|
Sacral,nerve,stimulation,test,lead A4290
| |
|
Safety,equipment E0700
| |
|
vest,wheelchair E0980
| |
|
hypertonic, J713 |
|
|
solution J7030 - J7050 , A4216 - A4218 |
|
|
Sterile water, saline andor dextrose, diluentflush, 10 ml A4216
| |
|
Sterile watersaline, 500 ml A4217
| |
|
Sterile saline or water, metered dose dispenser, 10 ml A4218
| |
|
Infusion, normal saline solution , 1000 cc J7030
| |
|
Infusion, normal saline solution, sterile (500 ml 1 unit) J7040
| |
|
5 dextrosenormal saline (500 ml 1 unit) J7042
| |
|
Infusion, normal saline solution, 250 cc J7050
| |
|
Sterile water, saline andor dextrose, diluentflush, 10 ml A4216
| |
|
Sterile watersaline, 500 ml A4217
| |
|
Sterile saline or water, metered dose dispenser, 10 ml A4218
| |
|
Samarium,SM,Lexidronamm A9605 |
|
|
Sargramostim,(GM-CSF) J2820
| |
|
Scale, E1639
| |
|
Scoliosis,- L1000, L1499 |
|
|
additions L1010 - L1120 , L1210 - L1290 |
|
|
Addition to tlso, (low profile), lateral thoracic extension L1210
| |
|
Addition to tlso, (low profile), anterior thoracic extension L1220
| |
|
Addition to tlso, (low profile), milwaukee type superstructure L1230
| |
|
Addition to tlso, (low profile), lumbar derotation pad L1240
| |
|
Addition to tlso, (low profile), anterior asis pad L1250
| |
|
Addition to tlso, (low profile), anterior thoracic derotation pad L1260
| |
|
Addition to tlso, (low profile), abdominal pad L1270
| |
|
Addition to tlso, (low profile), rib gusset (elastic), each L1280
| |
|
Addition to tlso, (low profile), lateral trochanteric pad L1290
| |
|
Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling L1010
| |
|
Addition to ctlso or scoliosis orthosis, kyphosis pad L1020
| |
|
Addition to ctlso or scoliosis orthosis, kyphosis pad, floating L1025
| |
|
Addition to ctlso or scoliosis orthosis, lumbar bolster pad L1030
| |
|
Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad L1040
| |
|
Addition to ctlso or scoliosis orthosis, sternal pad L1050
| |
|
Addition to ctlso or scoliosis orthosis, thoracic pad L1060
| |
|
Addition to ctlso or scoliosis orthosis, trapezius sling L1070
| |
|
Addition to ctlso or scoliosis orthosis, outrigger L1080
| |
|
Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions L1085
| |
|
Addition to ctlso or scoliosis orthosis, lumbar sling L1090
| |
|
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather L1100
| |
|
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model L1110
| |
|
Addition to ctlso, scoliosis orthosis, cover for upright, each L1120
| |
|
Addition to tlso, (low profile), lateral thoracic extension L1210
| |
|
Addition to tlso, (low profile), anterior thoracic extension L1220
| |
|
Addition to tlso, (low profile), milwaukee type superstructure L1230
| |
|
Addition to tlso, (low profile), lumbar derotation pad L1240
| |
|
Addition to tlso, (low profile), anterior asis pad L1250
| |
|
Addition to tlso, (low profile), anterior thoracic derotation pad L1260
| |
|
Addition to tlso, (low profile), abdominal pad L1270
| |
|
Addition to tlso, (low profile), rib gusset (elastic), each L1280
| |
|
Addition to tlso, (low profile), lateral trochanteric pad L1290
| |
|
Sculptra, Q2028
| |
|
skin, A6250
| |
|
attachment,walker E0156
| |
|
insert,wheelchair E0992
| |
|
lift,(patient) E0621, E0627 - E0629 |
|
|
Seat lift mechanism, electric, any type E0627
| |
|
Seat lift mechanism, non-electric, any type E0629
| |
|
Seat lift mechanism, electric, any type E0627
| |
|
Seat lift mechanism, non-electric, any type E0629
| |
|
upholstery,wheelchair E097 |
|
|
Sebelipase,alfa J2840
| |
|
Secretin, J2850
| |
|
Semen,analysis G0027
| |
|
Sensitivity,study P7001
| |
|
Sermorelin,acetate Q0515
| |
|
Serum,clotting,time,tube A4771
| |
|
SEWHO, L3960 - L3974 |
|
|
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment L3960
| |
|
Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3971
| |
|
Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3961
| |
|
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3973
| |
|
Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment L3962
| |
|
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3967
| |
|
Sheepskin,pad E0188, E0189 |
|
|
arch,support L3040 - L3100 |
|
|
Foot, arch support, removable, premolded, longitudinal, each L3040
| |
|
Foot, arch support, non-removable attached to shoe, longitudinal, each L3070
| |
|
Foot, arch support, removable, premolded, metatarsal, each L3050
| |
|
Foot, arch support, non-removable attached to shoe, metatarsal, each L3080
| |
|
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
| |
|
for,diabetics A5500 - A5514 |
|
|
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe A5500
| |
|
For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe A5501
| |
|
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe A5503
| |
|
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe A5504
| |
|
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe A5505
| |
|
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe A5506
| |
|
For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe A5507
| |
|
For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe A5508
| |
|
For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe A5510
| |
|
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 14 inch material of shore a 35 durometer or 316 inch material of shore a 40 durometer (or higher), prefabricated, each A5512
| |
|
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 316 inch material of shore a 35 durometer or higher), includes arch filler and other shaping material, custom fabricated, each A5513
| |
|
insert, L3000 - L3030 |
|
|
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each L3000
| |
|
Foot, insert, removable, molded to patient model, spenco, each L3001
| |
|
Foot, insert, removable, molded to patient model, plastazote or equal, each L3002
| |
|
Foot, insert, removable, molded to patient model, silicone gel, each L3003
| |
|
Foot, insert, removable, molded to patient model, longitudinal arch support, each L3010
| |
|
Foot, insert, removable, molded to patient model, longitudinal metatarsal support, each L3020
| |
|
Foot, insert, removable, formed to patient foot, each L3030
| |
|
lift, L3300 - L3334 |
|
|
Lift, elevation, heel, tapered to metatarsals, per inch L3300
| |
|
Lift, elevation, heel and sole, neoprene, per inch L3310
| |
|
Lift, elevation, heel and sole, cork, per inch L3320
| |
|
Lift, elevation, metal extension (skate) L3330
| |
|
Lift, elevation, inside shoe, tapered, up to one-half inch L3332
| |
|
Lift, elevation, heel, per inch L3334
| |
|
miscellaneous,additions L3500 - L3595 |
|
|
Orthopedic shoe addition, insole, leather L3500
| |
|
Orthopedic shoe addition, insole, rubber L3510
| |
|
Orthopedic shoe addition, insole, felt covered with leather L3520
| |
|
Orthopedic shoe addition, sole, half L3530
| |
|
Orthopedic shoe addition, sole, full L3540
| |
|
Orthopedic shoe addition, toe tap standard L3550
| |
|
Orthopedic shoe addition, toe tap, horseshoe L3560
| |
|
Orthopedic shoe addition, special extension to instep (leather with eyelets) L3570
| |
|
Orthopedic shoe addition, convert instep to velcro closure L3580
| |
|
Orthopedic shoe addition, convert firm shoe counter to soft counter L3590
| |
|
Orthopedic shoe addition, march bar L3595
| |
|
orthopedic, L3201 - L3265 |
|
|
Orthopedic shoe, oxford with supinator or pronator, infant L3201
| |
|
Orthopedic shoe, oxford with supinator or pronator, child L3202
| |
|
Orthopedic shoe, oxford with supinator or pronator, junior L3203
| |
|
Orthopedic shoe, hightop with supinator or pronator, infant L3204
| |
|
Orthopedic shoe, hightop with supinator or pronator, child L3206
| |
|
Orthopedic shoe, hightop with supinator or pronator, junior L3207
| |
|
Surgical boot, each, infant L3208
| |
|
Surgical boot, each, child L3209
| |
|
Surgical boot, each, junior L3211
| |
|
Benesch boot, pair, infant L3212
| |
|
Benesch boot, pair, child L3213
| |
|
Benesch boot, pair, junior L3214
| |
|
Orthopedic footwear, ladies shoe, oxford, each L3215
| |
|
Orthopedic footwear, ladies shoe, depth inlay, each L3216
| |
|
Orthopedic footwear, ladies shoe, hightop, depth inlay, each L3217
| |
|
Orthopedic footwear, mens shoe, oxford, each L3219
| |
|
Orthopedic footwear, mens shoe, depth inlay, each L3221
| |
|
Orthopedic footwear, mens shoe, hightop, depth inlay, each L3222
| |
|
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) L3224
| |
|
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) L3225
| |
|
Orthopedic footwear, custom shoe, depth inlay, each L3230
| |
|
Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each L3250
| |
|
Foot, shoe molded to patient model, silicone shoe, each L3251
| |
|
Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each L3252
| |
|
Foot, molded shoe plastazote (or similar) custom fitted, each L3253
| |
|
Non-standard size or width L3254
| |
|
Non-standard size or length L3255
| |
|
Orthopedic footwear, additional charge for split size L3257
| |
|
Surgical bootshoe, each L3260
| |
|
Plastazote sandal, each L3265
| |
|
positioning,device 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
| |
|
transfer, L3600 - L3649 |
|
|
Transfer of an orthosis from one shoe to another, caliper plate, existing L3600
| |
|
Transfer of an orthosis from one shoe to another, caliper plate, new L3610
| |
|
Transfer of an orthosis from one shoe to another, solid stirrup, existing L3620
| |
|
Transfer of an orthosis from one shoe to another, solid stirrup, new L3630
| |
|
Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes L3640
| |
|
Orthopedic shoe, modification, addition or transfer, not otherwise specified L3649
| |
|
wedge, L3340 - L3485 |
|
|
Heel wedge, sach L3340
| |
|
Heel, counter, plastic reinforced L3430
| |
|
Heel wedge L3350
| |
|
Heel, counter, leather reinforced L3440
| |
|
Heel, sach cushion type L3450
| |
|
Sole wedge, outside sole L3360
| |
|
Sole wedge, between sole L3370
| |
|
Heel, new leather, standard L3455
| |
|
Heel, new rubber, standard L3460
| |
|
Clubfoot wedge L3380
| |
|
Heel, thomas with wedge L3465
| |
|
Outflare wedge L3390
| |
|
Metatarsal bar wedge, rocker L3400
| |
|
Heel, thomas extended to ball L3470
| |
|
Metatarsal bar wedge, between sole L3410
| |
|
Heel, pad and depression for spur L3480
| |
|
Heel, pad, removable for spur L3485
| |
|
Full sole and heel wedge, between sole L3420
| |
|
disarticulation,prosthetic L6300 - L6320 , L6550 |
|
|
Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm L6300
| |
|
Shoulder disarticulation, passive restoration (complete prosthesis) L6310
| |
|
Shoulder disarticulation, passive restoration (shoulder cap only) L6320
| |
|
orthosis,(SO),- L3650, L3674 |
|
|
spinal,cervical L0100 - L0200 |
|
|
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated L0112
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable L0180
| |
|
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment L0113
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types) L0190
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension L0200
| |
|
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) L0120
| |
|
Cervical, flexible, thermoplastic collar, molded to patient L0130
| |
|
Cervical, semi-rigid, adjustable (plastic collar) L0140
| |
|
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibularoccipital piece) L0150
| |
|
Cervical, semi-rigid, wire frame occipitalmandibular support, prefabricated, off-the-shelf L0160
| |
|
Cervical, collar, molded to patient model L0170
| |
|
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf L0172
| |
|
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf L0174
| |
|
Shoulder-elbow-wrist-hand,orthosis,(SEWHO) L3960 - L3969 |
|
|
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment L3960
| |
|
Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3961
| |
|
Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment L3962
| |
|
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3967
| |
|
Shoulder,sling A4566
| |
|
Shunt,accessory,for,dialysis A4740
| |
|
aqueous, L8612
| |
|
Sigmoidoscopy,cancer,screening G0104, G0106 |
|
|
J2860 |
|
|
Sincalide, J2805
| |
|
Sipuleucel-T, Q2043
| |
|
Sirolimus, J7520
| |
|
Sitz,bath E0160 - E0162 |
|
|
Sitz type bath or equipment, portable, used with or without commode E0160
| |
|
Sitz type bath or equipment, portable, used with or without commode, with faucet attachments E0161
| |
|
Sitz bath chair E0162
| |
|
barrier,ostomy A4362, A4363, A4369 - A4373 , A4385, A5120 |
|
|
Ostomy skin barrier, liquid (spray, brush, etc), per oz A4369
| |
|
Ostomy skin barrier, powder, per oz A4371
| |
|
Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each A4372
| |
|
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each A4373
| |
|
bond,or,cement,ostomy A4364
| |
|
sealant,protectant,moisturizer A6250
| |
|
substitute, Q4100 - Q4204 |
|
|
Skin substitute, not otherwise specified Q4100
| |
|
Apligraf, per square centimeter Q4101
| |
|
Oasis wound matrix, per square centimeter Q4102
| |
|
Oasis burn matrix, per square centimeter Q4103
| |
|
Integra bilayer matrix wound dressing (bmwd), per square centimeter Q4104
| |
|
Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter Q4105
| |
|
Dermagraft, per square centimeter Q4106
| |
|
Graftjacket, per square centimeter Q4107
| |
|
Integra matrix, per square centimeter Q4108
| |
|
Primatrix, per square centimeter Q4110
| |
|
Gammagraft, per square centimeter Q4111
| |
|
Cymetra, injectable, 1 cc Q4112
| |
|
Graftjacket xpress, injectable, 1 cc Q4113
| |
|
Integra flowable wound matrix, injectable, 1 cc Q4114
| |
|
Alloskin, per square centimeter Q4115
| |
|
Alloderm, per square centimeter Q4116
| |
|
Hyalomatrix, per square centimeter Q4117
| |
|
Matristem micromatrix, 1 mg Q4118
| |
|
Theraskin, per square centimeter Q4121
| |
|
Dermacell, per square centimeter Q4122
| |
|
Alloskin rt, per square centimeter Q4123
| |
|
Oasis ultra tri-layer wound matrix, per square centimeter Q4124
| |
|
Arthroflex, per square centimeter Q4125
| |
|
Memoderm, dermaspan, tranzgraft or integuply, per square centimeter Q4126
| |
|
Talymed, per square centimeter Q4127
| |
|
Flex hd, allopatch hd, or matrix hd, per square centimeter Q4128
| |
|
Strattice tm, per square centimeter Q4130
| |
|
Epifix or epicord, per square centimeter Q413 |
|
|
Grafix core and grafixpl core, per square centimeter Q4132
| |
|
Grafix prime and grafixpl prime, per square centimeter Q4133
| |
|
Hmatrix, per square centimeter Q4134
| |
|
Mediskin, per square centimeter Q4135
| |
|
Ez-derm, per square centimeter Q4136
| |
|
Amnioexcel or biodexcel, per square centimeter Q4137
| |
|
Biodfence dryflex, per square centimeter Q4138
| |
|
Amniomatrix or biodmatrix, injectable, 1 cc Q4139
| |
|
Biodfence, per square centimeter Q4140
| |
|
Alloskin ac, per square centimeter Q4141
| |
|
Xcm biologic tissue matrix, per square centimeter Q4142
| |
|
Repriza, per square centimeter Q4143
| |
|
Epifix, injectable, 1 mg Q4145
| |
|
Tensix, per square centimeter Q4146
| |
|
Architect, architect px, or architect fx, extracellular matrix, per square centimeter Q4147
| |
|
Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter Q4148
| |
|
Excellagen, 01 cc Q4149
| |
|
Allowrap ds or dry, per square centimeter Q4150
| |
|
Amnioband or guardian, per square centimeter Q4151
| |
|
Dermapure, per square centimeter Q4152
| |
|
Dermavest and plurivest, per square centimeter Q4153
| |
|
Biovance, per square centimeter Q4154
| |
|
Neoxflo or clarixflo, 1 mg Q4155
| |
|
Neox 100 or clarix 100, per square centimeter Q4156
| |
|
Revitalon, per square centimeter Q4157
| |
|
Kerecis omega3, per square centimeter Q4158
| |
|
Affinity, per square centimeter Q4159
| |
|
Nushield, per square centimeter Q4160
| |
|
Bio-connekt wound matrix, per square centimeter Q4161
| |
|
Woundex flow, bioskin flow, 05 cc Q4162
| |
|
Woundex, bioskin, per square centimeter Q4163
| |
|
Helicoll, per square centimeter Q4164
| |
|
Keramatrix, per square centimeter Q4165
| |
|
Cytal, per square centimeter Q4166
| |
|
Truskin, per square centimeter Q4167
| |
|
Amnioband, 1 mg Q4168
| |
|
Artacent wound, per square centimeter Q4169
| |
|
Cygnus, per square centimeter Q4170
| |
|
Interfyl, 1 mg Q4171
| |
|
Puraply or puraply am, per square centimeter Q417 |
|
|
Palingen or palingen xplus, per square centimeter Q4173
| |
|
Palingen or promatrx, 036 mg per 025 cc Q4174
| |
|
Miroderm, per square centimeter Q4175
| |
|
Neopatch, per square centimeter Q4176
| |
|
Floweramnioflo, 01 cc Q4177
| |
|
Floweramniopatch, per square centimeter Q4178
| |
|
Flowerderm, per square centimeter Q4179
| |
|
Revita, per square centimeter Q4180
| |
|
Amnio wound, per square centimeter Q4181
| |
|
Transcyte, per square centimeter Q4182
| |
|
Sling, A4565
| |
|
patient,lift E0621, E0630, E0635 |
|
|
Social,worker,nonemergency,transport A0160
| |
|
body,sock L0984
| |
|
prosthetic,sock L8420 - L8435 , L8470, L8480, L8485 |
|
|
Prosthetic sock, multiple ply, below knee, each L8420
| |
|
Prosthetic sock, multiple ply, above knee, each L8430
| |
|
Prosthetic sock, multiple ply, upper limb, each L8435
| |
|
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
| |
|
chloride,injection J291 |
|
|
ferric,gluconate,complex,in,sucrose J2916
| |
|
fluoride,F-18 A9580
| |
|
Euflexxa, J7323
| |
|
GELSYN-3, J7328
| |
|
Hyalgan, J7321
| |
|
Orthovisc, J7324
| |
|
Supartz, J7321
| |
|
Synvisc,and,Synvisc-One J7325
| |
|
Visco-3, J7321
| |
|
phosphate P32, A9563 |
|
|
pyrophosphate, J1443
| |
|
succinate, J1720
| |
|
calibrator, A4256
| |
|
dialysate, A4760
| |
|
elliotts,b J9175
| |
|
enteral,formulae B4149 - B4156 |
|
|
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit B4149
| |
|
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit B4150
| |
|
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 15 kcalml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit B4152
| |
|
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit B4153
| |
|
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins andor minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit B4154
| |
|
Enteral formula, nutritionally incompletemodular nutrients, includes specific nutrients, carbohydrates (eg, glucose polymers), proteinsamino acids (eg, glutamine, arginine), fat (eg, medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories 1 unit B4155
| |
|
parenteral,nutrition B4164 - B5200 |
|
|
Parenteral nutrition solution carbohydrates (dextrose), 50 or less (500 ml 1 unit) - home mix B4164
| |
|
Parenteral nutrition solution amino acid, 35, (500 ml 1 unit) - home mix B4168
| |
|
Parenteral nutrition solution amino acid, 55 through 7, (500 ml 1 unit) - home mix B4172
| |
|
Parenteral nutrition solution amino acid, 7 through 85, (500 ml 1 unit) - home mix B4176
| |
|
Parenteral nutrition solution amino acid, greater than 85 (500 ml 1 unit) - home mix B4178
| |
|
Parenteral nutrition solution carbohydrates (dextrose), greater than 50 (500 ml 1 unit) - home mix B4180
| |
|
Parenteral nutrition solution, per 10 grams lipids B4185
| |
|
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix B4189
| |
|
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix B4193
| |
|
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix B4197
| |
|
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix B4199
| |
|
Parenteral nutrition additives (vitamins, trace elements, heparin, electrolytes), home mix, per day B4216
| |
|
Parenteral nutrition supply kit premix, per day B4220
| |
|
Parenteral nutrition supply kit home mix, per day B4222
| |
|
Parenteral nutrition administration kit, per day B4224
| |
|
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal-aminosyn-rf, nephramine, renamine-premix B5000
| |
|
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic, hepatamine-premix B5100
| |
|
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress-branch chain amino acids-freamine-hbc-premix B5200
| |
|
Somatrem, J2940
| |
|
Somatropin, J2941
| |
|
Sorbent,cartridge,ESRD E1636
| |
|
Specialty,absorptive,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
| |
|
Spectinomycin,HCl J3320
| |
|
Speech,assessment V5362 - V5364 |
|
|
Speech screening V5362
| |
|
Language screening V5363
| |
|
Dysphagia screening V5364
| |
|
Speech,generating,device E2500 - E2599 |
|
|
Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time E2500
| |
|
Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time E2502
| |
|
Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time E2504
| |
|
Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time E2506
| |
|
Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device E2508
| |
|
Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access E2510
| |
|
Speech generating software program, for personal computer or personal digital assistant E2511
| |
|
Accessory for speech generating device, mounting system E2512
| |
|
Accessory for speech generating device, not otherwise classified E2599
| |
|
Spinal |
|
|
cervical, L0100 - L0200 |
|
|
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated L0112
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable L0180
| |
|
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment L0113
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types) L0190
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension L0200
| |
|
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) L0120
| |
|
Cervical, flexible, thermoplastic collar, molded to patient L0130
| |
|
Cervical, semi-rigid, adjustable (plastic collar) L0140
| |
|
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibularoccipital piece) L0150
| |
|
Cervical, semi-rigid, wire frame occipitalmandibular support, prefabricated, off-the-shelf L0160
| |
|
Cervical, collar, molded to patient model L0170
| |
|
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf L0172
| |
|
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf L0174
| |
|
cervical-thoracic-lumbar-sacral,(CTLSO) L0700, L0710 |
|
|
DME, K0112 - K0116 |
|
|
halo, L0810 - L0830 |
|
|
Halo procedure, cervical halo incorporated into jacket vest L0810
| |
|
Halo procedure, cervical halo incorporated into plaster body jacket L0820
| |
|
Halo procedure, cervical halo incorporated into milwaukee type orthosis L0830
| |
|
multiple,post,collar L0180 - L0200 |
|
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable L0180
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types) L0190
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension L0200
| |
|
scoliosis, L1000 - L1499 |
|
|
Other scoliosis procedure, body jacket molded to patient model L1300
| |
|
Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model L1000
| |
|
Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only L1200
| |
|
Addition to tlso, (low profile), lateral thoracic extension L1210
| |
|
Other scoliosis procedure, post-operative body jacket L1310
| |
|
Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment L1001
| |
|
Spinal orthosis, not otherwise specified L1499
| |
|
Addition to tlso, (low profile), anterior thoracic extension L1220
| |
|
Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment L1005
| |
|
Addition to tlso, (low profile), milwaukee type superstructure L1230
| |
|
Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling L1010
| |
|
Addition to ctlso or scoliosis orthosis, kyphosis pad L1020
| |
|
Addition to tlso, (low profile), lumbar derotation pad L1240
| |
|
Addition to tlso, (low profile), anterior asis pad L1250
| |
|
Addition to ctlso or scoliosis orthosis, kyphosis pad, floating L1025
| |
|
Addition to tlso, (low profile), anterior thoracic derotation pad L1260
| |
|
Addition to ctlso or scoliosis orthosis, lumbar bolster pad L1030
| |
|
Addition to tlso, (low profile), abdominal pad L1270
| |
|
Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad L1040
| |
|
Addition to ctlso or scoliosis orthosis, sternal pad L1050
| |
|
Addition to tlso, (low profile), rib gusset (elastic), each L1280
| |
|
Addition to ctlso or scoliosis orthosis, thoracic pad L1060
| |
|
Addition to tlso, (low profile), lateral trochanteric pad L1290
| |
|
Addition to ctlso or scoliosis orthosis, trapezius sling L1070
| |
|
Addition to ctlso or scoliosis orthosis, outrigger L1080
| |
|
Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions L1085
| |
|
Addition to ctlso or scoliosis orthosis, lumbar sling L1090
| |
|
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather L1100
| |
|
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model L1110
| |
|
Addition to ctlso, scoliosis orthosis, cover for upright, each L1120
| |
|
torso,supports L096 |
|
|
Splint A4570, L3100, L4350 - L4380 |
|
|
Ankle control orthosis, stirrup style, rigid, includes any type interface (eg, pneumatic, gel), prefabricated, off-the-shelf L4350
| |
|
Walking boot, pneumatic andor vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L4360
| |
|
Pneumatic full leg splint, prefabricated, off-the-shelf L4370
| |
|
Walking boot, pneumatic andor vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf L4361
| |
|
ankle, L4390 - L4398 |
|
|
Replacement, soft interface material, static afo L4392
| |
|
Replace soft interface material, foot drop splint L4394
| |
|
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L4396
| |
|
Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf L4398
| |
|
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf L4397
| |
|
dynamic E1800, E1805, E1810, E1815, E1825, E1830, E1840 |
|
|
footdrop, L4398
| |
|
Ankle control orthosis, stirrup style, rigid, includes any type interface (eg, pneumatic, gel), prefabricated, off-the-shelf L4350
| |
|
Walking boot, pneumatic andor vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L4360
| |
|
Pneumatic full leg splint, prefabricated, off-the-shelf L4370
| |
|
Walking boot, pneumatic andor vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf L4361
| |
|
Static,progressive,stretch E1801, E1806, E1811, E1816, E1818, E1821 |
|
|
Sterile,cefuroxime,sodium J0697
| |
|
Sterile,water A4216 - A4217 |
|
|
Sterile water, saline andor dextrose, diluentflush, 10 ml A4216
| |
|
Sterile watersaline, 500 ml A4217
| |
|
neuromuscular E0744, E0745 |
|
|
osteogenesis,electrical E0747 - E0749 |
|
|
Osteogenesis stimulator, electrical, non-invasive, other than spinal applications E0747
| |
|
Osteogenesis stimulator, electrical, non-invasive, spinal applications E0748
| |
|
Osteogenesis stimulator, electrical, surgically implanted E0749
| |
|
ultrasound, E0760
| |
|
salivary,reflex E0755
| |
|
stoma,absorptive,cover A5083
| |
|
Stomach,tube B4083
| |
|
Streptokinase, J2995
| |
|
Streptomycin, J3000
| |
|
Streptozocin, J9320
| |
|
Strip,blood,glucose,test A4253, A4772 |
|
|
urine,reagent A4250
| |
|
Strontium-89,chloride,supply,of A9600
| |
|
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
| |
|
Stylet, A4212
| |
|
Succinylcholine,chloride J0330
| |
|
Suction |
|
|
gastric,home,model E2000
| |
|
portable, E0600
| |
|
respiratory,home,model E0600
| |
|
Sumatriptan,succinate J3030
| |
|
Supartz, J7321
| |
|
Supplyaccessoryservice, A9900
| |
|
arch, L3040 - L3090 |
|
|
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, non-removable attached to shoe, longitudinalmetatarsal, each L3090
| |
|
Foot, arch support, removable, premolded, longitudinal metatarsal, each L3060
| |
|
cervical, L0100 - L0200 |
|
|
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated L0112
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable L0180
| |
|
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment L0113
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types) L0190
| |
|
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension L0200
| |
|
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) L0120
| |
|
Cervical, flexible, thermoplastic collar, molded to patient L0130
| |
|
Cervical, semi-rigid, adjustable (plastic collar) L0140
| |
|
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibularoccipital piece) L0150
| |
|
Cervical, semi-rigid, wire frame occipitalmandibular support, prefabricated, off-the-shelf L0160
| |
|
Cervical, collar, molded to patient model L0170
| |
|
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf L0172
| |
|
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf L0174
| |
|
spinal, L096 |
|
|
stockings, L8100 - L8239 |
|
|
boot, L3208 - L3211 |
|
|
Surgical boot, each, infant L3208
| |
|
Surgical boot, each, child L3209
| |
|
Surgical boot, each, junior L3211
| |
|
dressing, A6196 - A6406 |
|
|
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
| |
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Gauze, non-impregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing A6404
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stocking, A4490 - A4510 |
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Surgical stockings above knee length, each A4490
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Surgical stockings thigh length, each A4495
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Surgical stockings below knee length, each A4500
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Surgical stockings full length, each A4510
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supplies, A4649
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tray, A4550
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Swabs,betadine,or,iodine A4247
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Syringe, A4213
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with,needle A4206 - A4209 |
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Syringe with needle, sterile, 1 cc or less, each A4206
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Syringe with needle, sterile 2 cc, each A4207
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Syringe with needle, sterile 3 cc, each A4208
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Syringe with needle, sterile 5 cc or greater, each A4209
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Synvisc,and,Synvisc-One J7325
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