|
Dacarbazine, J9130
| |
|
Daclizumab, J7513
| |
|
Dactinomycin, J9120
| |
|
Dalalone, J1100
| |
|
Dalteparin,sodium J1645
| |
|
Dalbavancin J0875 |
|
|
Daptomycin, J0878
| |
|
Daratumumab, J9145
| |
|
Darbepoetin,Alfa J0881 - J0882 |
|
|
Injection, darbepoetin alfa, 1 microgram (non-esrd use) J0881
| |
|
Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) J0882
| |
|
Daunorubicin,Citrate J9151
| |
|
Daunorubicin,HCl J9150
| |
|
DaunoXome,see,Daunorubicin |
|
|
Decitabine, J0894
| |
|
Decubitus,care,equipment E0180 - E0199 |
|
|
Powered pressure reducing mattress overlaypad, alternating, with pump, includes heavy duty E0181
| |
|
Pump for alternating pressure pad, for replacement only E0182
| |
|
Dry pressure mattress E0184
| |
|
Gel or gel-like pressure pad for mattress, standard mattress length and width E0185
| |
|
Air pressure mattress E0186
| |
|
Water pressure mattress E0187
| |
|
Synthetic sheepskin pad E0188
| |
|
Lambswool sheepskin pad, any size E0189
| |
|
Positioning cushionpillowwedge, any shape or size, includes all components and accessories E0190
| |
|
Heel or elbow protector, each E0191
| |
|
Powered air flotation bed (low air loss therapy) E0193
| |
|
Air fluidized bed E0194
| |
|
Gel pressure mattress E0196
| |
|
Air pressure pad for mattress, standard mattress length and width E0197
| |
|
Water pressure pad for mattress, standard mattress length and width E0198
| |
|
Dry pressure pad for mattress, standard mattress length and width E0199
| |
|
Deferoxamine,mesylate J0895
| |
|
Defibrillator,external E0617, K0606 |
|
|
battery, K0607
| |
|
electrode, K0609
| |
|
garment, K0608
| |
|
Degarelix, J9155
| |
|
Deionizer,water,purification,system E1615
| |
|
Deliveryset-updispensing, A9901
| |
|
Denileukin,diftitox J9160
| |
|
Denosumab, J0897
| |
|
Depo-estradiol,cypionate J1000
| |
|
Desmopressin,acetate J2597
| |
|
Detector,blood,leak,dialysis E1560
| |
|
Dexamethasone,acetate J1094
| |
|
Dexamethasone,inhalation,solution,concentrated J7637
| |
|
Dexamethasone,inhalation,solution,unit,dose J7638
| |
|
Dexamethasone,intravitreal,implant J7312
| |
|
Dexamethasone,oral J8540
| |
|
Dexamethasone,sodium,phosphate J1100
| |
|
Dextran, J7100
| |
|
saline,(normal) J7042
| |
|
water J7060, J7070 |
|
|
Dextrose,in,lactated,ringers,infusion J7121 |
|
|
Dextrostick, A4772
| |
|
radiology,services R0070 - R0076 |
|
|
Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen R0070
| |
|
Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen R0075
| |
|
Transportation of portable ekg to facility or location, per patient R0076
| |
|
flutemetamol Q9982 |
|
|
florbetaben, Q9983
| |
|
Dialysate,concentrate,additives A4765
| |
|
Dialysate,solution A4728
| |
|
Dialysate,testing,solution A4760
| |
|
air,bubble,detector E1530
| |
|
bath,conductivity,meter E1550
| |
|
chemicalsantiseptics,solution A4674
| |
|
disposable,cycler,set A4671
| |
|
equipment, E1510 - E1702 |
|
|
Jaw motion rehabilitation system E1700
| |
|
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
| |
|
Replacement cushions for jaw motion rehabilitation system, pkg of 6 E1701
| |
|
Replacement measuring scales for jaw motion rehabilitation system, pkg of 200 E1702
| |
|
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
| |
|
extension,line A4672 - A4673 |
|
|
Drainage extension line, sterile, for dialysis, each A4672
| |
|
Extension line with easy lock connectors, used with dialysis A4673
| |
|
filter, A4680
| |
|
fluid,barrier E1575
| |
|
kit, A482 |
|
|
pressure,alarm E1540
| |
|
shunt, A4740
| |
|
supplies, A4650 - A4927 |
|
|
Peritoneal dialysis catheter anchoring device, belt, each A4653
| |
|
Syringe, with or without needle, each A4657
| |
|
Implantable radiation dosimeter, each A4650
| |
|
Sphygmomanometerblood pressure apparatus with cuff and stethoscope A4660
| |
|
Blood pressure cuff only A4663
| |
|
Calibrated microcapillary tube, each A4651
| |
|
Microcapillary tube sealant A4652
| |
|
Automatic blood pressure monitor A4670
| |
|
Disposable cycler set used with cycler dialysis machine, each A4671
| |
|
Drainage extension line, sterile, for dialysis, each A4672
| |
|
Extension line with easy lock connectors, used with dialysis A4673
| |
|
Chemicalsantiseptics solution used to cleansterilize dialysis equipment, per 8 oz A4674
| |
|
Activated carbon filter for hemodialysis, each A4680
| |
|
Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each A4690
| |
|
Bicarbonate concentrate, solution, for hemodialysis, per gallon A4706
| |
|
Bicarbonate concentrate, powder, for hemodialysis, per packet A4707
| |
|
Acetate concentrate solution, for hemodialysis, per gallon A4708
| |
|
Acid concentrate, solution, for hemodialysis, per gallon A4709
| |
|
Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon A4714
| |
|
y set tubing for peritoneal dialysis A4719
| |
|
Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis A4720
| |
|
Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis A4721
| |
|
Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis A4722
| |
|
Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis A4723
| |
|
Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis A4724
| |
|
Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis A4725
| |
|
Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis A4726
| |
|
Dialysate solution, non-dextrose containing, 500 ml A4728
| |
|
Fistula cannulation set for hemodialysis, each A4730
| |
|
Topical anesthetic, for dialysis, per gram A4736
| |
|
Injectable anesthetic, for dialysis, per 10 ml A4737
| |
|
Shunt accessory, for hemodialysis, any type, each A4740
| |
|
Blood tubing, arterial or venous, for hemodialysis, each A4750
| |
|
Blood tubing, arterial and venous combined, for hemodialysis, each A4755
| |
|
Dialysate solution test kit, for peritoneal dialysis, any type, each A4760
| |
|
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet A4765
| |
|
Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml A4766
| |
|
Blood collection tube, vacuum, for dialysis, per 50 A4770
| |
|
Serum clotting time tube, for dialysis, per 50 A4771
| |
|
Blood glucose test strips, for dialysis, per 50 A4772
| |
|
Occult blood test strips, for dialysis, per 50 A4773
| |
|
Ammonia test strips, for dialysis, per 50 A4774
| |
|
Protamine sulfate, for hemodialysis, per 50 mg A4802
| |
|
Disposable catheter tips for peritoneal dialysis, per 10 A4860
| |
|
Plumbing andor electrical work for home hemodialysis equipment A4870
| |
|
Contracts, repair and maintenance, for hemodialysis equipment A4890
| |
|
Drain bagbottle, for dialysis, each A4911
| |
|
Miscellaneous dialysis supplies, not otherwise specified A4913
| |
|
Venous pressure clamp, for hemodialysis, each A4918
| |
|
Gloves, non-sterile, per 100 A4927
| |
|
tourniquet, A4929
| |
|
unipuncture,control,system E1580
| |
|
venous,pressure,clamp A4918
| |
|
incontinence,supply,rectal,insert,any,type,each A4337
| |
|
disposable,penile,wrap T4545
| |
|
lower,extremities,prosthesis L5000 - L5999 |
|
|
Dialyzer, A4690
| |
|
Diaper T1500, T4521 - T4540 , T4543, T4544 |
|
|
Adult sized disposable incontinence product, briefdiaper, small, each T4521
| |
|
Adult sized disposable incontinence product, briefdiaper, medium, each T4522
| |
|
Adult sized disposable incontinence product, briefdiaper, large, each T4523
| |
|
Adult sized disposable incontinence product, briefdiaper, extra large, each T4524
| |
|
Adult sized disposable incontinence product, protective underwearpull-on, small size, each T4525
| |
|
Adult sized disposable incontinence product, protective underwearpull-on, medium size, each T4526
| |
|
Adult sized disposable incontinence product, protective underwearpull-on, large size, each T4527
| |
|
Adult sized disposable incontinence product, protective underwearpull-on, extra large size, each T4528
| |
|
Pediatric sized disposable incontinence product, briefdiaper, smallmedium size, each T4529
| |
|
Pediatric sized disposable incontinence product, briefdiaper, large size, each T4530
| |
|
Pediatric sized disposable incontinence product, protective underwearpull-on, smallmedium size, each T4531
| |
|
Pediatric sized disposable incontinence product, protective underwearpull-on, large size, each T4532
| |
|
Youth sized disposable incontinence product, briefdiaper, each T4533
| |
|
Youth sized disposable incontinence product, protective underwearpull-on, each T4534
| |
|
Disposable linershieldguardpadundergarment, for incontinence, each T4535
| |
|
Incontinence product, protective underwearpull-on, reusable, any size, each T4536
| |
|
Incontinence product, protective underpad, reusable, bed size, each T4537
| |
|
Diaper service, reusable diaper, each diaper T4538
| |
|
Incontinence product, diaperbrief, reusable, any size, each T4539
| |
|
Incontinence product, protective underpad, reusable, chair size, each T4540
| |
|
Diaper,adult,incontinence,garment A4520, A4553 |
|
|
Diazepam, J3360
| |
|
Diazoxide, J1730
| |
|
Diclofenac, J1130
| |
|
Dicyclomine,HCl J0500
| |
|
Diethylstilbestrol,diphosphate J9165
| |
|
Digoxin, J1160
| |
|
Digoxin,immune,fab,(ovine) J1162
| |
|
Dihydroergotamine,mesylate J1110
| |
|
Dimenhydrinate, J1240
| |
|
Dimercaprol, J0470
| |
|
Dimethyl,sulfoxide,(DMSO) J1212
| |
|
Diphenhydramine,HCl J1200
| |
|
Dipyridamole, J1245
| |
|
upper,extremities,prosthesis L6000 - L6692 |
|
|
Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping L6400
| |
|
Above elbow, molded double wall socket, internal locking elbow, forearm L6250
| |
|
Upper extremity additions, polycentric hinge, pair L6600
| |
|
Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping L6500
| |
|
Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm L6300
| |
|
Partial hand, thumb remaining L6000
| |
|
Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping L6450
| |
|
Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad L6050
| |
|
Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm L6350
| |
|
Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping L6570
| |
|
Elbow disarticulation, molded socket, outside locking hinge, forearm L6200
| |
|
Below elbow, molded socket, flexible elbow hinge, triceps pad L6100
| |
|
Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping L6550
| |
|
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
| |
|
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
| |
|
Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad L6055
| |
|
Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm L6205
| |
|
Below elbow, molded socket, (muenster or northwestern suspension types) L6110
| |
|
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
| |
|
Shoulder disarticulation, passive restoration (complete prosthesis) L6310
| |
|
Interscapular thoracic, passive restoration (complete prosthesis) L6360
| |
|
Upper extremity additions, single pivot hinge, pair L6605
| |
|
Partial hand, little andor ring finger remaining L6010
| |
|
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
| |
|
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
| |
|
Below elbow, molded double wall split socket, step-up hinges, half cuff L6120
| |
|
Shoulder disarticulation, passive restoration (shoulder cap only) L6320
| |
|
Partial hand, no finger remaining L6020
| |
|
Interscapular thoracic, passive restoration (shoulder cap only) L6370
| |
|
Upper extremity additions, flexible metal hinge, pair L6610
| |
|
Immediate post surgical or early fitting, each additional cast change and realignment L6386
| |
|
Addition to upper extremity prosthesis, external powered, additional switch, any type L6611
| |
|
Below elbow, molded double wall split socket, stump activated locking hinge, half cuff L6130
| |
|
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
| |
|
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
| |
|
Upper extremity addition, disconnect locking wrist unit L6615
| |
|
Immediate post surgical or early fitting, application of rigid dressing only L6388
| |
|
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
| |
|
Upper extremity addition, additional disconnect insert for locking wrist unit, each L6616
| |
|
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
| |
|
Upper extremity addition, flexionextension wrist unit, with or without friction L6620
| |
|
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
| |
|
Upper extremity prosthesis addition, flexionextension wrist with or without friction, for use with external powered terminal device L6621
| |
|
Upper extremity addition, spring assisted rotational wrist unit with latch release L6623
| |
|
Upper extremity addition, flexionextension and rotation wrist unit L6624
| |
|
Upper extremity addition, rotation wrist unit with cable lock L6625
| |
|
Upper extremity addition, quick disconnect hook adapter, otto bock or equal L6628
| |
|
Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal L6629
| |
|
Upper extremity addition, stainless steel, any wrist L6630
| |
|
Upper extremity addition, latex suspension sleeve, each L6632
| |
|
Upper extremity addition, lift assist for elbow L6635
| |
|
Upper extremity addition, nudge control elbow lock L6637
| |
|
Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow L6638
| |
|
Upper extremity additions, shoulder abduction joint, pair L6640
| |
|
Upper extremity addition, excursion amplifier, pulley type L6641
| |
|
Upper extremity addition, excursion amplifier, lever type L6642
| |
|
Upper extremity addition, shoulder flexion-abduction joint, each L6645
| |
|
Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system L6646
| |
|
Upper extremity addition, shoulder lock mechanism, body powered actuator L6647
| |
|
Upper extremity addition, shoulder lock mechanism, external powered actuator L6648
| |
|
Upper extremity addition, shoulder universal joint, each L6650
| |
|
Upper extremity addition, standard control cable, extra L6655
| |
|
Upper extremity addition, heavy duty control cable L6660
| |
|
Upper extremity addition, teflon, or equal, cable lining L6665
| |
|
Upper extremity addition, hook to hand, cable adapter L6670
| |
|
Upper extremity addition, harness, chest or shoulder, saddle type L6672
| |
|
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
| |
|
Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow L6677
| |
|
Upper extremity addition, test socket, wrist disarticulation or below elbow L6680
| |
|
Upper extremity addition, test socket, elbow disarticulation or above elbow L6682
| |
|
Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic L6684
| |
|
Upper extremity addition, suction socket L6686
| |
|
Upper extremity addition, frame type socket, below elbow or wrist disarticulation L6687
| |
|
Upper extremity addition, frame type socket, above elbow or elbow disarticulation L6688
| |
|
Upper extremity addition, frame type socket, shoulder disarticulation L6689
| |
|
Upper extremity addition, frame type socket, interscapular-thoracic L6690
| |
|
Upper extremity addition, removable insert, each L6691
| |
|
Upper extremity addition, silicone gel insert or equal, each L6692
| |
|
Disposable,supplies,ambulance A0382, A0384, A0392 , A0398 |
|
|
DMSO, J1212
| |
|
Dobutamine,HCl J1250
| |
|
Docetaxel, J9171
| |
|
Dolasetron,mesylate J1260
| |
|
Dome,and,mouthpiece,(for,nebulizer) A7016
| |
|
Dopamine,HCl J1265
| |
|
Doripenem, J1267
| |
|
Dornase,alpha,inhalation,solution,unit,dose,form J7639
| |
|
Doxercalciferol, J1270
| |
|
Doxil, J900 |
|
|
Doxorubicin,HCl J9000, J9002 |
|
|
bag A4357, A4358 |
|
|
board,postural E0606
| |
|
bottle, A5102
| |
|
Dressing,(see,also,Bandage) A6020 - A6406 |
|
|
Collagen dressing, sterile, size 16 sq in or less, each A6021
| |
|
Collagen dressing, sterile, size more than 16 sq in but less than or equal to 48 sq in, each A6022
| |
|
Collagen dressing, sterile, size more than 48 sq in, each A6023
| |
|
Collagen dressing wound filler, sterile, per 6 inches A6024
| |
|
Gel sheet for dermal or epidermal application, (eg, silicone, hydrogel, other), each A6025
| |
|
Wound pouch, each A6154
| |
|
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
| |
|
Composite dressing, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6203
| |
|
Composite dressing, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6204
| |
|
Composite dressing, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6205
| |
|
Contact layer, sterile, 16 sq in or less, each dressing A6206
| |
|
Contact layer, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing A6207
| |
|
Contact layer, sterile, more than 48 sq in, each dressing A6208
| |
|
Foam dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6209
| |
|
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6210
| |
|
Foam dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6211
| |
|
Foam dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6212
| |
|
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6213
| |
|
Foam dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6214
| |
|
Foam dressing, wound filler, sterile, per gram A6215
| |
|
Gauze, non-impregnated, non-sterile, pad size 16 sq in or less, without adhesive border, each dressing A6216
| |
|
Gauze, non-impregnated, non-sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6217
| |
|
Gauze, non-impregnated, non-sterile, pad size more than 48 sq in, without adhesive border, each dressing A6218
| |
|
Gauze, non-impregnated, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6219
| |
|
Gauze, non-impregnated, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6220
| |
|
Gauze, non-impregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6221
| |
|
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6222
| |
|
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq in, but less than or equal to 48 sq in, without adhesive border, each dressing A6223
| |
|
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6224
| |
|
Gauze, impregnated, water or normal saline, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6228
| |
|
Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6229
| |
|
Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6230
| |
|
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq in or less, each dressing A6231
| |
|
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq in, but less than or equal to 48 sq in, each dressing A6232
| |
|
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq in, each dressing A6233
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6234
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6235
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6236
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6237
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6238
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6239
| |
|
Hydrocolloid dressing, wound filler, paste, sterile, per ounce A6240
| |
|
Hydrocolloid dressing, wound filler, dry form, sterile, per gram A6241
| |
|
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6242
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6243
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6244
| |
|
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6245
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6246
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6247
| |
|
Hydrogel dressing, wound filler, gel, per fluid ounce A6248
| |
|
Skin sealants, protectants, moisturizers, ointments, any type, any size A6250
| |
|
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
| |
|
Transparent film, sterile, 16 sq in or less, each dressing A6257
| |
|
Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing A6258
| |
|
Transparent film, sterile, more than 48 sq in, each dressing A6259
| |
|
Wound cleansers, any type, any size A6260
| |
|
Wound filler, gelpaste, per fluid ounce, not otherwise specified A6261
| |
|
Wound filler, dry form, per gram, not otherwise specified A6262
| |
|
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard A6266
| |
|
Gauze, non-impregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6402
| |
|
Gauze, non-impregnated, sterile, pad size more than 16 sq in less than or equal to 48 sq in, without adhesive border, each dressing A6403
| |
|
Gauze, non-impregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6404
| |
|
alginate, 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
| |
|
collagen, A6020 - A6024 |
|
|
Collagen dressing, sterile, size 16 sq in or less, each A6021
| |
|
Collagen dressing, sterile, size more than 16 sq in but less than or equal to 48 sq in, each A6022
| |
|
Collagen dressing, sterile, size more than 48 sq in, each A6023
| |
|
Collagen dressing wound filler, sterile, per 6 inches A6024
| |
|
composite, A6200 - A6205 |
|
|
Composite dressing, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6203
| |
|
Composite dressing, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6204
| |
|
Composite dressing, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6205
| |
|
contact,layer A6206 - A6208 |
|
|
Contact layer, sterile, 16 sq in or less, each dressing A6206
| |
|
Contact layer, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing A6207
| |
|
Contact layer, sterile, more than 48 sq in, each dressing A6208
| |
|
foam, A6209 - A6215 |
|
|
Foam dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6209
| |
|
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6210
| |
|
Foam dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6211
| |
|
Foam dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6212
| |
|
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6213
| |
|
Foam dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6214
| |
|
Foam dressing, wound filler, sterile, per gram A6215
| |
|
gauze A6216 - A6230 , A6402 - A6406 |
|
|
Gauze, non-impregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6402
| |
|
Gauze, non-impregnated, sterile, pad size more than 16 sq in less than or equal to 48 sq in, without adhesive border, each dressing A6403
| |
|
Gauze, non-impregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6404
| |
|
Gauze, non-impregnated, non-sterile, pad size 16 sq in or less, without adhesive border, each dressing A6216
| |
|
Gauze, non-impregnated, non-sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6217
| |
|
Gauze, non-impregnated, non-sterile, pad size more than 48 sq in, without adhesive border, each dressing A6218
| |
|
Gauze, non-impregnated, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6219
| |
|
Gauze, non-impregnated, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6220
| |
|
Gauze, non-impregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6221
| |
|
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6222
| |
|
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq in, but less than or equal to 48 sq in, without adhesive border, each dressing A6223
| |
|
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6224
| |
|
Gauze, impregnated, water or normal saline, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6228
| |
|
Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6229
| |
|
Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6230
| |
|
Gauze, non-impregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6402
| |
|
Gauze, non-impregnated, sterile, pad size more than 16 sq in less than or equal to 48 sq in, without adhesive border, each dressing A6403
| |
|
Gauze, non-impregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6404
| |
|
holderbinder, A446 |
|
|
hydrocolloid, A6234 - A6241 |
|
|
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6234
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6235
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6236
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6237
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6238
| |
|
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6239
| |
|
Hydrocolloid dressing, wound filler, paste, sterile, per ounce A6240
| |
|
Hydrocolloid dressing, wound filler, dry form, sterile, per gram A6241
| |
|
hydrogel, A6242 - A6248 |
|
|
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing A6242
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing A6243
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6244
| |
|
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing A6245
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing A6246
| |
|
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing A6247
| |
|
Hydrogel dressing, wound filler, gel, per fluid ounce A6248
| |
|
specialty,absorptive 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
| |
|
transparent,film A6257 - A6259 |
|
|
Transparent film, sterile, 16 sq in or less, each dressing A6257
| |
|
Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing A6258
| |
|
Transparent film, sterile, more than 48 sq in, each dressing A6259
| |
|
tubular, A6457
| |
|
Droperidol, J1790
| |
|
and,fentanyl,citrate J1810
| |
|
Dropper, A4649
| |
|
Drugs,(see,also,Table,of |
|
|
administered,through,a,metered,dose,inhaler J3535
| |
|
chemotherapy, J8500 - J9999 |
|
|
Aprepitant, oral, 5 mg J8501
| |
|
Busulfan oral, 2 mg J8510
| |
|
Cabergoline, oral, 025 mg J8515
| |
|
Capecitabine, oral, 150 mg J8520
| |
|
Capecitabine, oral, 500 mg J8521
| |
|
Cyclophosphamide oral, 25 mg J8530
| |
|
Dexamethasone, oral, 025 mg J8540
| |
|
Etoposide oral, 50 mg J8560
| |
|
Fludarabine phosphate, oral, 10 mg J8562
| |
|
Gefitinib, oral, 250 mg J8565
| |
|
Antiemetic drug, oral, not otherwise specified J8597
| |
|
Melphalan oral, 2 mg J8600
| |
|
Methotrexate oral, 25 mg J8610
| |
|
Nabilone, oral, 1 mg J8650
| |
|
Netupitant 300 mg and palonosetron 05 mg J8655
| |
|
Rolapitant, oral, 1 mg J8670
| |
|
Temozolomide, oral, 5 mg J8700
| |
|
Topotecan, oral, 025 mg J8705
| |
|
Prescription drug, oral, chemotherapeutic, nos J8999
| |
|
Injection, doxorubicin hydrochloride, 10 mg J9000
| |
|
Injection, aldesleukin, per single use vial J9015
| |
|
Injection, arsenic trioxide, 1 mg J9017
| |
|
Injection, asparaginase (erwinaze), 1,000 iu J9019
| |
|
Injection, asparaginase, not otherwise specified, 10,000 units J9020
| |
|
Injection, atezolizumab, 10 mg J9022
| |
|
Injection, avelumab, 10 mg J9023
| |
|
Injection, azacitidine, 1 mg J9025
| |
|
Injection, clofarabine, 1 mg J9027
| |
|
Bcg (intravesical) per instillation J9031
| |
|
Injection, belinostat, 10 mg J9032
| |
|
Injection, bendamustine hcl (treanda), 1 mg J9033
| |
|
Injection, bendamustine hcl (bendeka), 1 mg J9034
| |
|
Injection, bevacizumab, 10 mg J9035
| |
|
Injection, blinatumomab, 1 microgram J9039
| |
|
Injection, bleomycin sulfate, 15 units J9040
| |
|
Injection, bortezomib, 01 mg J9041
| |
|
Injection, brentuximab vedotin, 1 mg J9042
| |
|
Injection, cabazitaxel, 1 mg J9043
| |
|
Injection, carboplatin, 50 mg J9045
| |
|
Injection, carfilzomib, 1 mg J9047
| |
|
Injection, carmustine, 100 mg J9050
| |
|
Injection, cetuximab, 10 mg J9055
| |
|
Injection, cisplatin, powder or solution, 10 mg J9060
| |
|
Injection, cladribine, per 1 mg J9065
| |
|
Cyclophosphamide, 100 mg J9070
| |
|
Injection, cytarabine liposome, 10 mg J9098
| |
|
Injection, cytarabine, 100 mg J9100
| |
|
Injection, dactinomycin, 05 mg J9120
| |
|
Dacarbazine, 100 mg J9130
| |
|
Injection, daratumumab, 10 mg J9145
| |
|
Injection, daunorubicin, 10 mg J9150
| |
|
Injection, daunorubicin citrate, liposomal formulation, 10 mg J9151
| |
|
Injection, degarelix, 1 mg J9155
| |
|
Injection, denileukin diftitox, 300 micrograms J9160
| |
|
Injection, diethylstilbestrol diphosphate, 250 mg J9165
| |
|
Injection, docetaxel, 1 mg J9171
| |
|
Injection, elliotts' b solution, 1 ml J9175
| |
|
Injection, elotuzumab, 1 mg J9176
| |
|
Injection, epirubicin hcl, 2 mg J9178
| |
|
Injection, eribulin mesylate, 01 mg J9179
| |
|
Injection, etoposide, 10 mg J9181
| |
|
Injection, fludarabine phosphate, 50 mg J9185
| |
|
Injection, fluorouracil, 500 mg J9190
| |
|
Injection, floxuridine, 500 mg J9200
| |
|
Injection, gemcitabine hydrochloride, 200 mg J9201
| |
|
Goserelin acetate implant, per 36 mg J9202
| |
|
Injection, gemtuzumab ozogamicin, 01 mg J9203
| |
|
Injection, irinotecan liposome, 1 mg J9205
| |
|
Injection, irinotecan, 20 mg J9206
| |
|
Injection, ixabepilone, 1 mg J9207
| |
|
Injection, ifosfamide, 1 gram J9208
| |
|
Injection, mesna, 200 mg J9209
| |
|
Injection, idarubicin hydrochloride, 5 mg J9211
| |
|
Injection, interferon alfacon-1, recombinant, 1 microgram J9212
| |
|
Injection, interferon, alfa-2a, recombinant, 3 million units J9213
| |
|
Injection, interferon, alfa-2b, recombinant, 1 million units J9214
| |
|
Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu J9215
| |
|
Injection, interferon, gamma 1-b, 3 million units J9216
| |
|
Leuprolide acetate (for depot suspension), 75 mg J9217
| |
|
Leuprolide acetate, per 1 mg J9218
| |
|
Leuprolide acetate implant, 65 mg J9219
| |
|
Histrelin implant (vantas), 50 mg J9225
| |
|
Histrelin implant (supprelin la), 50 mg J9226
| |
|
Injection, ipilimumab, 1 mg J9228
| |
|
Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg J9230
| |
|
Injection, melphalan hydrochloride, 50 mg J9245
| |
|
Methotrexate sodium, 5 mg J9250
| |
|
Methotrexate sodium, 50 mg J9260
| |
|
Injection, nelarabine, 50 mg J9261
| |
|
Injection, omacetaxine mepesuccinate, 001 mg J9262
| |
|
Injection, oxaliplatin, 05 mg J9263
| |
|
Injection, paclitaxel protein-bound particles, 1 mg J9264
| |
|
Injection, pegaspargase, per single dose vial J9266
| |
|
Injection, paclitaxel, 1 mg J9267
| |
|
Injection, pentostatin, 10 mg J9268
| |
|
Injection, plicamycin, 25 mg J9270
| |
|
Injection, pembrolizumab, 1 mg J9271
| |
|
Injection, mitomycin, 5 mg J9280
| |
|
Injection, olaratumab, 10 mg J9285
| |
|
Injection, mitoxantrone hydrochloride, per 5 mg J9293
| |
|
Injection, necitumumab, 1 mg J9295
| |
|
Injection, nivolumab, 1 mg J9299
| |
|
Injection, gemtuzumab ozogamicin, 5 mg J9300
| |
|
Injection, obinutuzumab, 10 mg J9301
| |
|
Injection, ofatumumab, 10 mg J9302
| |
|
Injection, panitumumab, 10 mg J9303
| |
|
Injection, pemetrexed, 10 mg J9305
| |
|
Injection, pertuzumab, 1 mg J9306
| |
|
Injection, pralatrexate, 1 mg J9307
| |
|
Injection, ramucirumab, 5 mg J9308
| |
|
Injection, rituximab, 100 mg J931 |
|
|
Injection, romidepsin, 1 mg J9315
| |
|
Injection, streptozocin, 1 gram J9320
| |
|
Injection, talimogene laherparepvec, per 1 million plaque forming units J9325
| |
|
Injection, temozolomide, 1 mg J9328
| |
|
Injection, temsirolimus, 1 mg J9330
| |
|
Injection, thiotepa, 15 mg J9340
| |
|
Injection, topotecan, 01 mg J9351
| |
|
Injection, trabectedin, 01 mg J9352
| |
|
Injection, ado-trastuzumab emtansine, 1 mg J9354
| |
|
Injection, trastuzumab, 10 mg J9355
| |
|
Injection, valrubicin, intravesical, 200 mg J9357
| |
|
Injection, vinblastine sulfate, 1 mg J9360
| |
|
Vincristine sulfate, 1 mg J9370
| |
|
Injection, vincristine sulfate liposome, 1 mg J9371
| |
|
Injection, vinorelbine tartrate, 10 mg J9390
| |
|
Injection, fulvestrant, 25 mg J9395
| |
|
Injection, ziv-aflibercept, 1 mg J9400
| |
|
Injection, porfimer sodium, 75 mg J9600
| |
|
Not otherwise classified, antineoplastic drugs J9999
| |
|
disposable,delivery,system,ml,or,less,per,hour A4306 |
|
|
disposable,delivery,system,ml,or,greater,per,hour A4305 |
|
|
immunosuppressive, J7500 - J7599 |
|
|
Azathioprine, oral, 50 mg J7500
| |
|
Azathioprine, parenteral, 100 mg J7501
| |
|
Cyclosporine, oral, 100 mg J7502
| |
|
Tacrolimus, extended release, (envarsus xr), oral, 025 mg J7503
| |
|
Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg J7504
| |
|
Muromonab-cd3, parenteral, 5 mg J7505
| |
|
Tacrolimus, immediate release, oral, 1 mg J7507
| |
|
Tacrolimus, extended release, (astagraf xl), oral, 01 mg J7508
| |
|
Methylprednisolone oral, per 4 mg J7509
| |
|
Prednisolone oral, per 5 mg J7510
| |
|
Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg J7511
| |
|
Prednisone, immediate release or delayed release, oral, 1 mg J7512
| |
|
Daclizumab, parenteral, 25 mg J7513
| |
|
Cyclosporine, oral, 25 mg J7515
| |
|
Cyclosporin, parenteral, 250 mg J7516
| |
|
Mycophenolate mofetil, oral, 250 mg J7517
| |
|
Mycophenolic acid, oral, 180 mg J7518
| |
|
Sirolimus, oral, 1 mg J7520
| |
|
Tacrolimus, parenteral, 5 mg J7525
| |
|
Everolimus, oral, 025 mg J7527
| |
|
Immunosuppressive drug, not otherwise classified J7599
| |
|
infusion,supplies A4230 - A4232 , A4221, A4222 |
|
|
Infusion set for external insulin pump, non needle cannula type A4230
| |
|
Infusion set for external insulin pump, needle type A4231
| |
|
Syringe with needle for external insulin pump, sterile, 3 cc A4232
| |
|
inhalation,solutions J7608 - J7699 |
|
|
Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram J7608
| |
|
Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg J7609
| |
|
Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg J7610
| |
|
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg J7611
| |
|
Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 05 mg J7612
| |
|
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613
| |
|
Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 05 mg J7614
| |
|
Levalbuterol, inhalation solution, compounded product, administered through dme, unit dose, 05 mg J7615
| |
|
Albuterol, up to 25 mg and ipratropium bromide, up to 05 mg, fda-approved final product, non-compounded, administered through dme J7620
| |
|
Beclomethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7622
| |
|
Betamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7624
| |
|
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 05 mg J7626
| |
|
Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 05 mg J7627
| |
|
Bitolterol mesylate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7628
| |
|
Bitolterol mesylate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7629
| |
|
Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams J7631
| |
|
Cromolyn sodium, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams J7632
| |
|
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 025 milligram J7633
| |
|
Budesonide, inhalation solution, compounded product, administered through dme, concentrated form, per 025 milligram J7634
| |
|
Atropine, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7635
| |
|
Atropine, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7636
| |
|
Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7637
| |
|
Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7638
| |
|
Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram J7639
| |
|
Formoterol, inhalation solution, compounded product, administered through dme, unit dose form, 12 micrograms J7640
| |
|
Flunisolide, inhalation solution, compounded product, administered through dme, unit dose, per milligram J7641
| |
|
Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7642
| |
|
Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7643
| |
|
Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram J7644
| |
|
Ipratropium bromide, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7645
| |
|
Isoetharine hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7647
| |
|
Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram J7648
| |
|
Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram J7649
| |
|
Isoetharine hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7650
| |
|
Isoproterenol hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7657
| |
|
Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram J7658
| |
|
Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram J7659
| |
|
Isoproterenol hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7660
| |
|
Mannitol, administered through an inhaler, 5 mg J7665
| |
|
Metaproterenol sulfate, inhalation solution, compounded product, concentrated form, per 10 milligrams J7667
| |
|
Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 10 milligrams J7668
| |
|
Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams J7669
| |
|
Metaproterenol sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams J7670
| |
|
Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg J7674
| |
|
Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg J7676
| |
|
Terbutaline sulfate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7680
| |
|
Terbutaline sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7681
| |
|
Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams J7682
| |
|
Triamcinolone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram J7683
| |
|
Triamcinolone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram J7684
| |
|
Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams J7685
| |
|
Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 174 mg J7686
| |
|
Noc drugs, inhalation solution administered through dme J7699
| |
|
not,otherwise,classified J3490, J7599, J7699, J7799, J7999, J8499, J8999, J9999 |
|
|
prescription,oral J8499, J8999 |
|
|
Dry,pressure,padmattress E0179, E0184, E0199 |
|
|
Durable,medical,equipment,(DME),K E0100 - E1830 |
|
|
Wheelchair specially sized or constructed, (indicate brand name, model number, if any) and justification E1220
| |
|
Walker, rigid (pickup), adjustable or fixed height E0130
| |
|
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery E0550
| |
|
Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests E1050
| |
|
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation E0720
| |
|
Platform attachment, forearm crutch, each E0153
| |
|
Dynamic adjustable elbow extensionflexion device, includes soft interface material E1800
| |
|
Jaw motion rehabilitation system E1700
| |
|
Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) E0610
| |
|
Centrifuge, for dialysis E1500
| |
|
Traction frame, attached to footboard, extremity traction, (eg, buck's) E0870
| |
|
Oxygen accessory, flow regulator capable of positive inspiratory pressure E1352
| |
|
Stationary compressed gaseous oxygen system, rental includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing E0424
| |
|
Cane, includes canes of all materials, adjustable or fixed, with tip E0100
| |
|
Traction frame, attached to footboard, pelvic traction E0890
| |
|
Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips E0110
| |
|
Iv pole E0776
| |
|
Ambulatory traction device, all types, each E0830
| |
|
Traction frame, attached to headboard, cervical traction E0840
| |
|
Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests E1100
| |
|
Traction equipment, overdoor, cervical E0860
| |
|
Heat lamp, without stand (table model), includes bulb, or infrared element E0200
| |
|
Restraints, any type (body, chest, wrist or ankle) E0710
| |
|
Trapeze bars, aka patient helper, attached to bed, with grab bar E0910
| |
|
Whirlpool, portable (overtub type) E1300
| |
|
Sling or seat, patient lift, canvas or nylon E0621
| |
|
Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest E1240
| |
|
Regulator E1353
| |
|
Bathshower chair, with or without wheels, any size E0240
| |
|
Home blood glucose monitor E0607
| |
|
Hospital bed, fixed height, with any type side rails, with mattress E0250
| |
|
Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests E1170
| |
|
Powered pressure reducing mattress overlaypad, alternating, with pump, includes heavy duty E0181
| |
|
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests E1130
| |
|
Wheelchair accessory, tray, each E0950
| |
|
Sitz type bath or equipment, portable, used with or without commode E0160
| |
|
Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests E1280
| |
|
Respiratory suction pump, home model, portable or stationary, electric E0600
| |
|
Ippb machine, all types, with built-in nebulization manual or automatic valves internal or external power source E0500
| |
|
Rollabout chair, any and all types with casters 5 or greater E1031
| |
|
Safety equipment, device or accessory, any type E0700
| |
|
Pneumatic compressor, non-segmental home model E0650
| |
|
Traction stand, free standing, extremity traction, (eg, buck's) E0880
| |
|
Transfer device, any type, each E0705
| |
|
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
| |
|
Pneumatic compressor, segmental home model without calibrated gradient pressure E0651
| |
|
Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips E0111
| |
|
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests E1060
| |
|
Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each E1354
| |
|
Heavy duty wheelchair, fixed full length arms, swing away detachable footrest E1285
| |
|
Heel loopholder, any type, with or without ankle strap, each E0951
| |
|
Walker, folding (pickup), adjustable or fixed height E0135
| |
|
Platform attachment, walker, each E0154
| |
|
Stationary compressed gas system, purchase includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing E0425
| |
|
Hospital bed, fixed height, with any type side rails, without mattress E0251
| |
|
Sitz type bath or equipment, portable, used with or without commode, with faucet attachments E0161
| |
|
Patient lift, bathroom or toilet, not otherwise classified E0625
| |
|
Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digitalvisible check systems E0615
| |
|
Continuous positive airway pressure (cpap) device E0601
| |
|
Traction equipment, cervical, free-standing standframe, pneumatic, applying traction force to other than mandible E0849
| |
|
Pump for alternating pressure pad, for replacement only E0182
| |
|
Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs E1035
| |
|
Wheelchair with fixed arm, footrests E1221
| |
|
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar E0911
| |
|
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation E0730
| |
|
Static progressive stretch elbow device, extension andor flexion, with or without range of motion adjustment, includes all components and accessories E1801
| |
|
Replacement cushions for jaw motion rehabilitation system, pkg of 6 E1701
| |
|
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips E0105
| |
|
Traction stand, free standing, pelvic traction, (eg, buck's) E0900
| |
|
Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater E0779
| |
|
Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest E1110
| |
|
Whirlpool, non-portable (built-in type) E1310
| |
|
Phototherapy (bilirubin) light with photometer E0202
| |
|
Lightweight wheelchair, fixed full length arms, swing away detachable footrest E1250
| |
|
Amputee wheelchair, fixed full length arms, without footrests or legrest E1171
| |
|
Bath tub wall rail, each E0241
| |
|
Wheelchair, detachable arms, desk or full length, swing away detachable footrests E1140
| |
|
Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter E0555
| |
|
Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery E0560
| |
|
Traction stand, free standing, cervical traction E0850
| |
|
Walker, with trunk support, adjustable or fixed height, any type E0140
| |
|
Wheel attachment, rigid pick-up walker, per pair E0155
| |
|
Sitz bath chair E0162
| |
|
Dry pressure mattress E0184
| |
|
Therapeutic lightbox, minimum 10,000 lux, table top model E0203
| |
|
Bath tub rail, floor base E0242
| |
|
Standrack E1355
| |
|
Heparin infusion pump for hemodialysis E1520
| |
|
Pneumatic compressor, segmental home model with calibrated gradient pressure E0652
| |
|
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests E1150
| |
|
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest E1260
| |
|
Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest E1290
| |
|
Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours E0780
| |
|
Replacement measuring scales for jaw motion rehabilitation system, pkg of 200 E1702
| |
|
Dynamic adjustable forearm pronationsupination device, includes soft interface material E1802
| |
|
Wheelchair with fixed arm, elevating legrests E1222
| |
|
Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs E1036
| |
|
Breast pump, manual, any type E0602
| |
|
Implantable cardiac event recorder with memory, activator and programmer E0616
| |
|
Seat lift mechanism, electric, any type E0627
| |
|
Hospital bed, variable height, hi-lo, with any type side rails, with mattress E0255
| |
|
Portable gaseous oxygen system, purchase includes regulator, flowmeter, humidifier, cannula or mask, and tubing E0430
| |
|
Toe loopholder, any type, each E0952
| |
|
Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest E1172
| |
|
Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric) E0731
| |
|
Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips E0112
| |
|
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar E0912
| |
|
Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest E1070
| |
|
Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests E1270
| |
|
Hospital bed, variable height, hi-lo, with any type side rails, without mattress E0256
| |
|
Heavy duty wheelchair, fixed full length arms, elevating legrest E1295
| |
|
Humidifier, non-heated, used with positive airway pressure device E0561
| |
|
External defibrillator with integrated electrocardiogram analysis E0617
| |
|
Seat attachment, walker E0156
| |
|
Heat lamp, with stand, includes bulb, or infrared element E0205
| |
|
Air bubble detector for hemodialysis, each, replacement E1530
| |
|
Cervical traction equipment not requiring additional stand or frame E0855
| |
|
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient E0781
| |
|
Transport chair, pediatric size E1037
| |
|
Commode chair, mobile or stationary, with fixed arms E0163
| |
|
Seat lift mechanism, non-electric, any type E0629
| |
|
Dynamic adjustable wrist extension flexion device, includes soft interface material E1805
| |
|
Oxygen accessory, battery packcartridge for portable concentrator, any type, replacement only, each E1356
| |
|
Non-implanted pelvic floor electrical stimulator, complete system E0740
| |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, half arm E0655
| |
|
Gel or gel-like pressure pad for mattress, standard mattress length and width E0185
| |
|
Wheelchair, fixed full length arms, swing away detachable elevating legrests E1160
| |
|
Fracture frame, attached to bed, includes weights E0920
| |
|
Toilet rail, each E0243
| |
|
Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip E0113
| |
|
Walker, rigid, wheeled, adjustable or fixed height E0141
| |
|
Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests E1180
| |
|
Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest E1083
| |
|
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each E0953
| |
|
Portable gaseous oxygen system, rental includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
| |
|
Breast pump, electric (ac andor dc), any type E0603
| |
|
Wheelchair with detachable arms, footrests E1223
| |
|
Transport chair, adult size, patient weight capacity up to and including 300 pounds E1038
| |
|
Neuromuscular stimulator for scoliosis E0744
| |
|
Wheelchair with detachable arms, elevating legrests E1224
| |
|
Cervical traction device, with inflatable air bladder(s) E0856
| |
|
Fracture frame, free standing, includes weights E0930
| |
|
Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each E1357
| |
|
Manual adult size wheelchair, includes tilt in space E1161
| |
|
Walker, folding, wheeled, adjustable or fixed height E0143
| |
|
Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests E1190
| |
|
Crutch attachment, walker, each E0157
| |
|
Special wheelchair seat height from floor E1296
| |
|
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260
| |
|
Raised toilet seat E0244
| |
|
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) E0630
| |
|
Infusion pump, implantable, non-programmable (includes all components, eg, pump, catheter, connectors, etc) E0782
| |
|
Commode chair, mobile or stationary, with detachable arms E0165
| |
|
Portable liquid oxygen system, rental home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge E0433
| |
|
Apnea monitor, without recording feature E0618
| |
|
Breast pump, hospital grade, electric (ac and or dc), any type E0604
| |
|
Electric heat pad, standard E0210
| |
|
Air pressure mattress E0186
| |
|
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot E0954
| |
|
Pressure alarm for hemodialysis, each, replacement E1540
| |
|
Segmental pneumatic appliance for use with pneumatic compressor, trunk E0656
| |
|
Humidifier, heated, used with positive airway pressure device E0562
| |
|
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips E0114
| |
|
Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests E1084
| |
|
Static progressive stretch wrist device, flexion andor extension, with or without range of motion adjustment, includes all components and accessories E1806
| |
|
Compressor, air power source for equipment which is not self-contained or cylinder driven E0565
| |
|
Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each E0116
| |
|
Vaporizer, room type E0605
| |
|
Continuous passive motion exercise device for use on knee only E0935
| |
|
Pail or pan for use with commode chair, replacement only E0167
| |
|
Leg extensions for walker, per set of four (4) E0158
| |
|
Neuromuscular stimulator, electronic shock unit E0745
| |
|
Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests E1195
| |
|
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each E1225
| |
|
Water pressure mattress E0187
| |
|
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat E0144
| |
|
Dynamic adjustable knee extension flexion device, includes soft interface material E1810
| |
|
Hemi-wheelchair, fixed full length arms, swing away detachable foot rests E1085
| |
|
Patient lift, electric with seat or sling E0635
| |
|
Bath conductivity meter for hemodialysis, each E1550
| |
|
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each E0955
| |
|
Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each E1358
| |
|
Infusion pump system, implantable, programmable (includes all components, eg, pump, catheter, connectors, etc) E0783
| |
|
Segmental pneumatic appliance for use with pneumatic compressor, chest E0657
| |
|
Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds E1039
| |
|
Tub stool or bench E0245
| |
|
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress E0261
| |
|
Apnea monitor, with recording feature E0619
| |
|
Portable liquid oxygen system, rental includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing E0434
| |
|
Special wheelchair seat depth, by upholstery E1297
| |
|
Electric heat pad, moist E0215
| |
|
Walker, heavy duty, multiple braking system, variable wheel resistance E0147
| |
|
Nebulizer, with compressor E0570
| |
|
Transfer tub rail attachment E0246
| |
|
Amputee wheelchair, fixed full length arms, swing away detachable footrest E1200
| |
|
Water circulating heat pad with pump E0217
| |
|
Special wheelchair seat depth andor width, by construction E1298
| |
|
Immersion external heater for nebulizer E1372
| |
|
Continuous passive motion exercise device for use other than knee E0936
| |
|
External ambulatory infusion pump, insulin E0784
| |
|
Blood leak detector for hemodialysis, each, replacement E1560
| |
|
Multipositional patient support system, with integrated lift, patient accessible controls E0636
| |
|
Electromyography (emg), biofeedback device E0746
| |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, full leg E0660
| |
|
Synthetic sheepskin pad E0188
| |
|
Crutch, underarm, articulating, spring assisted, each E0117
| |
|
Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests E1086
| |
|
Commode chair, extra wide andor heavy duty, stationary or mobile, with or without arms, any type, each E0168
| |
|
Skin piercing device for collection of capillary blood, laser, each E0620
| |
|
Static progressive stretch knee device, extension andor flexion, with or without range of motion adjustment, includes all components and accessories E1811
| |
|
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress E0265
| |
|
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each E1226
| |
|
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each E0956
| |
|
Portable liquid oxygen system, purchase includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor E0435
| |
|
Brake attachment for wheeled walker, replacement, each E0159
| |
|
Postural drainage board E0606
| |
|
Dynamic knee, extensionflexion device with active resistance control E1812
| |
|
High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests E1087
| |
|
Crutch substitute, lower leg platform, with or without wheels, each E0118
| |
|
Aerosol compressor, adjustable pressure, light duty for intermittent use E0572
| |
|
Special height arms for wheelchair E1227
| |
|
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each E0957
| |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, full arm E0665
| |
|
Implantable intraspinal (epiduralintrathecal) catheter used with implantable infusion pump, replacement E0785
| |
|
Commode chair with integrated seat lift mechanism, electric, any type E0170
| |
|
Trapeze bar, free standing, complete with grab bar E0940
| |
|
Transfer bench for tub or toilet with or without commode opening E0247
| |
|
Osteogenesis stimulator, electrical, non-invasive, other than spinal applications E0747
| |
|
Adjustable chair, for esrd patients E1570
| |
|
Stationary liquid oxygen system, rental includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, tubing E0439
| |
|
Walker, heavy duty, without wheels, rigid or folding, any type, each E0148
| |
|
Combination sit to stand frametable system, any size including pediatric, with seat lift feature, with or without wheels E0637
| |
|
Lambswool sheepskin pad, any size E0189
| |
|
Water circulating cold pad with pump E0218
| |
|
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress E0266
| |
|
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
| |
|
Walker, heavy duty, wheeled, rigid or folding, any type E0149
| |
|
Osteogenesis stimulator, electrical, non-invasive, spinal applications E0748
| |
|
Transducer protectorsfluid barriers, for hemodialysis, any size, per 10 E1575
| |
|
Transfer bench, heavy duty, for tub or toilet with or without commode opening E0248
| |
|
Special back height for wheelchair E1228
| |
|
Gravity assisted traction device, any type E0941
| |
|
Manual wheelchair accessory, one-arm drive attachment, each E0958
| |
|
Commode chair with integrated seat lift mechanism, non-electric, any type E0171
| |
|
Infrared heating pad system E0221
| |
|
Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) E0786
| |
|
Ultrasonicelectronic aerosol generator with small volume nebulizer E0574
| |
|
Dynamic adjustable ankle extensionflexion device, includes soft interface material E1815
| |
|
Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each E1391
| |
|
Hospital bed, institutional type includes oscillating, circulating and stryker frame, with mattress E0270
| |
|
Stationary liquid oxygen system, purchase includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing E0440
| |
|
Standing frametable system, one position (eg, upright, supine or prone stander), any size including pediatric, with or without wheels E0638
| |
|
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests E1088
| |
|
Non-segmental pneumatic appliance for use with pneumatic compressor, half leg E0666
| |
|
Positioning cushionpillowwedge, any shape or size, includes all components and accessories E0190
| |
|
Segmental pneumatic appliance for use with pneumatic compressor, full leg E0667
| |
|
Stationary oxygen contents, gaseous, 1 month's supply 1 unit E0441
| |
|
High strength lightweight wheelchair, fixed length arms, swing away detachable footrest E1089
| |
|
Pad for water circulating heat unit, for replacement only E0249
| |
|
Mattress, innerspring E0271
| |
|
Wheelchair, pediatric size, not otherwise specified E1229
| |
|
Unipuncture control system for hemodialysis E1580
| |
|
Hydrocollator unit, includes pads E0225
| |
|
Seat lift mechanism placed over or on top of toilet, any type E0172
| |
|
Osteogenesis stimulator, electrical, surgically implanted E0749
| |
|
Cervical head harnesshalter E0942
| |
|
Patient lift, moveable from room to room with disassembly and reassembly, includes all componentsaccessories E0639
| |
|
Static progressive stretch ankle device, flexion andor extension, with or without range of motion adjustment, includes all components and accessories E1816
| |
|
Heel or elbow protector, each E0191
| |
|
Parenteral infusion pump, stationary, single or multi-channel E0791
| |
|
Portable oxygen concentrator, rental E1392
| |
|
Manual wheelchair accessory, adapter for amputee, each E0959
| |
|
Nebulizer, ultrasonic, large volume E0575
| |
|
Power operated vehicle (three or four wheel nonhighway) specify brand name and model number E1230
| |
|
Electronic salivary reflex stimulator (intra-oralnon-invasive) E0755
| |
|
Patient lift, fixed system, includes all componentsaccessories E0640
| |
|
Stationary oxygen contents, liquid, 1 month's supply 1 unit E0442
| |
|
Powered air flotation bed (low air loss therapy) E0193
| |
|
Static progressive stretch forearm pronation supination device, with or without range of motion adjustment, includes all components and accessories E1818
| |
|
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests E1090
| |
|
Pelvic beltharnessboot E0944
| |
|
Wheelchair accessory, shoulder harnessstraps or chest strap, including any type mounting hardware E0960
| |
|
Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover E0231
| |
|
Mattress, foam rubber E0272
| |
|
Segmental pneumatic appliance for use with pneumatic compressor, full arm E0668
| |
|
Durable medical equipment, miscellaneous E1399
| |
|
Foot rest, for use with commode chair, each E0175
| |
|
Hemodialysis machine E1590
| |
|
Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter E0580
| |
|
Warming card for use with the non contact wound warming device and non contact wound warming wound cover E0232
| |
|
Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests E1092
| |
|
Osteogenesis stimulator, low intensity ultrasound, non-invasive E0760
| |
|
Manual wheelchair accessory, wheel lock brake extension (handle), each E0961
| |
|
Air fluidized bed E0194
| |
|
Automatic intermittent peritoneal dialysis system E1592
| |
|
Oxygen and water vapor enriching system with heated delivery E1405
| |
|
Extremity beltharness E0945
| |
|
Bed board E0273
| |
|
Nebulizer, with compressor and heater E0585
| |
|
Portable oxygen contents, gaseous, 1 month's supply 1 unit E0443
| |
|
Segmental pneumatic appliance for use with pneumatic compressor, half leg E0669
| |
|
Standing frametable system, multi-position (eg, three-way stander), any size including pediatric, with or without wheels E0641
| |
|
Replacement soft interface material, dynamic adjustable extensionflexion device E1820
| |
|
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system E1231
| |
|
Portable oxygen contents, liquid, 1 month's supply 1 unit E0444
| |
|
Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests E1093
| |
|
Fracture, frame, dual with cross bars, attached to bed, (eg, balken, 4 poster) E0946
| |
|
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system E1232
| |
|
Standing frametable system, mobile (dynamic stander), any size including pediatric E0642
| |
|
Over-bed table E0274
| |
|
Paraffin bath unit, portable (see medical supply code a4265 for paraffin) E0235
| |
|
Oxygen and water vapor enriching system without heated delivery E1406
| |
|
Cycler dialysis machine for peritoneal dialysis E1594
| |
|
Replacement soft interface materialcuffs for bi-directional static progressive stretch device E1821
| |
|
Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk E0670
| |
|
Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device E0761
| |
|
Gel pressure mattress E0196
| |
|
Manual wheelchair accessory, headrest extension, each E0966
| |
|
Transcutaneous electrical joint stimulation device system, includes all accessories E0762
| |
|
Pump for water circulating pad E0236
| |
|
Air pressure pad for mattress, standard mattress length and width E0197
| |
|
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system E1233
| |
|
Bed pan, standard, metal or plastic E0275
| |
|
Oximeter device for measuring blood oxygen levels non-invasively E0445
| |
|
Manual wheelchair accessory, hand rim with projections, any type, replacement only, each E0967
| |
|
Delivery andor installation charges for hemodialysis equipment E1600
| |
|
Dynamic adjustable finger extensionflexion device, includes soft interface material E1825
| |
|
Segmental gradient pressure pneumatic appliance, full leg E0671
| |
|
Fracture frame, attachments for complex pelvic traction E0947
| |
|
Reverse osmosis water purification system, for hemodialysis E1610
| |
|
Commode seat, wheelchair E0968
| |
|
Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories E0446
| |
|
Water pressure pad for mattress, standard mattress length and width E0198
| |
|
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system E1234
| |
|
Fracture frame, attachments for complex cervical traction E0948
| |
|
Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program E0764
| |
|
Bed pan, fracture, metal or plastic E0276
| |
|
Dynamic adjustable toe extensionflexion device, includes soft interface material E1830
| |
|
Hydrocollator unit, portable E0239
| |
|
Segmental gradient pressure pneumatic appliance, full arm E0672
| |
|
Powered pressure-reducing air mattress E0277
| |
|
Narrowing device, wheelchair E0969
| |
|
Segmental gradient pressure pneumatic appliance, half leg E0673
| |
|
Fda approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting E0765
| |
|
Deionizer water purification system, for hemodialysis E1615
| |
|
Dry pressure pad for mattress, standard mattress length and width E0199
| |
|
Oxygen tent, excluding croup or pediatric tents E0455
| |
|
Wheelchair, pediatric size, rigid, adjustable, with seating system E1235
| |
|
No 2 footplates, except for elevating leg rest E0970
| |
|
Blood pump for hemodialysis, replacement E1620
| |
|
Electrical stimulation device used for cancer treatment, includes all accessories, any type E0766
| |
|
Wheelchair, pediatric size, folding, adjustable, with seating system E1236
| |
|
Pneumatic compression device, high pressure, rapid inflationdeflation cycle, for arterial insufficiency (unilateral or bilateral system) E0675
| |
|
Bed cradle, any type E0280
| |
|
Chest shell (cuirass) E0457
| |
|
Chest wrap E0459
| |
|
Electrical stimulation or electromagnetic wound treatment device, not otherwise classified E0769
| |
|
Intermittent limb compression device (includes all accessories), not otherwise specified E0676
| |
|
Manual wheelchair accessory, anti-tipping device, each E0971
| |
|
Water softening system, for hemodialysis E1625
| |
|
Hospital bed, fixed height, without side rails, with mattress E0290
| |
|
Wheelchair, pediatric size, rigid, adjustable, without seating system E1237
| |
|
Ultraviolet light therapy system, includes bulbslamps, timer and eye protection treatment area 2 square feet or less E0691
| |
|
Reciprocating peritoneal dialysis system E1630
| |
|
Functional electrical stimulator, transcutaneous stimulation of nerve andor muscle groups, any type, complete system, not otherwise specified E0770
| |
|
Hospital bed, fixed height, without side rails, without mattress E0291
| |
|
Rocking bed with or without side rails E0462
| |
|
Wheelchair, pediatric size, folding, adjustable, without seating system E1238
| |
|
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each E0973
| |
|
Manual wheelchair accessory, anti-rollback device, each E0974
| |
|
Home ventilator, any type, used with invasive interface, (eg, tracheostomy tube) E0465
| |
|
Power wheelchair, pediatric size, not otherwise specified E1239
| |
|
Wearable artificial kidney, each E1632
| |
|
Hospital bed, variable height, hi-lo, without side rails, with mattress E0292
| |
|
Ultraviolet light therapy system panel, includes bulbslamps, timer and eye protection, 4 foot panel E0692
| |
|
Wheelchair accessory, positioning beltsafety beltpelvic strap, each E0978
| |
|
Peritoneal dialysis clamps, each E1634
| |
|
Ultraviolet light therapy system panel, includes bulbslamps, timer and eye protection, 6 foot panel E0693
| |
|
Hospital bed, variable height, hi-lo, without side rails, without mattress E0293
| |
|
Home ventilator, any type, used with non-invasive interface, (eg, mask, chest shell) E0466
| |
|
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, eg, nasal or facial mask (intermittent assist device with continuous positive airway pressure device) E0470
| |
|
Safety vest, wheelchair E0980
| |
|
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress E0294
| |
|
Compact (portable) travel hemodialyzer system E1635
| |
|
Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbslamps, timer and eye protection E0694
| |
|
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, eg, nasal or facial mask (intermittent assist device with continuous positive airway pressure device) E0471
| |
|
Sorbent cartridges, for hemodialysis, per 10 E1636
| |
|
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress E0295
| |
|
Wheelchair accessory, seat upholstery, replacement only, each E0981
| |
|
Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress E0296
| |
|
Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, eg, tracheostomy tube (intermittent assist device with continuous positive airway pressure device) E0472
| |
|
Hemostats, each E1637
| |
|
Wheelchair accessory, back upholstery, replacement only, each E0982
| |
|
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control E0983
| |
|
Scale, each E1639
| |
|
Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress E0297
| |
|
Percussor, electric or pneumatic, home model E0480
| |
|
Pediatric crib, hospital grade, fully enclosed, with or without top enclosure E0300
| |
|
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control E0984
| |
|
Dialysis equipment, not otherwise specified E1699
| |
|
Intrapulmonary percussive ventilation system and related accessories E0481
| |
|
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
| |
|
Wheelchair accessory, seat lift mechanism E0985
| |
|
Cough stimulating device, alternating positive and negative airway pressure E0482
| |
|
High frequency chest wall oscillation air-pulse generator system, (includes hoses and vest), each E0483
| |
|
Manual wheelchair accessory, push-rim activated power assist system E0986
| |
|
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
| |
|
Oscillatory positive expiratory pressure device, non-electric, any type, each E0484
| |
|
Manual wheelchair accessory, lever-activated, wheel drive, pair E0988
| |
|
Wheelchair accessory, elevating leg rest, complete assembly, each E0990
| |
|
Oral deviceappliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment E0485
| |
|
Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress E0304
| |
|
Manual wheelchair accessory, solid seat insert E0992
| |
|
Bed side rails, half length E0305
| |
|
Oral deviceappliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment E0486
| |
|
Spirometer, electronic, includes all accessories E0487
| |
|
Bed side rails, full length E0310
| |
|
Arm rest, each E0994
| |
|
Bed accessory board, table, or support device, any type E0315
| |
|
Wheelchair accessory, calf restpad, replacement only, each E0995
| |
|
Wheelchair accessory, power seating system, tilt only E1002
| |
|
Safety enclosure framecanopy for use with hospital bed, any type E0316
| |
|
Urinal male, jug-type, any material E0325
| |
|
Wheelchair accessory, power seating system, recline only, without shear reduction E1003
| |
|
Urinal female, jug-type, any material E0326
| |
|
Wheelchair accessory, power seating system, recline only, with mechanical shear reduction E1004
| |
|
Wheelchair accessory, power seatng system, recline only, with power shear reduction E1005
| |
|
Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress E0328
| |
|
Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress E0329
| |
|
Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction E1006
| |
|
Control unit for electronic bowel irrigationevacuation system E0350
| |
|
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction E1007
| |
|
Disposable pack (water reservoir bag, speculum, valving mechanism and collection bagbox) for use with the electronic bowel irrigationevacuation system E0352
| |
|
Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction E1008
| |
|
Air pressure elevator for heel E0370
| |
|
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
| |
|
Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width E0371
| |
|
Powered air overlay for mattress, standard mattress length and width E0372
| |
|
Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) E1011
| |
|
Nonpowered advanced pressure reducing mattress E0373
| |
|
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
| |
|
Duraclon,see |
|
|
Dyphylline, J1180
| |
