choline c-11, diagnostic, per study dose up to 20 millicuries   A9515
Inversioneversion correction device   A9285
Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified   A9598
Fluciclovine f-18, diagnostic, 1 millicurie   A9588
Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified   A9597
Technetium tc-99m sestamibi, diagnostic, per study dose   A9500
Non-prescription drugs   A9150
Miscellaneous dme supply, accessory, andor service component of another hcpcs code   A9900
Technetium tc-99m teboroxime, diagnostic, per study dose   A9501
Dme delivery, set up, andor dispensing service component of another hcpcs code   A9901
Single vitaminmineraltrace element, oral, per dose, not otherwise specified   A9152
Miscellaneous dme supply or accessory, not otherwise specified   A9999
Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified   A9153
Technetium tc-99m tetrofosmin, diagnostic, per study dose   A9502
Artificial saliva, 30 ml   A9155
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries   A9503
Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries   A9504
Pediculosis (lice infestation) treatment, topical, for administration by patientcaretaker   A9180
Non-covered item or service   A9270
Thallium tl-201 thallous chloride, diagnostic, per millicurie   A9505
Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries   A9507
Wound suction, disposable, includes dressing, all accessories and components, any type, each   A9272
Hot water bottle, ice cap or collar, heat andor cold wrap, any type   A9273
Iodine i-131 iobenguane sulfate, diagnostic, per 05 millicurie   A9508
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories   A9274
Iodine i-123 sodium iodide, diagnostic, per millicurie   A9509
Home glucose disposable monitor, includes test strips   A9275
Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries   A9510
Sensor invasive (eg, subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit 1 day supply   A9276
Technetium tc-99m pertechnetate, diagnostic, per millicurie   A9512
Transmitter external, for use with interstitial continuous glucose monitoring system   A9277
Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries   A9516
Receiver (monitor) external, for use with interstitial continuous glucose monitoring system   A9278
Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie   A9517
Monitoring featuredevice, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified   A9279
Technetium tc-99m tilmanocept, diagnostic, up to 05 millicuries   A9520
Alert or alarm device, not otherwise classified   A9280
Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries   A9521
Reachinggrabbing device, any type, any length, each   A9281
Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries   A9524
Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries   A9526
Wig, any type, each   A9282
Foot pressure off loadingsupportive device, any type, each   A9283
Iodine i-125, sodium iodide solution, therapeutic, per millicurie   A9527
Spirometer, non-electronic, includes all accessories   A9284
Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie   A9528
Iodine i-131 sodium iodide solution, diagnostic, per millicurie   A9529
Exercise equipment   A9300
Iodine i-131 sodium iodide solution, therapeutic, per millicurie   A9530
Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)   A9531
Iodine i-125 serum albumin, diagnostic, per 5 microcuries   A9532
Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries   A9536
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries   A9537
Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries   A9538
Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries   A9539
Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries   A9540
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries   A9541
Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries   A9542
Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries   A9543
Cobalt co-5758, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie   A9546
Indium in-111 oxyquinoline, diagnostic, per 05 millicurie   A9547
Indium in-111 pentetate, diagnostic, per 05 millicurie   A9548
Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie   A9550
Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries   A9551
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries   A9552
Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries   A9553
Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries   A9554
Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries   A9555
Gallium ga-67 citrate, diagnostic, per millicurie   A9556
Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries   A9557
Xenon xe-133 gas, diagnostic, per 10 millicuries   A9558
Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie   A9559
Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries   A9560
Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries   A9561
Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries   A9562
Sodium phosphate p-32, therapeutic, per millicurie   A9563
Chromic phosphate p-32 suspension, therapeutic, per millicurie   A9564
Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries   A9566
Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries   A9567
Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries   A9568
Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose   A9569
Indium in-111 labeled autologous white blood cells, diagnostic, per study dose   A9570
Indium in-111 labeled autologous platelets, diagnostic, per study dose   A9571
Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries   A9572
Injection, gadoterate meglumine, 01 ml   A9575
Injection, gadoteridol, (prohance multipack), per ml   A9576
Injection, gadobenate dimeglumine (multihance), per ml   A9577
Injection, gadobenate dimeglumine (multihance multipack), per ml   A9578
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml   A9579
Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries   A9580
Injection, gadoxetate disodium, 1 ml   A9581
Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries   A9582
Injection, gadofosveset trisodium, 1 ml   A9583
Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries   A9584
Injection, gadobutrol, 01 ml   A9585
Florbetapir f18, diagnostic, per study dose, up to 10 millicuries   A9586
Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified   A9599
Strontium sr-89 chloride, therapeutic, per millicurie   A9600
Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries   A9604
Radium ra-223 dichloride, therapeutic, per microcurie   A9606
Non-radioactive contrast imaging material, not otherwise classified, per study   A9698
Radiopharmaceutical, therapeutic, not otherwise classified   A9699
Supply of injectable contrast material for use in echocardiography, per study   A9700
Ado-trastuzumab,   J9354
Adrenalin,   J0171
compressor,   E0571, E0572
compressor filter,   K0178 - K0179
mask,   K018
Aflibercept,   J0178
AFO,   E1815, E1830, L1900 - L1990 , L4392, L4396
Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated   L1900
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf   L1902
Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated   L1904
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf   L1906
Ankle orthosis, supramalleolar with straps, with or without interfacepads, custom fabricated   L1907
Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment   L1910
Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated   L1920
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment   L1930
Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment   L1932
Ankle foot orthosis, plastic or other material, custom fabricated   L1940
Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated   L1945
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated   L1950
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment   L1951
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated   L1960
Ankle foot orthosis, plastic with ankle joint, custom fabricated   L1970
Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment   L1971
Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf bandcuff (single bar 'bk' orthosis), custom fabricated   L1980
Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf bandcuff (double bar 'bk' orthosis), custom fabricated   L1990
Agalsidase beta,   J0180
Aggrastat,   J324
A-hydroCort,   J1710
Air bubble detector,dialysis,   E1530
Air fluidized bed,   E0194
Air pressure padmattress,   E0186, E0197
Air travel and nonemergency transportation,   A0140
Alarm, pressure, dialysis,   E1540
Alatrofloxacin mesylate,   J0200
Albumin, human,   P9041, P9042
Albuterol, all formulations, inhalation solution, concentrated,   J7610, J7611
Albuterol, all formulations, inhalation solution, unit dose,   J7609, J7613
Albuterol, all formulations, inhalation solution,   J7620
Alcohol,   A4244
Alcohol wipes,   A4245
Aldesleukin (IL2),   J9015
Alefacept,   J0215
Alemtuzumab,   J0202
Alert device,   A9280
Alginate dressing,   A6196 - A6199
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq in or less, each dressing   A6196
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, each dressing   A6197
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq in, each dressing   A6198
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches   A6199
Alglucerase,   J0205
Alglucosidase,   J0220
Alglucosidase alfa,   J0221
Alphanate,   J7186
Alpha-1-proteinase inhibitor, human,   J0256, J0257
Alprostadil, injection,   J0270
Alprostadil, urethral supposity,   J0275
Alteplase recombinant,   J2997
Alternating pressure mattresspad,   A4640, E0180, E0181, E0277
Ambulance,   A0021 - A0999
Ambulance service, outside state per mile, transport (medicaid only)   A0021
Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest   A0080
Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest   A0090
Non-emergency transportation taxi   A0100
Non-emergency transportation and bus, intra or inter state carrier   A0110
Non-emergency transportation mini-bus, mountain area transports, or other transportation systems   A0120
Non-emergency transportation wheelchair van   A0130
Non-emergency transportation and air travel (private or commercial) intra or inter state   A0140
Non-emergency transportation per mile - case worker or social worker   A0160
Transportation ancillary parking fees, tolls, other   A0170
Non-emergency transportation ancillary lodging-recipient   A0180
Non-emergency transportation ancillary meals-recipient   A0190
Non-emergency transportation ancillary lodging escort   A0200
Non-emergency transportation ancillary meals-escort   A0210
Ambulance service, neonatal transport, base rate, emergency transport, one way   A0225
Bls mileage (per mile)   A0380
Bls routine disposable supplies   A0382
Bls specialized service disposable supplies defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances)   A0384
Als mileage (per mile)   A0390
Als specialized service disposable supplies defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances)   A0392
Als specialized service disposable supplies iv drug therapy   A0394
Als specialized service disposable supplies esophageal intubation   A0396
Als routine disposable supplies   A0398
Ambulance waiting time (als or bls), one half (12) hour increments   A0420
Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation   A0422
Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged) (requires medical review)   A0424
Ground mileage, per statute mile   A0425
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)   A0426
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)   A0427
Ambulance service, basic life support, non-emergency transport, (bls)   A0428
Ambulance service, basic life support, emergency transport (bls-emergency)   A0429
Ambulance service, conventional air services, transport, one way (fixed wing)   A0430
Ambulance service, conventional air services, transport, one way (rotary wing)   A0431
Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers   A0432
Advanced life support, level 2 (als 2)   A0433
Specialty care transport (sct)   A0434
Fixed wing air mileage, per statute mile   A0435
Rotary wing air mileage, per statute mile   A0436
Noncovered ambulance mileage, per mile (eg, for miles traveled beyond closest appropriate facility)   A0888
Ambulance response and treatment, no transport   A0998
Unlisted ambulance service   A0999
air,   A0430, A0431, A0435, A0436
disposable supplies,   A0382 - A0398
Bls routine disposable supplies   A0382
Bls specialized service disposable supplies defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances)   A0384
Als mileage (per mile)   A0390
Als specialized service disposable supplies defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances)   A0392
Als specialized service disposable supplies iv drug therapy   A0394
Als specialized service disposable supplies esophageal intubation   A0396
Als routine disposable supplies   A0398
non-emergency transport, fixed wing,   S9960
non-emergency transport, rotary wing,   S9961
oxygen,   A0422
Ambulation device,   E0100 - E0159
Cane, includes canes of all materials, adjustable or fixed, with tip   E0100
Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips   E0110
Platform attachment, forearm crutch, each   E0153
Walker, rigid (pickup), adjustable or fixed height   E0130
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips   E0105
Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips   E0111
Walker, folding (pickup), adjustable or fixed height   E0135
Platform attachment, walker, each   E0154
Wheel attachment, rigid pick-up walker, per pair   E0155
Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips   E0112
Walker, with trunk support, adjustable or fixed height, any type   E0140
Walker, rigid, wheeled, adjustable or fixed height   E0141
Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip   E0113
Seat attachment, walker   E0156
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips   E0114
Walker, folding, wheeled, adjustable or fixed height   E0143
Crutch attachment, walker, each   E0157
Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each   E0116
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat   E0144
Leg extensions for walker, per set of four (4)   E0158
Brake attachment for wheeled walker, replacement, each   E0159
Walker, heavy duty, multiple braking system, variable wheel resistance   E0147
Crutch, underarm, articulating, spring assisted, each   E0117
Walker, heavy duty, without wheels, rigid or folding, any type, each   E0148
Crutch substitute, lower leg platform, with or without wheels, each   E0118
Walker, heavy duty, wheeled, rigid or folding, any type   E0149
Amikacin Sulfate,   J0278
Aminolevulinate,   J7309
Aminolevulinic acid HCl,   J7308
Aminophylline,   J0280
Amiodarone Hcl,   J0282
Amitriptyline HCI,   J1320
Ammonia N-13,   A9526
Ammonia test paper,   A4774
Amniotic membrane,   V2790
Amobarbital,   J0300
Amphotericin B,   J0285
Amphotericin B Lipid Complex,   J0287 - J0289
Injection, amphotericin b lipid complex, 10 mg   J0287
Injection, amphotericin b cholesteryl sulfate complex, 10 mg   J0288
Injection, amphotericin b liposome, 10 mg   J0289
Ampicillin sodium,   J0290
Ampicillin sodiumsulbactam sodium,   J0295
adapter, wheelchair,   E0959
prosthesis,   L5000 - L7510 , L7520, L7900, L8400 - L8465
Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm   L6350
Above knee, molded socket, single axis constant friction knee, shin, sach foot   L5200
Hip disarticulation, canadian type molded socket, hip joint, single axis constant friction knee, shin, sach foot   L5250
Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining   L6900
Above elbow, molded double wall socket, internal locking elbow, forearm   L6250
Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad   L6050
Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot   L5150
Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment   L6890
Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6550
Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device   L6920
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow   L6380
Terminal device, passive handmitt, any material, any size   L6703
Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6400
Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6500
Upper extremity additions, polycentric hinge, pair   L6600
Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6450
Hemipelvectomy, canadian type molded socket, hip joint, single axis constant friction knee, shin, sach foot   L5280
Partial foot, shoe insert with longitudinal arch, toe filler   L5000
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee   L5400
Addition, exoskeletal knee-shin system, single axis, manual lock   L5710
Ankle, symes, molded socket, sach foot   L5050
Elbow disarticulation, molded socket, outside locking hinge, forearm   L6200
Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6570
Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed   L5500
Below knee, molded socket, shin, sach foot   L5100
Below elbow, molded socket, flexible elbow hinge, triceps pad   L6100
Replacement, socket, below knee, molded to patient model   L5700
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model   L5510
Addition to lower extremity, endoskeletal system, above knee, hydracadence system   L5610
Six volt battery, each   L7360
Addition to lower extremity, test socket, symes   L5618
Addition to lower extremity, symes type, expandable wall socket   L5630
Addition, endoskeletal knee-shin system, single axis, manual lock   L5810
Repair of prosthetic device, repair or replace minor parts   L7510
Electronic elbow, hosmer or equal, switch controlled   L7170
Partial hand, thumb remaining   L6000
Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm   L6300
Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)   L5785
Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)   L5654
Hip disarticulation, tilt table type molded socket, locking hip joint, single axis constant friction knee, shin, sach foot   L5270
Addition to lower extremity, above knee or knee disarticulation, acrylic socket   L5631
Terminal device, sportrecreationalwork attachment, any material, any size   L6704
Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)   L5655
Shoulder disarticulation, passive restoration (complete prosthesis)   L6310
Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model   L6580
Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm   L6205
Electronic elbow, microprocessor sequential control of elbow and terminal device   L7180
Interscapular thoracic, passive restoration (complete prosthesis)   L6360
Upper extremity additions, single pivot hinge, pair   L6605
Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device   L6925
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow   L6382
Partial foot, molded socket, ankle height, with toe filler   L5010
Ankle, symes, metal frame, molded leather socket, articulated anklefoot   L5060
Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad   L6055
Battery charger, six volt, each   L7362
Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot   L5160
Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)   L5790
Below knee, plastic socket, joints and thigh lacer, sach foot   L5105
Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each   L5210
Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining   L6905
Partial hand, little andor ring finger remaining   L6010
Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material   L5811
Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated   L6895
Replacement, socket, above kneeknee disarticulation, including attachment plate, molded to patient model   L5701
Below elbow, molded socket, (muenster or northwestern suspension types)   L6110
Below knee, molded socket, shin, sach foot, endoskeletal system   L5301
Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material   L5711
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment   L5410
Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed   L5505
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed   L5520
Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control   L5611
Addition to lower extremity, test socket, below knee   L5620
Upper extremity additions, flexible metal hinge, pair   L6610
Partial hand, no finger remaining   L6020
Electronic elbow, microprocessor simultaneous control of elbow and terminal device   L7181
Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed   L6582
Twelve volt battery, each   L7364
Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)   L5795
Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining   L6910
Replacement, socket, hip disarticulation, including hip joint, molded to patient model   L5702
Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)   L5712
Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)   L5812
Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)   L5656
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined   L6706
Addition to lower extremity, symes type, 'ptb' brim design socket   L5632
Addition to lower extremity, test socket, knee disarticulation   L5622
Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control   L5613
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model   L5530
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation   L5420
Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system   L5312
Below elbow, molded double wall split socket, step-up hinges, half cuff   L6120
Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device   L6930
Above knee, short prosthesis, no knee joint ('stubbies'), with articulated anklefoot, dynamically aligned, each   L5220
Partial foot, molded socket, tibial tubercle height, with toe filler   L5020
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic   L6384
Interscapular thoracic, passive restoration (shoulder cap only)   L6370
Shoulder disarticulation, passive restoration (shoulder cap only)   L6320
Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control   L5614
Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only   L5703
Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot   L5230
Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)   L5658
Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device   L6935
Addition to lower extremity, symes type, posterior opening (canadian) socket   L5634
Transcarpalmetacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)   L6026
Addition to upper extremity prosthesis, external powered, additional switch, any type   L6611
Electronic elbow, adolescent, variety village or equal, switch controlled   L7185
Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock   L5814
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined   L6707
Battery charger, twelve volt, each   L7366
Hand restoration (shading, and measurements included), replacement glove for above   L6915
Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket   L5535
Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model   L6584
Immediate post surgical or early fitting, application of initial rigid dressing, incl fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment   L5430
Immediate post surgical or early fitting, each additional cast change and realignment   L6386
Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control   L5714
Addition to lower extremity, test socket, above knee   L5624
Below elbow, molded double wall split socket, stump activated locking hinge, half cuff   L6130
Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee   L5321
Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control   L5616
Addition to lower extremity, symes type, medial opening socket   L5636
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee   L5450
Electronic elbow, child, variety village or equal, switch controlled   L7186
Immediate post surgical or early fitting, application of rigid dressing only   L6388
Custom shaped protective cover, below knee   L5704
Addition to lower extremity, test socket, hip disarticulation   L5626
Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot   L5331
Lithium ion battery, rechargeable, replacement   L7367
Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock   L5816
Addition to lower extremity, socket insert, multi-durometer symes   L5661
Terminal device, hand, mechanical, voluntary opening, any material, any size   L6708
Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device   L6940
Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed   L6586
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model   L5540
Upper extremity addition, disconnect locking wrist unit   L6615
Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock   L5716
Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot   L5341
Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model   L6588
Addition to lower extremity, test socket, hemipelvectomy   L5628
Terminal device, hand, mechanical, voluntary closing, any material, any size   L6709
Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each   L5617
Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control   L5818
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled   L7190
Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model   L5560
Addition to lower extremity, socket insert, multi-durometer, below knee   L5665
Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control   L5718
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee   L5460
Custom shaped protective cover, above knee   L5705
Upper extremity addition, additional disconnect insert for locking wrist unit, each   L6616
Lithium ion battery charger, replacement only   L7368
Addition to lower extremity, below knee, total contact   L5637
Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device   L6945
Addition to upper extremity prosthesis, below elbowwrist disarticulation, ultralight material (titanium, carbon fiber or equal)   L7400
Addition to lower extremity, below knee, acrylic socket   L5629
Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric   L6711
Upper extremity addition, flexionextension wrist unit, with or without friction   L6620
Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device   L6950
Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed   L6590
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed   L5570
Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control   L5822
Custom shaped protective cover, knee disarticulation   L5706
Addition to lower extremity, below knee, leather socket   L5638
Electronic elbow, child, variety village or equal, myoelectronically controlled   L7191
Addition to lower extremity, below knee, cuff suspension   L5666
Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control   L5722
Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric   L6712
Addition to lower extremity, below knee, wood socket   L5639
Addition, endoskeletal knee-shin system, single axis, fluid swing phase control   L5824
Upper extremity prosthesis addition, flexionextension wrist with or without friction, for use with external powered terminal device   L6621
Addition, exoskeletal knee-shin system, single axis, fluid swing phase control   L5724
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model   L5580
Custom shaped protective cover, hip disarticulation   L5707
Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device   L6955
Electronic wrist rotator, any type   L7259
Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)   L7401
Addition to lower extremity, below knee, molded distal cushion   L5668
Upper extremity addition, spring assisted rotational wrist unit with latch release   L6623
Addition to upper extremity prosthesis, shoulder disarticulationinterscapular thoracic, ultralight material (titanium, carbon fiber or equal)   L7402
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket   L5585
Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)   L5670
Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric   L6713
Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control   L5726
Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame   L5826
Addition to lower extremity, knee disarticulation, leather socket   L5640
Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device   L6960
Upper extremity addition, flexionextension and rotation wrist unit   L6624
Addition to lower extremity, above knee, leather socket   L5642
Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control   L5828
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model   L5590
Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric   L6714
Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control   L5728
Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device   L6965
Addition to upper extremity prosthesis, below elbowwrist disarticulation, acrylic material   L7403
Addition to lower extremity, below knee above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert   L5671
Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement   L6715
Upper extremity addition, rotation wrist unit with cable lock   L6625
Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material   L7404
Addition to lower extremity, below knee, removable medial brim suspension   L5672
Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device   L6970
Addition, endoskeletal knee-shin system, single axis, pneumatic swing phase control   L5830
Addition to lower extremity, hip disarticulation, flexible inner socket, external frame   L5643
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model   L5595
Addition, exoskeletal knee-shin system, single axis, pneumatichydra pneumatic swing phase control   L5780
Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined   L6721
Addition to upper extremity prosthesis, shoulder disarticulationinterscapular thoracic, acrylic material   L7405
Addition, endoskeletal kneeshin system, 4-bar linkage or multiaxial, pneumatic swing phase control   L5840
Addition to lower extremity, below kneeabove knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism   L5673
Addition to lower extremity, above knee, wood socket   L5644
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model   L5600
Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device   L6975
Upper extremity addition, quick disconnect hook adapter, otto bock or equal   L6628
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system   L5781
Upper extremity prosthesis, not otherwise specified   L7499
Electric hand, switch or myoelectric controlled, adult   L7007
Additions to lower extremity, below knee, knee joints, single axis, pair   L5676
Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined   L6722
Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal   L6629
Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable   L5845
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty   L5782
Addition to lower extremity, below knee, flexible inner socket, external frame   L5645
Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability   L5848
Additions to lower extremity, below knee, knee joints, polycentric, pair   L5677
Electric hand, switch or myoelectric, controlled, pediatric   L7008
Upper extremity addition, stainless steel, any wrist   L6630
Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket   L5646
Addition to terminal device, modifier wrist unit   L6805
Electric hook, switch or myoelectric controlled, adult   L7009
Additions to lower extremity, below knee, joint covers, pair   L5678
Upper extremity addition, latex suspension sleeve, each   L6632
Addition to terminal device, precision pinch device   L6810
Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist   L5850
Addition to lower extremity, below knee suction socket   L5647
Upper extremity addition, lift assist for elbow   L6635
Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist   L5855
Prehensile actuator, switch controlled   L7040
Addition to lower extremity, below kneeabove knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism   L5679
Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)   L6880
Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket   L5648
Addition to lower extremity, ischial containmentnarrow m-l socket   L5649
Electric hook, switch or myoelectric controlled, pediatric   L7045
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type   L5856
Upper extremity addition, nudge control elbow lock   L6637
Addition to lower extremity, below knee, thigh lacer, nonmolded   L5680
Automatic grasp feature, addition to upper limb electric prosthetic terminal device   L6881
Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow   L6638
Microprocessor control feature, addition to upper limb prosthetic terminal device   L6882
Additions to lower extremity, total contact, above knee or knee disarticulation socket   L5650
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type   L5857
Addition to lower extremity, below kneeabove knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)   L5681
Replacement socket, below elbowwrist disarticulation, molded to patient model, for use with or without external power   L6883
Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type   L5858
Addition to lower extremity, below knee, thigh lacer, glutealischial, molded   L5682
Upper extremity additions, shoulder abduction joint, pair   L6640
Addition to lower extremity, above knee, flexible inner socket, external frame   L5651
Addition to lower extremity, suction suspension, above knee or knee disarticulation socket   L5652
Replacement socket, above elbowelbow disarticulation, molded to patient model, for use with or without external power   L6884
Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexionextension assist control, includes any type motor(s)   L5859
Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)   L5969
Upper extremity addition, excursion amplifier, pulley type   L6641
Addition to lower extremity, below kneeabove knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)   L5683
Addition to lower extremity, below knee, fork strap   L5684
Addition to lower extremity, knee disarticulation, expandable wall socket   L5653
Replacement socket, shoulder disarticulationinterscapular thoracic, molded to patient model, for use with or without external power   L6885
Addition, endoskeletal system, below knee, alignable system   L5910
Upper extremity addition, excursion amplifier, lever type   L6642
Upper extremity addition, shoulder flexion-abduction joint, each   L6645
Addition, endoskeletal system, above knee or hip disarticulation, alignable system   L5920
Addition to lower extremity prosthesis, below knee, suspensionsealing sleeve, with or without valve, any material, each   L5685
Addition to lower extremity, below knee, back check (extension control)   L5686
Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system   L6646
Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock   L5925
Addition to lower extremity, below knee, waist belt, webbing   L5688
Upper extremity addition, shoulder lock mechanism, body powered actuator   L6647
Addition, endoskeletal system, high activity knee control frame   L5930
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)   L5940
Addition to lower extremity, below knee, waist belt, padded and lined   L5690
Upper extremity addition, shoulder lock mechanism, external powered actuator   L6648
Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)   L5950
Addition to lower extremity, above knee, pelvic control belt, light   L5692
Upper extremity addition, shoulder universal joint, each   L6650
Addition to lower extremity, above knee, pelvic control belt, padded and lined   L5694
Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)   L5960
Upper extremity addition, standard control cable, extra   L6655
Upper extremity addition, heavy duty control cable   L6660
Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion andor extension control   L5961
Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each   L5695
Addition to lower extremity, above knee or knee disarticulation, pelvic joint   L5696
Upper extremity addition, teflon, or equal, cable lining   L6665
Addition, endoskeletal system, below knee, flexible protective outer surface covering system   L5962
Upper extremity addition, hook to hand, cable adapter   L6670
Addition to lower extremity, above knee or knee disarticulation, pelvic band   L5697
Addition, endoskeletal system, above knee, flexible protective outer surface covering system   L5964
Addition to lower extremity, above knee or knee disarticulation, silesian bandage   L5698
Upper extremity addition, harness, chest or shoulder, saddle type   L6672
Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system   L5966
Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature   L5968
All lower extremity prostheses, shoulder harness   L5699
Upper extremity addition, harness, (eg, figure of eight type), single cable design   L6675
Upper extremity addition, harness, (eg, figure of eight type), dual cable design   L6676
All lower extremity prostheses, foot, external keel, sach foot   L5970
All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only   L5971
Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow   L6677
All lower extremity prostheses, foot, flexible keel   L5972
Upper extremity addition, test socket, wrist disarticulation or below elbow   L6680
Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion andor plantar flexion control, includes power source   L5973
Upper extremity addition, test socket, elbow disarticulation or above elbow   L6682
Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic   L6684
All lower extremity prostheses, foot, single axis anklefoot   L5974
Upper extremity addition, suction socket   L6686
All lower extremity prosthesis, combination single axis ankle and flexible keel foot   L5975
All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)   L5976
Upper extremity addition, frame type socket, below elbow or wrist disarticulation   L6687
All lower extremity prostheses, foot, multiaxial anklefoot   L5978
Upper extremity addition, frame type socket, above elbow or elbow disarticulation   L6688
Upper extremity addition, frame type socket, shoulder disarticulation   L6689
All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system   L5979
Upper extremity addition, frame type socket, interscapular-thoracic   L6690
All lower extremity prostheses, flex foot system   L5980
Upper extremity addition, removable insert, each   L6691
All lower extremity prostheses, flex-walk system or equal   L5981
All exoskeletal lower extremity prostheses, axial rotation unit   L5982
Upper extremity addition, silicone gel insert or equal, each   L6692
All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability   L5984
Upper extremity addition, locking elbow, forearm counterbalance   L6693
Addition to upper extremity prosthesis, below elbowabove elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism   L6694
All endoskeletal lower extremity prostheses, dynamic prosthetic pylon   L5985
Addition to upper extremity prosthesis, below elbowabove elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism   L6695
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)   L5986
Addition to upper extremity prosthesis, below elbowabove elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)   L6696
All lower extremity prosthesis, shank foot system with vertical loading pylon   L5987
Addition to upper extremity prosthesis, below elbowabove elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)   L6697
Addition to lower limb prosthesis, vertical shock reducing pylon feature   L5988
Addition to lower extremity prosthesis, user adjustable heel height   L5990
Addition to upper extremity prosthesis, below elbowabove elbow, lock mechanism, excludes socket insert   L6698
Lower extremity prosthesis, not otherwise specified   L5999
Prosthetic sheath, below knee, each   L8400
Prosthetic sheath, above knee, each   L8410
Prosthetic sheath, upper limb, each   L8415
Prosthetic sheathsock, including a gel cushion layer, below knee or above knee, each   L8417
Prosthetic sock, multiple ply, below knee, each   L8420
Prosthetic sock, multiple ply, above knee, each   L8430
Prosthetic sock, multiple ply, upper limb, each   L8435
Prosthetic shrinker, below knee, each   L8440
Prosthetic shrinker, above knee, each   L8460
Prosthetic shrinker, upper limb, each   L8465
stump sock,   L8470 - L8485
Prosthetic sock, single ply, fitting, below knee, each   L8470
Prosthetic sock, single ply, fitting, above knee, each   L8480
Prosthetic sock, single ply, fitting, upper limb, each   L8485
wheelchair,   E1170 - E1190 , E1200, K0100
Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests   E1170
Amputee wheelchair, fixed full length arms, without footrests or legrest   E1171
Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest   E1172
Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests   E1180
Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests   E1190
Anti-neoplastic drug, NOC,   J9999
Amygdalin,   J3570
Anadulafungin,   J0348
Anistreplase,   J0350
Ankle splint, recumbent,   K0126 - K0130
Ankle-foot orthosis (AFO),   L1900 - L1990 , L2106 - L2116 , L4361, L4392, L4396
Ankle foot orthosis, plastic or other material, custom fabricated   L1940
Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated   L1900
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf   L1902
Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated   L1904
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf   L1906
Ankle orthosis, supramalleolar with straps, with or without interfacepads, custom fabricated   L1907
Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment   L1910
Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated   L1920
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment   L1930
Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment   L1932
Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated   L1945
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated   L1950
Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment   L1951
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated   L1960
Ankle foot orthosis, plastic with ankle joint, custom fabricated   L1970
Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment   L1971
Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf bandcuff (single bar 'bk' orthosis), custom fabricated   L1980
Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf bandcuff (double bar 'bk' orthosis), custom fabricated   L1990
Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated   L2106
Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated   L2108
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment   L2112
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment   L2114
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment   L2116
Anterior-posterior-lateral orthosis,   L0700, L0710
Anti-emetic, oral,   Q0163 - Q0181 , J8498, J8597
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen   Q0163
Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0164
Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen   Q0166
Dronabinol, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0167
Promethazine hydrochloride, 125 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0169
Trimethobenzamide hydrochloride, 250 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0173
Thiethylperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0174
Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0175
Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0177
Dolasetron mesylate, 100 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen   Q0180
Unspecified oral dosage form, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for a iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen   Q0181
Anti-hemophilic factor (Factor VIII),   J7190 - J7192
Factor viii (antihemophilic factor, human) per iu   J7190
Factor viii (antihemophilic factor (porcine)), per iu   J7191
Factor viii (antihemophilic factor, recombinant) per iu, not otherwise specified   J7192
Anti-inhibitors, per IU,   J7198
Antithrombin recombinant,   J7196
Apomorphine,   J0364
cleaner,   A5131
pneumatic,   E0655 - E0673
Non-segmental pneumatic appliance for use with pneumatic compressor, half arm   E0655
Segmental pneumatic appliance for use with pneumatic compressor, trunk   E0656
Segmental pneumatic appliance for use with pneumatic compressor, chest   E0657
Non-segmental pneumatic appliance for use with pneumatic compressor, full leg   E0660
Non-segmental pneumatic appliance for use with pneumatic compressor, full arm   E0665
Non-segmental pneumatic appliance for use with pneumatic compressor, half leg   E0666
Segmental pneumatic appliance for use with pneumatic compressor, full leg   E0667
Segmental pneumatic appliance for use with pneumatic compressor, full arm   E0668
Segmental pneumatic appliance for use with pneumatic compressor, half leg   E0669
Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk   E0670
Segmental gradient pressure pneumatic appliance, full leg   E0671
Segmental gradient pressure pneumatic appliance, full arm   E0672
Segmental gradient pressure pneumatic appliance, half leg   E0673
Aprotinin,   J0365
shunt,   L8612
sterile,   J705
Arbutamine HCl,   J0395
Arch support,   L3040 - L3100
Foot, arch support, non-removable attached to shoe, longitudinal, each   L3070
Foot, arch support, removable, premolded, longitudinal, each   L3040
Foot, arch support, non-removable attached to shoe, metatarsal, each   L3080
Foot, arch support, removable, premolded, metatarsal, each   L3050
Foot, arch support, removable, premolded, longitudinal metatarsal, each   L3060
Foot, arch support, non-removable attached to shoe, longitudinalmetatarsal, each   L3090
Hallus-valgus night dynamic splint, prefabricated, off-the-shelf   L3100
Intralesional,   J3302
Arformoterol,   J7605
Argatroban,   J0883 - J0884
Injection, argatroban, 1 mg (for non-esrd use)   J0883
Injection, argatroban, 1 mg (for esrd on dialysis)   J0884
Aripiprazole,   J0400, J0401, J1942
Arm, wheelchair,   E0973
Arsenic trioxide,   J9017
Cornea,   L8609
kidney machines and accessories (see also Dialysis),   E1510 - E1699
Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, iv poles, pressure gauge, concentrate container   E1510
Heparin infusion pump for hemodialysis   E1520
Air bubble detector for hemodialysis, each, replacement   E1530
Pressure alarm for hemodialysis, each, replacement   E1540
Bath conductivity meter for hemodialysis, each   E1550
Blood leak detector for hemodialysis, each, replacement   E1560
Adjustable chair, for esrd patients   E1570
Transducer protectorsfluid barriers, for hemodialysis, any size, per 10   E1575
Unipuncture control system for hemodialysis   E1580
Hemodialysis machine   E1590
Automatic intermittent peritoneal dialysis system   E1592
Cycler dialysis machine for peritoneal dialysis   E1594
Delivery andor installation charges for hemodialysis equipment   E1600
Reverse osmosis water purification system, for hemodialysis   E1610
Deionizer water purification system, for hemodialysis   E1615
Blood pump for hemodialysis, replacement   E1620
Water softening system, for hemodialysis   E1625
Reciprocating peritoneal dialysis system   E1630
Wearable artificial kidney, each   E1632
Peritoneal dialysis clamps, each   E1634
Compact (portable) travel hemodialyzer system   E1635
Sorbent cartridges, for hemodialysis, per 10   E1636
Hemostats, each   E1637
Scale, each   E1639
Dialysis equipment, not otherwise specified   E1699
larynx,   L8500
saliva,   A9155
Asparaginase,   J9019 - J9020
Injection, asparaginase (erwinaze), 1,000 iu   J9019
Injection, asparaginase, not otherwise specified, 10,000 units   J9020
audiologic,   V5008 - V5020
Hearing screening   V5008
Assessment for hearing aid   V5010
Fittingorientationchecking of hearing aid   V5011
Repairmodification of a hearing aid   V5014
Conformity evaluation   V5020
cardiac output,   M030
speech,   V5362 - V5364
Speech screening   V5362
Language screening   V5363
Dysphagia screening   V5364
Assistive Listening Devices and accessories,   V5281 - V5290
Assistive listening device, personal fmdm system, monaural, (1 receiver, transmitter, microphone), any type   V5281
Assistive listening device, personal fmdm system, binaural, (2 receivers, transmitter, microphone), any type   V5282
Assistive listening device, personal fmdm neck, loop induction receiver   V5283
Assistive listening device, personal fmdm, ear level receiver   V5284
Assistive listening device, personal fmdm, direct audio input receiver   V5285
Assistive listening device, personal blue tooth fmdm receiver   V5286
Assistive listening device, personal fmdm receiver, not otherwise specified   V5287
Assistive listening device, personal fmdm transmitter assistive listening device   V5288
Assistive listening device, personal fmdm adapterboot coupling device for receiver, any type   V5289
Assistive listening device, transmitter microphone, any type   V5290
Astramorph,   J227
Atropine, inhalation solution, concentrated,   J7635
Atropine, inhalation solution, unit dose,   J7636
Atropine sulfate,   J0461
Audiologic assessment,   V5008 - V5020
Hearing screening   V5008
Assessment for hearing aid   V5010
Fittingorientationchecking of hearing aid   V5011
Repairmodification of a hearing aid   V5014
Conformity evaluation   V5020
Auditory osseointegrated device,   L8690 - L8693
Auditory osseointegrated device, includes all internal and external components   L8690
Auditory osseointegrated device, external sound processor, replacement   L8691
Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment   L8692
Auditory osseointegrated device abutment, any length, replacement only   L8693
Aurothioglucose,   J2910
Azacitidine,   J9025
Azathioprine,   J7500, J7501
Azithromycin injection,   J0456