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HCPCS Codes
1 HCPCS Codes Effective January 2004 *NOTE: This HCPCS listing does not indicate what is or is not considered appropriate assistive technology for First Steps purposes. Please consult Program policy or listserv messages for further guidance. HCPCS Code Description A0021 Outside state ambulance serv A0080 Noninterest escort in non er A0090 Interest escort in non er A0100 Nonemergency transport taxi A0110 Nonemergency transport bus A0120 Noner transport mini-bus A0130 Noner transport wheelch van A0140 Nonemergency transport air A0160 Noner transport case worker A0170 Noner transport parking fees A0180 Noner transport lodgng recip A0190 Noner transport meals recip A0200 Noner transport lodgng escrt A0210 Noner transport meals escort A0225 Neonatal emergency transport A0368 Adv er no serv sep mile&supp A0382 Basic support routine suppls A0384 Bls defibrillation supplies A0392 Als defibrillation supplies A0394 Als IV drug therapy supplies A0396 Als esophageal intub suppls A0398 Als routine disposble suppls A0420 Ambulance waiting 1/2 hr A0422 Ambulance 02 life sustaining A0424 Extra ambulance attendant A0425 Ground mileage A0426 Als 1 A0427 ALS1-emergency A0428 bls A0429 BLS-emergency A0430 Fixed wing air transport A0431 Rotary wing air transport A0432 PI volunteer ambulance co A0433 als 2 A0434 Specialty care transport A0435 Fixed wing air mileage A0436 Rotary wing air mileage A0888 Noncovered ambulance mileage A0999 Unlisted ambulance service A4206 1 CC sterile syringe&needle A4207 2 CC sterile syringe&needle A4208 3 CC sterile syringe&needle A4209 5+ CC sterile syringe&needle 2 A4210 A4211 A4212 A4213 A4214 A4215 A4220 A4221 A4222 A4230 A4231 A4232 A4244 A4245 A4246 A4247 A4250 A4253 A4254 A4255 A4256 A4258 A4259 A4260 A4261 A4262 A4263 A4265 A4270 A4280 A4290 A4300 A4301 A4305 A4306 A4310 A4311 A4312 A4313 A4314 A4315 A4316 A4319 A4320 A4321 A4322 A4323 A4324 A4325 A4326 A4327 A4328 Nonneedle injection device Supp for self-adm injections Non coring needle or stylet 20+ CC syringe only 30 CC sterile water/saline Sterile needle Infusion pump refill kit Maint drug infus cath per wk Drug infusion pump supplies Infus insulin pump non needl Infusion insulin pump needle Syringe w/needle insulin 3cc Alcohol or peroxide per pint Alcohol wipes per box Betadine/phisohex solution Betadine/iodine swabs/wipes Urine reagent strips/tablets Blood glucose/reagent strips Battery for glucose monitor Glucose monitor platforms Calibrator solution/chips Lancet device each Lancets per box Levonorgestrel implant Cervical cap contraceptive Temporary tear duct plug Permanent tear duct plug Paraffin Disposable endoscope sheath Brst prsths adhsv attchmnt Sacral nerve stim test lead Cath impl vasc access portal Implantable access syst perc Drug delivery system >=50 ML Drug delivery system <=5 ML Insert tray w/o bag/cath Catheter w/o bag 2-way latex Cath w/o bag 2-way silicone Catheter w/bag 3-way Cath w/drainage 2-way latex Cath w/drainage 2-way silcne Cath w/drainage 3-way Sterile H2O irrigation solut Irrigation tray Cath therapeutic irrig agent Irrigation syringe Saline irrigation solution Male ext cath w/adh coating Male ext cath w/adh strip Male external catheter Fem urinary collect dev cup Fem urinary collect pouch 3 A4329 A4330 A4331 A4332 A4333 A4334 A4335 A4338 A4340 A4344 A4346 A4347 A4348 A4351 A4352 A4353 A4354 A4355 A4356 A4357 A4358 A4359 A4361 A4362 A4364 A4365 A4367 A4368 A4369 A4370 A4371 A4372 A4373 A4374 A4375 A4376 A4377 A4378 A4379 A4380 A4381 A4382 A4383 A4384 A4385 A4386 A4387 A4388 A4389 A4390 A4391 A4392 External catheter start set Stool collection pouch Extension drainage tubing Lubricant for cath insertion Urinary cath anchor device Urinary cath leg strap Incontinence supply Indwelling catheter latex Indwelling catheter special Cath indw foley 2 way silicn Cath indw foley 3 way Male external catheter Male ext cath extended wear Straight tip urine catheter Coude tip urinary catheter Intermittent urinary cath Cath insertion tray w/bag Bladder irrigation tubing Ext ureth clmp or compr dvc Bedside drainage bag Urinary leg bag Urinary suspensory w/o leg b Ostomy face plate Solid skin barrier Liq adhes for facial prosth Adhesive remover wipes Ostomy belt Ostomy filter Skin barrier liquid per oz Skin barrier paste per oz Skin barrier powder per oz Skin barrier solid 4x4 equiv Skin barrier with flange Skin barrier extended wear Drainable plastic pch w fcpl Drainable rubber pch w fcplt Drainable plstic pch w/o fp Drainable rubber pch w/o fp Urinary plastic pouch w fcpl Urinary rubber pouch w fcplt Urinary plastic pouch w/o fp Urinary hvy plstc pch w/o fp Urinary rubber pouch w/o fp Ostomy faceplt/silicone ring Ost skn barrier sld ext wear Ost skn barrier w flng ex wr Ost clsd pouch w att st barr Drainable pch w ex wear barr Drainable pch w st wear barr Drainable pch ex wear convex Urinary pouch w ex wear barr Urinary pouch w st wear barr 4 A4393 A4394 A4395 A4396 A4397 A4398 A4399 A4400 A4402 A4404 A4421 A4454 A4455 A4460 A4462 A4464 A4465 A4470 A4480 A4481 A4483 A4490 A4495 A4500 A4510 A4550 A4554 A4556 A4557 A4558 A4561 A4562 A4565 A4570 A4572 A4575 A4580 A4590 A4595 A4608 A4611 A4612 A4613 A4614 A4615 A4616 A4617 A4618 A4619 A4620 A4621 A4622 Urine pch w ex wear bar conv Ostomy pouch liq deodorant Ostomy pouch solid deodorant Peristomal hernia supprt blt Irrigation supply sleeve Ostomy irrigation bag Ostomy irrig cone/cath w brs Ostomy irrigation set Lubricant per ounce Ostomy ring each Ostomy supply misc Tape all types all sizes Adhesive remover per ounce Elastic compression bandage Abdmnl drssng holder/binder Joint support device/garment Non-elastic extremity binder Gravlee jet washer Vabra aspirator Tracheostoma filter Moisture exchanger Above knee surgical stocking Thigh length surg stocking Below knee surgical stocking Full length surg stocking Surgical trays Disposable underpads Electrodes, pair Lead wires, pair Conductive paste or gel Pessary rubber, any type Pessary, non rubber,any type Slings Splint Rib belt Hyperbaric o2 chamber disps Cast supplies (plaster) Special casting material TENS suppl 2 lead per month Transtracheal oxygen cath Heavy duty battery Battery cables Battery charger Hand-held PEFR meter Cannula nasal Tubing (oxygen) per foot Mouth piece Breathing circuits Face tent Variable concentration mask Tracheotomy mask or collar Tracheostomy or larngectomy 5 A4623 A4624 A4625 A4626 A4627 A4628 A4629 A4630 A4631 A4635 A4636 A4637 A4640 A4641 A4642 A4643 A4644 A4645 A4646 A4647 A4649 A4650 A4655 A4660 A4663 A4670 A4680 A4690 A4700 A4705 A4712 A4714 A4730 A4735 A4740 A4750 A4755 A4760 A4765 A4770 A4771 A4772 A4773 A4774 A4780 A4790 A4800 A4820 A4850 A4860 A4870 A4880 Tracheostomy inner cannula Tracheal suction tube Trach care kit for new trach Tracheostomy cleaning brush Spacer bag/reservoir Oropharyngeal suction cath Tracheostomy care kit Repl bat t.e.n.s. own by pt Wheelchair battery Underarm crutch pad Handgrip for cane etc Repl tip cane/crutch/walker Alternating pressure pad Diagnostic imaging agent Satumomab pendetide per dose High dose contrast MRI Contrast 100-199 MGs iodine Contrast 200-299 MGs iodine Contrast 300-399 MGs iodine Supp- paramagnetic contr mat Surgical supplies Supp esrd centrifuge Esrd syringe/needle Esrd blood pressure device Esrd blood pressure cuff Auto blood pressure monitor Activated carbon filters Dialyzers Standard dialysate solution Bicarb dialysate solution Sterile water Treated water for dialysis Fistula cannulation set dial Local/topical anesthetics Esrd shunt accessory Arterial or venous tubing Arterial and venous tubing Standard testing solution Dialysate concentrate Blood testing supplies Blood clotting time tube Dextrostick/glucose strips Hemostix Ammonia test paper Esrd sterilizing agent Esrd cleansing agents Heparin/antidote dialysis Supplies hemodialysis kit Rubber tipped hemostats Disposable catheter caps Plumbing/electrical work Water storage tanks 6 A4890 A4900 A4901 A4905 A4910 A4912 A4913 A4914 A4918 A4919 A4920 A4921 A4927 A5051 A5052 A5053 A5054 A5055 A5061 A5062 A5063 A5064 A5071 A5072 A5073 A5074 A5075 A5081 A5082 A5093 A5102 A5105 A5112 A5113 A5114 A5119 A5121 A5122 A5123 A5126 A5131 A5200 A5500 A5501 A5502 A5503 A5504 A5505 A5506 A5507 A5508 A6020 Contracts/repair/maintenance Capd supply kit Ccpd supply kit Ipd supply kit Esrd nonmedical supplies Gomco drain bottle Esrd supply Preparation kit Venous pressure clamp Supp dialysis dialyzer holde Harvard pressure clamp Measuring cylinder Gloves Pouch clsd w barr attached Clsd ostomy pouch w/o barr Clsd ostomy pouch faceplate Clsd ostomy pouch w/flange Stoma cap Pouch drainable w barrier at Drnble ostomy pouch w/o barr Drain ostomy pouch w/flange Drain ostomy pouch w/fceplte Urinary pouch w/barrier Urinary pouch w/o barrier Urinary pouch on barr w/flng Urinary pouch w/faceplate Urinary pouch on faceplate Continent stoma plug Continent stoma catheter Ostomy accessory convex inse Bedside drain btl w/wo tube Urinary suspensory Urinary leg bag Latex leg strap Foam/fabric leg strap Skin barrier wipes box pr 50 Solid skin barrier 6x6 Solid skin barrier 8x8 Skin barrier with flange Disk/foam pad +or- adhesive Appliance cleaner Percutaneous catheter anchor Diab shoe for density insert Diabetic custom molded shoe Diabetic shoe density insert Diabetic shoe w/roller/rockr Diabetic shoe with wedge Diab shoe w/metatarsal bar Diabetic shoe w/off set heel Modification diabetic shoe Diabetic deluxe shoe Collagen wound dressing 7 A6021 A6022 A6023 A6024 A6025 A6154 A6196 A6197 A6198 A6199 A6200 A6201 A6202 A6203 A6204 A6205 A6206 A6207 A6208 A6209 A6210 A6211 A6212 A6213 A6214 A6215 A6216 A6217 A6218 A6219 A6220 A6221 A6222 A6223 A6224 A6228 A6229 A6230 A6231 A6232 A6233 A6234 A6235 A6236 A6237 A6238 A6239 A6240 A6241 A6242 A6243 A6244 Collagen dressing <=16 sq in Collagen drsg>6<=48 sq in Collagen dressing >48 sq in Collagen dsg wound filler Silicone gel sheet, each Wound pouch each Alginate dressing <=16 sq in Alginate drsg >16 <=48 sq in alginate dressing > 48 sq in Alginate drsg wound filler Compos drsg <=16 no border Compos drsg >16<=48 no bdr Compos drsg >48 no border Composite drsg <= 16 sq in Composite drsg >16<=48 sq in Composite drsg > 48 sq in Contact layer <= 16 sq in Contact layer >16<= 48 sq in Contact layer > 48 sq in Foam drsg <=16 sq in w/o bdr Foam drg >16<=48 sq in w/o b Foam drg > 48 sq in w/o brdr Foam drg <=16 sq in w/border Foam drg >16<=48 sq in w/bdr Foam drg > 48 sq in w/border Foam dressing wound filler Non-sterile gauze<=16 sq in Non-sterile gauze>16<=48 sq Non-sterile gauze > 48 sq in Gauze <= 16 sq in w/border Gauze >16 <=48 sq in w/bordr Gauze > 48 sq in w/border Gauze <=16 in no w/sal w/o b Gauze >16<=48 no w/sal w/o b Gauze > 48 in no w/sal w/o b Gauze <= 16 sq in water/sal Gauze >16<=48 sq in watr/sal Gauze > 48 sq in water/salne Hydrogel dsg<=16 sq in Hydrogel dsg>16<=48 sq in Hydrogel dressing >48 sq in Hydrocolld drg <=16 w/o bdr Hydrocolld drg >16<=48 w/o b Hydrocolld drg > 48 in w/o b Hydrocolld drg <=16 in w/bdr Hydrocolld drg >16<=48 w/bdr Hydrocolld drg > 48 in w/bdr Hydrocolld drg filler paste Hydrocolloid drg filler dry Hydrogel drg <=16 in w/o bdr Hydrogel drg >16<=48 w/o bdr Hydrogel drg >48 in w/o bdr 8 A6245 A6246 A6247 A6248 A6250 A6251 A6252 A6253 A6254 A6255 A6256 A6257 A6258 A6259 A6260 A6261 A6262 A6263 A6264 A6265 A6266 A6402 A6403 A6404 A6405 A6406 A7000 A7001 A7002 A7003 A7004 A7005 A7006 A7007 A7008 A7009 A7010 A7011 A7012 A7013 A7014 A7015 A7016 A7017 A7018 A7019 A7020 A7501 A7502 A7503 A7504 A7505 Hydrogel drg <= 16 in w/bdr Hydrogel drg >16<=48 in w/b Hydrogel drg > 48 sq in w/b Hydrogel drsg gel filler Skin seal protect moisturizr Absorpt drg <=16 sq in w/o b Absorpt drg >16 <=48 w/o bdr Absorpt drg > 48 sq in w/o b Absorpt drg <=16 sq in w/bdr Absorpt drg >16<=48 in w/bdr Absorpt drg > 48 sq in w/bdr Transparent film <= 16 sq in Transparent film >16<=48 in Transparent film > 48 sq in Wound cleanser any type/size Wound filler gel/paste /oz Wound filler dry form / gram Non-sterile elastic gauze/yd Non-sterile no elastic gauze Tape per 18 sq inches Impreg gauze no h20/sal/yard Sterile gauze <= 16 sq in Sterile gauze>16 <= 48 sq in Sterile gauze > 48 sq in Sterile elastic gauze /yd Sterile non-elastic gauze/yd Disposable canister for pump Nondisposable pump canister Tubing used w suction pump Nebulizer administration set Disposable nebulizer sml vol Nondisposable nebulizer set Filtered nebulizer admin set Lg vol nebulizer disposable Disposable nebulizer prefill Nebulizer reservoir bottle Disposable corrugated tubing Nondispos corrugated tubing Nebulizer water collec devic Disposable compressor filter Compressor nondispos filter Aerosol mask used w nebulize Nebulizer dome & mouthpiece Nebulizer not used w oxygen Water distilled w/nebulizer Saline solution dispenser Sterile H2O or NSS w lgv neb Tracheostoma valve w diaphra Replacement diaphragm/fplate HMES filter holder or cap Tracheostoma HMES filter HMES or trach valve housing 9 A7506 A7507 A7508 A7509 A9150 A9160 A9170 A9190 A9270 A9300 A9500 A9502 A9503 A9504 A9505 A9507 A9508 A9510 A9600 A9605 A9700 A9900 A9901 B4034 B4035 B4036 B4081 B4082 B4083 B4084 B4085 B4150 B4151 B4152 B4153 B4154 B4155 B4156 B4164 B4168 B4172 B4176 B4178 B4180 B4184 B4186 B4189 B4193 B4197 B4199 B4216 B4220 HMES/trachvalve adhesivedisk Integrated filter & holder Housing & Integrated Adhesiv Heat & moisture exchange sys Misc/exper non-prescript dru Podiatrist non-covered servi Chiropractor non-covered ser Misc/expe personal comfort i Non-covered item or service Exercise equipment Technetium TC 99m sestamibi Technetium TC99M tetrofosmin Technetium TC 99m medronate Technetium tc 99m apcitide Thallous chloride TL 201/mci Indium/111 capromab pendetid Iobenguane sulfate I-131 Technetium TC99m Disofenin Strontium-89 chloride Samarium sm153 lexidronamm Echocardiography Contrast Supply/accessory/service Delivery/set up/dispensing Enter feed supkit syr by day Enteral feed supp pump per d Enteral feed sup kit grav by Enteral ng tubing w/ stylet Enteral ng tubing w/o stylet Enteral stomach tube levine Gastrostomy/jejunostomy tubi Gastrostomy tube w/ring each Enteral formulae category i Enteral formulae cat1natural Enteral formulae category ii Enteral formulae categoryIII Enteral formulae category IV Enteral formulae category v Enteral formulae category vi Parenteral 50% dextrose solu Parenteral sol amino acid 3. Parenteral sol amino acid 5. Parenteral sol amino acid 7Parenteral sol amino acid > Parenteral sol carb > 50% Parenteral sol lipids 10% Parenteral sol lipids 20% Parenteral sol amino acid & Parenteral sol 52-73 gm prot Parenteral sol 74-100 gm pro Parenteral sol > 100gm prote Parenteral nutrition additiv Parenteral supply kit premix 10 B4222 B4224 B5000 B5100 B5200 B9000 B9002 B9004 B9006 B9998 B9999 C1000 C1001 C1003 C1004 C1006 C1007 C1008 C1009 C1010 C1011 C1012 C1013 C1014 C1016 C1017 C1018 C1019 C1024 C1025 C1026 C1027 C1028 C1029 C1030 C1031 C1033 C1034 C1035 C1036 C1037 C1038 C1039 C1040 C1042 C1043 C1045 C1047 C1048 C1050 C1051 C1053 Parenteral supply kit homemi Parenteral administration ki Parenteral sol renal-amirosy Parenteral sol hepatic-fream Parenteral sol stres-brnch c Enter infusion pump w/o alrm Enteral infusion pump w/ ala Parenteral infus pump portab Parenteral infus pump statio Enteral supp not otherwise c Parenteral supp not othrws c PERCLOSCLOSR PROSTARArtVas ACUNAV-DIAGNSTIC ULTRSND Ca Cath, ablation, Livewire TC Fast-Cath,Swartz,SAFL,CSTA ARRAY POST Chamb IOL AMS 700/Ambicor Prosthesis UROLUME-IMPLT URETHRAL Stnt PLASMA,CRYOPRECIPITATE-Reduc Blood, L/R, CMV-NEG Platelet, L/R CMV-NEG, UNIT PLATELET CONC, L/R, Irrad PLATELET CONC, L/R, Unit Platelet,Aph/Pher, L/R, unit BLOOD,L/R,FROZ/DEGLY/Washed Plt, APH/PHER,L/R,CMV-NEG Blood, L/R, IRRADIATED Plt, APH/PHER, L/R, IRRAD QUINOPRISTIN 10ml/DALFOPRIS Marinr CS Cath RF PERFRMR CATH 5F RF Marinr MAGIC X/SHORT RADIUS 14mm PRCIS TWST TRSNSVG ANCH Sys CRE GUIDED BALLOON DIL Cath CTHTR:MRSHAL,BLU MAX UTR Dmd MR COMP/MOD LEVEEN NED Elect SONICATH Mdl 37-410 SURPASS, LONG30 SURPASS-Cath Cath, Ultra ICE R PORT/RESERVOIR IMPL Dev VAXCELCHRONIC DIALYSIS Cath UltraCross Imaging Cath WALLSTENT, RP/Trach Wallstent, TIPS Wallstent, Biliary ATHERECTOMY SYS, Coronary I-131 Mibg(IOBEN-SULFATE)0.5 NOGA/NAVI-STAR Cath NEUROCYBERNETICPROS:Gen PROSORBA Column Oasis Thrombectomy Cath ENSITE 3000 Catheter 11 C1054 C1055 C1056 C1057 C1059 C1060 C1061 C1063 C1067 C1068 C1069 C1071 C1072 C1073 C1074 C1075 C1076 C1077 C1078 C1079 C1084 C1086 C1087 C1088 C1089 C1090 C1091 C1092 C1094 C1095 C1096 C1097 C1098 C1099 C1100 C1101 C1102 C1103 C1104 C1105 C1106 C1107 C1109 C1110 C1111 C1112 C1113 C1114 C1115 C1116 C1117 C1118 Hydrolyser Thromb Cath 6/7F Transesoph 210, 210-S cath Thermachoice II Cath MICROMARK TISSUE Marker CARTICEL,AUTO CULT-CHNDR Cyt ACS MULTI-LINK TRISTAR Stent ACS VIKING GUIDING Cath ENDOTAK ENDURANCE EZ,RX Lead MEGALINK BILIARY Stent PULSAR DDD Pmkr DISCOVERY DR, Pmkr PULSAR MAX, PULSAR SR Pmkr GUIDANT:BLLN DIL Cath Morcellator RX/OTW VIATRAC-PERI DIL Cath GUIDANT:LEAD,Pmkr VENTAK MINI SC Defib VENTAK VR,PRIZM VR, SC Defib VENTAK:PRIZM,AV III DR Defib CO 57/58 0.5 Mci DENILEUKIN DIFTITOX, 300 Mcg TEMOZOLOMIDE, 5 mg I-123, per uCi, capsule LASER OPTIC TR Sys Co 57, 0.5 Mci INN I-111 CHLORIDE, PER mci INI111 OXYQUINOLINE,PER 5mci IN 111 PENETATE, PER 1.5 mci TC99M ALBUMIN AGGR, PER Vial TC 99M DEPREOTIDE, PER Vial TC 99M EXAMETAZIME, PER Dose TC 99M MEBROFENIN, PER Vial TC 99M PENTETATE, PER Vial TC 99M PYROPHOSPHATE,PER Via Medtronic AVE GT1 GUIDEWIRE MEDTRONIC AVE Zuma Guidecath SYNERGY NEUROSTIM Genrtr MICRO Jewel DEFIBRILLATOR RF Conductr Ablation Cath SIGMA 300VDD Pmkr SYNERGYEX Pt PROGRMR TORQR,SOLOIST Cath IMPLANTABLE ANCHOR:Ethicon STABLE MAPPER,Cath ELECTR ANEURXAORT-UNI-Iliac Stnt ANEURX STENT GRAFT/DEL Cath TLNT ENDO SPRNG STNT GRFT Sy TALNTSPRGSTNT+GRAF ENDO Pros 5038S, 5038 5038L PACE Lead CAPSURESP PACING Lead Ancure Endograft Del Sys SIGMA300DR LEGIIDR, Pmkr 12 C1119 C1120 C1121 C1122 C1123 C1124 C1125 C1126 C1127 C1128 C1129 C1130 C1131 C1132 C1133 C1134 C1135 C1136 C1137 C1143 C1144 C1145 C1146 C1147 C1148 C1149 C1151 C1152 C1153 C1154 C1155 C1156 C1157 C1158 C1159 C1160 C1161 C1162 C1163 C1164 C1166 C1167 C1170 C1171 C1172 C1173 C1174 C1175 C1176 C1177 C1178 C1179 SPRINT6932,6943 DEFIB Lead SPRINT6942,6945 DEFIB Lead Gem DEFIBRILLATOR Tc 99M ARCITUMOMAB PER VIAL Gem II VR DEFIBRILLATOR INTERSTIM TEST STIM Kit Kappa 400SR,TOPAZ II SR PMKR Kappa 700 DR, PMKR Kappa 700SR, SC PMKR Kappa 700D, RUBY IID PMKR Kappa 700VDD, PMKR Sigma200D, LGCY IID DC PMKR Sigma 200DR, PMKR Sigma 200 SR Leg II:SC PA Sigma SR, VITA SR, PMKR Sigma 300D PMKR Entity DR 5326L/R, DC, pmkr Affinity DR 5330L/R, DC, pmk CardioSeal IMPLANT SYS AddVent MOD 2060BL, VDD Afnty SP 5130,INTEGRITY SR Angio-SEAL 6FR,8FR Vett Tube Av PLUS DX 1368:LEAD Contour MD SC DEFIB Entity DC 5226R,PMKR PASSIVEPLUS DX LEAD, 10mdls LifeSite ACCESS SYSTEM REGENCY SC+2402L Pmkr SPL:SPO1,02,04-DEFIB Lead Repliform 8 SQ CM Tr1102TRSR+2260L,2264L,5131 Trilogy DCT 23/8L PMKR Tvl LEAD SV01,SV02,SV04 Tvl RV02, RV06,RV07:LEAD TVL-ADX 1559:Lead Tendril DX, 1388 PACING LEAD TempoDR TRILOGYDR+DC PMKR Tendril SDX, 1488T LEAD IODINE-125 Brachytx Seed CYTARABINE LIPOSOMAL, 10 mg EPIRUBICIN HCL, 2 mg ABBI DISP BIOPSY Device AUTOSUTURE SITE MARKER Stple SPACEMAKER DISSECT Balloon COR STNTS540,S670,O-WIRE Stn BARD BRACHYTX Needle MIBB disp biopsy device Mammotome HH Probe w/Vac Sys 11-G Mammotome Probe BUSULFAN IV, 6 Mg 14-G Mammotome Probe 13 C1180 C1181 C1182 C1183 C1184 C1188 C1200 C1201 C1202 C1203 C1205 C1207 C1300 C1302 C1303 C1304 C1305 C1306 C1311 C1312 C1313 C1314 C1315 C1316 C1317 C1318 C1319 C1320 C1321 C1322 C1323 C1324 C1325 C1326 C1328 C1329 C1333 C1334 C1335 C1336 C1337 C1348 C1350 C1351 C1352 C1353 C1354 C1355 C1356 C1357 C1358 C1359 Vigor SR, SC, pmkr Meridian SSI, SC, pmkr Pulsar SSI, SC, pmkr Jade IIS, Sigma 300S, SC, pm Sigma 200S, SC, pmkr I-131, PER Uci TC 99M Sodium Glucoheptonat TC 99M SUCCIMER, PER Vial TC 99M SULFUR COLLOID, Vial VERTEPORFIN FOR Inj TC 99M DISOFENIN, PER Vial OCTREOTIDE ACETATE DEPOT 1mg HYPERBARIC Oxygen SQ01: Lead CapSure Fix 6940/4068-110 SONCATH Mdl 37-416,-418 Apligraf NEUROCYBERNETICPROS:Lead TRILOGY DR+/DAO Pmkr MAGIC WALLSTENT--Mini MAGIC MEDIUM,RADIUS 31mm MAGIC WALLSTENT--Long VIGOR DR, MERIDIAN DR Pmkr MERIDIAN DDD Pmkr DISCOVERY SR, Pmkr MERIDIAN SR Pmkr Wallstent: Enteral--60mm Wallstent: Iliac Palate/Base of Tongue electr Turbinate Somnoplasty electr VAPR/T disp electrode LIGASURE DISPOSABLE Electrod Palladium-103 Seed ANGIO-JET RHEOLYTIC Thromb ANS RENEW NS Trnsmtr Versapoint disp electrode PALMAZ CORINTHIAN BIL Stent CROWN,MINI-CROWN,CROSSLc MESH, Prolene CONSTANT Flow Imp Pump IsoMed 8472-20/35/60 I-131 PER MCI Solution PROSTASEED I-125, PER Source CAPSURE FIX Lead Gem II DR ITREL INTERSTM NEUROSTIM+Ext Kappa 400DR,DIAMOND II 820DR Kappa 600DR, VITA DR Profile MD V-186HV3 Sc DEFIB ANGSTROM MD V-190HV3 Sc DEF AFFINITY DC 5230R, Pmkr PULSAR,PULSAR MAX DR, Pmkr 14 C1360 C1361 C1362 C1363 C1364 C1365 C1366 C1367 C1368 C1369 C1370 C1371 C1372 C1375 C1376 C1377 C1378 C1379 C1420 C1421 C1450 C1451 C1500 C1700 C1701 C1702 C1703 C1704 C1705 C1706 C1707 C1708 C1709 C1710 C1711 C1712 C1790 C1791 C1792 C1793 C1794 C1795 C1796 C1797 C1798 C1799 C1800 C1801 C1802 C1803 C1804 C1805 OCULAR PHOTODYNAMIC Tx REVEAL CARDIAC Recorder HERCULINK,OTW,SDS BIL Stnt Gem DR, DC, defib Photon DR V-230HV3 DC defib Guidewire, Hi-Torque14/18/35 Guidewire,PTCA,Hi-Torque Guide wire, Hi-TorqueCrossIt On-Q Pain Mgt Sys ANS Renew Stim Sys recvr Tension-Free Vaginal Tape Symp Nitinol Transhep Bil Sy Cordis Nitinol bil stent Stent, coronary, NIR ANS Renew Stim Sys lead Specify 3988 neuro lead InterStim Tx 3080/3886 lead Pisces-Quad 3887 lead StapleTac2 Bonew/Dermis stapletac2 bone wo Dermis ORTHOSPHERE Arthroplasty ORTHOSPHERE ARTHROPLASTY Kit Atherectomy sys, peripheral Authen Mick TP brachy needle Medtec MT-BT-5201-25 needle WWMT Brachy Needle Mentor Prostate Brachy MT-Bt-5001-25/5051-25 Best Flexi Brachy Needle Indigo Prostate Seeding Ndl Varisource Implt Ndl UroMed Prostate Seed Ndl Remington Brachytx Needle US BIOPSY Prostate Needle MD TECH Brachytx Needle Imagyn brachytx needle Iridium 192 HDR OncoSeed, Rapid Strand I-125 UroMed I-125 Brachy seed Bard InterSource P-103 seed Bard IsoSeed P-103 seed Bard BrachySource I-125 SourceTech Med I-125 Draximage I-125 seed Syncor I-125 PharmaSeed I-Plant I-125 Brachytx seed Pd-103 brachytx seed IoGold I-125 brachytx seed Iridium 192 brachytx seeds Best Iodine 125 brachytx sds Best Palladium 103 seeds IsoStar Iodine-125 seeds 15 C1806 C1810 C1811 C1812 C1850 C1851 C1852 C1853 C1854 C1855 C1856 C1857 C1858 C1859 C1860 C1861 C1862 C1863 C1864 C1865 C1866 C1867 C1868 C1869 C1870 C1871 C1872 C1873 C1929 C1930 C1931 C1932 C1933 C1934 C1935 C1936 C1937 C1938 C1939 C1940 C1941 C1942 C1943 C1944 C1945 C1946 C1947 C1948 C1949 C1979 C1980 C1981 Best Gold 198 brachytx seed D114S Dilatation Cath Sugical Dynamics Anchors OBL Anchors Repliform 14/21 sq cm Repliform 24/28 sq cm TransCyte, per 247 sq cm Suspend, per 8/14 sq cm Suspend, per 24/28 sq cm Suspend, per 36 sq cm Suspend, per 48 sq cm Suspend, per 84 sq cm DuraDerm, per 8/14 sq cm DuraDerm, per 21/24/28 sq cm DuraDerm, per 48 sq cm DuraDerm, per 36 sq cm DuraDerm, per 72 sq cm DuraDerm, per 84 sq cm SpermaTex, per 13.44 sq cm FasLata, per 8/14 sq cm FasLata, per 24/28 sq cm FasLata, per 36/48 sq cm FasLata, per 96 sq cm Gore Thyroplasty Device DermMatrix, per 16 sq cm DermMatrix, 32 or 64 sq cm Dermagraft, per 37.5 sq cm Bard 3DMax Mesh Maverick PTCA Cath Coyote Dil Cath, 20/30/40mm Talon Dil Cath SciMed Remedy Dil Cath Opti-Plast XL/Centurion Cath Ultraverse 3.5F Bal Dil Cath Workhorse PTA Bal Cath Uromax Ultra Bal Dil Cath Synergy/Explorer Cath UroForce Bal Dil Cath Raptur, Ninja PTCA Dil Cath PowerFlex,OPTA 5/LP Bal Cath Jupiter PTA Dil Cath Cordis Maxi LD PTA Bal Cath RXCrossSail OTW OpenSail Rapid Exchange Bil Dil Cath Savvy PTA Dil Cath R1s Rapid Dil Cath Gazelle Bal Dil Cath Oracle Megasonics Cath Oracle Megasonics Cath Visions PV/Avanar US Cath Atlantis SR Coronary Cath PTCA Catheters 16 C2000 C2001 C2002 C2003 C2004 C2005 C2006 C2007 C2008 C2009 C2010 C2011 C2012 C2013 C2014 C2015 C2016 C2017 C2018 C2019 C2020 C2021 C2022 C2023 C2100 C2101 C2102 C2103 C2104 C2151 C2152 C2153 C2200 C2300 C2597 C2598 C2599 C2600 C2601 C2602 C2603 C2604 C2605 C2606 C2607 C2608 C2609 C2610 C2611 C2612 C2676 C2700 Orbiter ST Steerable Cath Constellation Diag Cath Irvine 5F Inquiry EP Cath Irvine 6F Inquiry EP Cath EP Cath--Octapolar EP Tip Cath--Hexapolar EP Cath--Decapolar Irvine 6F Luma-Cath EP Cath Luma-Cath Ep Cath 81910-15 Irvine 7F Luma-Cath EP Cath Fixed Curve EP Cath Deflectable Tip Cath--Quad Celsius Abln Cath Celsius Large Abln Cath Celsius II Asym Abln Cath Celsius II Sym Abln Cath Navi-Star DS, Navi-Star Ther Navi-Star Abln Cath Polaris T Ablation Cath EP Deflectable Cath Blazer II XP Abln Cath SilverFlex EP Cath CP Chilli Cooled Abln Cath Chilli Cld AblnCath-std,lg CP CS Reference Cath CP RV Reference Cath CP Radii 7F EP Cath CP Radii 7F EP Cath w/Track Lasso Deflectable Cath Veripath Guiding Cath Cordis Vista Brite Tip Cath Bard Viking Cath Arrow-Trerotola PTD Cath Varisource Stnd Cath Clinicath 16/18 sgl/dbl CliniCath 18/20/24G--single CliniCath 16/18 double Gold Probe Catheter Bard DL Ureteral Cath Vitesse Laser Cath 1.4/1.7mm Vitesse Laser Cath 2.0mm Vitesse E Laser Cath 2.0mm Extreme Laser Cath SpineCath XL Catheter SpineCath Intradiscal Cath SciMed 6F Wiseguide Catheter Flexima Bil Drainage Cath FlexTipPlus Intraspinal Cath AlgoLine Intraspinal Cath InDura Catheter Rsponse CV Catheter MycroPhylax Plus SC defib 17 C2701 C2702 C2703 C2704 C2801 C2802 C2803 C2804 C2805 C2806 C2807 C2808 C3001 C3002 C3003 C3004 C3400 C3401 C3500 C3510 C3551 C3552 C3553 C3554 C3555 C3556 C3557 C3800 C3801 C3851 C4000 C4001 C4002 C4003 C4004 C4005 C4006 C4007 C4008 C4009 C4300 C4301 C4302 C4303 C4304 C4305 C4306 C4307 C4308 C4309 C4310 C4311 Phylax XM SC defib Ventak Prizm 2 VR Defib Ventak Prizm VR HE Defib Ventak Mini IV+ Defib Defender IV DR 612 DC defib Phylax AV Ventak Prizm DR HE Defib Ventak Prizm 2 DR Defib Jewel AF 7250 Defib Gem VR 7227 Defib Contak CD 1823 Contak TR 1241 Kainox SL/RV defib lead EasyTrak Defib Lead Endotak SQ Aray XP lead Intervene Defib Lead Siltex Spectrum,Contour Prof Saline-Filled Spectrum Alpha I Inf Pro AMS 800 URINARY Pros Choice/PT Graphix/Luge/Troop Hi-Torque Whisper Cordis guidewires Jindo guidewire Wholey Hi-Torque Plus GW Wave/FlowWire Guidewire HyTek guidewire SynchroMed EL Infusion Pump Arrow/MicroJect PCA Sys Elastic UV IOLAA-4203T/TF/TL Opus G 4621, 4624 SC pmkr Opus S 4121/4124 SC pmkr Talent 113 SC pmkr Kairos SR SC pmkr Actros SR, ActrosSR-B SC pmk Philos SR/SR-B SC pmkr Pulsar Max II SR pmkr Marathon SR pmkr Discovery II SSI pmkr Discovery II SR pmkr Integrity AFx DR 5342 pmkr Integrity AFx DR 5346 pmkr Affinity VDR 5430 pmkr Brio 112 DC pmkr Brio212,Talent213/223DCpmkr Brio 222 DC pmkr Brio 220 DC pmkr Kairos DR DC pmkr Inos2, Inos2+ DC pmkr Actros DR,D,DR-A,SLR DC pmkr Actros DR-B DC pmkr Philos DR/DR-B/SLR DC pmkr 18 C4312 C4313 C4314 C4315 C4316 C4317 C4600 C4601 C4602 C4603 C4604 C4605 C4606 C4607 C5000 C5001 C5002 C5003 C5004 C5005 C5006 C5007 C5008 C5009 C5010 C5011 C5012 C5013 C5014 C5015 C5016 C5017 C5018 C5019 C5020 C5021 C5022 C5023 C5024 C5025 C5026 C5027 C5028 C5029 C5030 C5031 C5032 C5033 C5034 C5035 C5036 C5037 Pulsar Max II DR pmkr Marathon DR pmkr Momentum DR pmkr Selection AFm pmkr Discovery II DR Discovery II DDD Synox,Polyrox,Elox,Retrox Aescula LV pmkr lead Tendril SDX, 1488k pmkr lead Oscor/Flexion pmkr lead CrystallineActFix,CapsureFix CapSure Epi pmkr lead Flextend pmkr lead FinelineII/EZ, ThinlineII/EZ BX Velocity w/Hepacoat Memotherm Bil Stent, sm, med Memotherm Bil Stent, large Memotherm Bil Stent, x-large PalmazCorinthian IQ Bil Stnt PalmazCorinthian IQ Trans/Bi PalmazTrans Bil StentSys-Med PalmazTrans XL Bil St-40mm PalmazTrans XL Bil St-50mm VistaFlex Biliary Stent Rapid Exchange Bil Stent Sys IntraStent, IntraStent LP IntraStent DoubleStrut LD IntraStent DoubleStrut, XS AVE Bridge StentSys10/17/28 AVE/X3 Bridge Sys, 40-100 Biliary Stent Single Use Cov WallstentRP-Bil-20/40/60/68 WallstentRP Bil--80/94mm Flexima Bil Stent Sys Smart Nitinol Stent--20MM Smart Nitinol Stent--40/60MM Smart Nitinol Stent--80MM BX Velocity Stent--8/13mm BX Velocity Stent BX Velocity Stent--23mm BX Velocity Stent--28/33mm BX Velocity w/Hep--8/13mm BX Velocity w/Hep--18mm BX Velocity w/Hep--23mm Stent, coronary, S660 9/12mm Stent, coronary, S660 15/18 Stent,coronary, S660 24/30 Niroyal Stnt Sys, 9mm Niroyal Stent Sys, 12/15mm Niroyal Stent Sys, 18mm Niroyal Stent Sys, 25mm Niroyal Stent Sys, 31mm 19 C5038 C5039 C5040 C5041 C5042 C5043 C5044 C5045 C5046 C5047 C5048 C5130 C5131 C5132 C5133 C5134 C5279 C5280 C5281 C5282 C5283 C5284 C5600 C5601 C6001 C6002 C6003 C6004 C6005 C6006 C6012 C6013 C6014 C6015 C6016 C6017 C6018 C6019 C6020 C6021 C6022 C6023 C6024 C6025 C6026 C6027 C6028 C6029 C6030 C6031 C6032 C6033 BX Velocity Stnt w/Raptor IntraCoil Perip Stent--40mm IntraCoil Periph Stent--60mm BeStent Over-the-Wire24/30mm BeStent Over-the-Wire 18mm BeStent Over-the-Wire 15mm BeStent Over-the-Wire 9/12mm Multilink Tetra Cor Stent Sy Radius 20mm cor stent Niroyal Elite Cor Stent Sys GR II Coronary Stent Wilson-Cook Z-stent Bard Colorectal Stent--60mm Bard Colorectal Stent--80mm Bard Colorectal Stent-100mm Enteral Wallstent--90mm Contour/Percuflex Stent Inlay Dbl Ureteral Stent Wallgraft Trach Sys 70mm Wallgraft Trach Sys 20/30/50 Wallstent/RP TIPS--80mm Wallstent TrachUltraFlex Closure dev, VasoSeal ES VasoSeal 1000 Composix Mesh 8/18 in Composix Mesh 32 in Composix Mesh 48 in Composix Mesh 80 in Composix Mesh 140 in Composix Mesh 144 in Pelvicol Collagen 8/14 sq cm Pelvicol Collagen 21/24/28 Pelvicol Collagen 40 sq cm Pelvicol Collagen 48 sq cm Pelvicol Collagen 96 sq cm Gore-Tex DualMesh 75/96 sqcm Gore-Tex DualMesh 150sqcm Gore-Tex DualMesh 285 sqcm Gore-Tex DualMesh 432sqcm Gore-Tex DualMesh 600 sqcm Gore-Tex DualMesh 884 sqcm Gore-TexPlus 1mm,75/96 sqcm Gore-TexPlus 1mm, 150 sq cm Gore-TexPlus 1mm, 285 sq cm Gore-TexPlus 1mm, 432 sqcm Gore-TexPlus 1mm, 600 sqcm Gore-TexPlus 1mm,884 sq cm Gore-TexPlus 2mm, 150 sq cm Gore-TexPlus 2mm, 285 sq cm Gore-TexPlus 2mm, 432 sq cm Gore-TexPlus 2mm, 600 sq cm Gore-TexPlus 2mm,884 sq cm 20 C6034 C6035 C6036 C6037 C6038 C6039 C6040 C6041 C6050 C6051 C6052 C6053 C6054 C6055 C6056 C6057 C6058 C6080 C6200 C6201 C6202 C6203 C6204 C6205 C6206 C6207 C6208 C6209 C6210 C6300 C6500 C6501 C6525 C6600 C6650 C6651 C6652 C6700 C8099 C8100 C8102 C8103 C8500 C8501 C8502 C8503 C8504 C8505 C8506 C8507 C8508 C8509 Bard ePTFE: 150 sq cm-2mm Bard ePTFE150sqcm-1mm,75-2mm Bard ePTFE: 50/75sqcm-1,2mm Bard ePFTE: 300sq cm-1mm Bard ePTFE: 600sq cm-1mm Bard ePTFE: 884 cm--1mm Bard ePTFE: 600sq cm-2mm Bard ePTFE: 884sq cm-2mm Female Sling Sys w/wo Matrl Stratasis Sling, 20/40cm Stratasis Sling, 60cm Surgisis Soft Graft Surgisis Enchanced Graft Surgisis Enhanced Tissue Surgisis Soft Tissue Graft Surgisis Hernia Graft SurgiPro Hernia Plug,med/lg Male Sling Sys w/wo Matrl Exxcel Sft ePTFE vas graft Impra Venaflo-10/20cm Impra Venaflo-30/40cm Impra Venaflo-50cm/vt45 Impra Venaflo-stepped Impra Carboflo-10cm Impra Carboflo-20cm Impra Carboflo-30/34/40cm Impra Carboflo-40/50cm Impra Carboflo-ctrflex Exxcel ePTFE vas graft Vanguard III Endovas Graft Preface Guiding Sheath Soft Tip Sheaths Spectranetics Laser Sheath Micro Litho Flex Probes Fast-cath Guiding Introducer Seal-AwayGuiding Introducer Bard Excalibur Introducer Focal Seal-L Spectranetics Lead Lock Dev Adhesion barrier, ADCON-L SurgiVision Esoph Coil Capio Capturing Dev Atherocath-GTO Vigor SSI, SC, pmkr Livewire Steerable EP Cath SynchroMed Vas Cath VasoSeal Hemostasis Dev SynchroMed Infusion Pump Pmkr leads 4057M,4058M 6721L/M/S,6939 lead CapSure 4965 defib lead Transvene 6933/6937 lead 21 C8510 C8511 C8512 C8513 C8514 C8516 C8518 C8519 C8520 C8521 C8522 C8523 C8524 C8525 C8526 C8528 C8529 C8530 C8531 C8532 C8533 C8534 C8535 C8536 C8539 C8540 C8541 C8542 C8543 C8550 C8551 C8552 C8597 C8598 C8599 C8600 C8650 C8724 C8725 C8748 C8749 C8750 C8775 C8776 C8777 C8800 C8801 C8802 C8830 C8890 C8891 C9000 DP-3238 defib lead EndoTak DSP defib lead On-Point,Pisces-Quad lead Pisces,Resume II lead Dura II Penile Prosthesis Mentor Acu-Form/Mal Pros Vigor DDD DC pmkr Vista DDD C pmkr Legacy II S, SC, pmkr Medtronic Mattrix rcvr/trmr Palmaz Bal Stent Wallstent Trans Bil Wallstent Esop wallstent Esoph--double OptiPlast XT PTA Cath MS Classique Bl Dil Cath Crista Cath II Def 20-Pole Gel-Filled/Smooth Mammary Pr Wilson-Cook Esoph Z-Stent UltraFlex Esophageal Pros SynchroMed Vas Cath 8700A/V AMS 650 Penile Prosthesis Za/Spiral Z Bil Stent Esoph Z Metal Stent Quantum Dil Balloon Flex-EZ Bal Dilator Carson/Passprt Dil Cath UrethraMax Dil Cath Amplatz Renal Dil Livewire 5F, 7F EP Cath Livewire 7F Duo-Decapolar Santuro Fixed Curve Cath Wisdom ST guidewire SV Guidewire-5/8/14cm Stabilizer XS guidewire Shinobi Plus guidewire XL Check-Flo Introducer Octad neuro lead SymMix neuro lead Endotak SQ Patch defib lead Endotak SQ Array defib lead Unity VDDR dc pmkr 2188 Cor pmkr lead Innomedica pmkr lead Unipass pmkr lead Lg Palmaz Bil Stent Gianturco Bil Z Stent Oasis Stent Intro Sys Gianturco-Roubin Cor Snt Perfluoron, 2ml Perfluoron, 5/7ml Na chromateCr51, per 0.25mCi 22 C9001 C9002 C9003 C9004 C9005 C9006 C9007 C9008 C9009 C9010 C9011 C9100 C9102 C9103 C9104 C9105 C9106 C9107 C9500 C9501 C9502 C9503 C9504 C9505 C9700 C9701 C9702 E0100 E0105 E0110 E0111 E0112 E0113 E0114 E0116 E0130 E0135 E0141 E0142 E0143 E0144 E0145 E0146 E0147 E0148 E0149 E0153 E0154 E0155 E0156 E0157 E0158 Linezolid inj, 200mg Tenecteplase, 50mg/vial Palivizumab, per 50 mg Gemtuzumab ozogamicin inj,5m Reteplase inj, half-kit,18.8 Tacrolimus inj, per 5 mg Baclofen Intrathecal kit-1am Baclofen Refill Kit-500mcg Baclofen Refill Kit-2000mcg Baclofen Refill Kit--4000mcg Caffeine Citrate, inj, 1ml Iodinated I-131 Albumin 51 Na Chromate, 50mCi Na Iothalamate I-125, 10 uCi Anti-thymocyte globulin,25mg Hep B imm glob, per 1 ml Sirolimus 1mg/ml Tinzaparin sodium, 2ml vial Platelets, irrad, ea unit Platelets, pheresis, ea unit Platelets, pher/irrad, ea un Fresh frozen plasma, ea unit RBC, deglycerolized, ea unit RBC, Irradiated, each unit Water Induced Thermo Stretta System Chkmate Intra Brachytx Sys Cane adjust/fixed with tip Cane adjust/fixed quad/3 pro Crutch forearm pair Crutch forearm each Crutch underarm pair wood Crutch underarm each wood Crutch underarm pair no wood Crutch underarm each no wood Walker rigid adjust/fixed ht Walker folding adjust/fixed Rigid walker wheeled wo seat Walker rigid wheeled with se Walker folding wheeled w/o s Enclosed walker w rear seat Walker whled seat/crutch att Folding walker wheels w seat Walker variable wheel resist Heavyduty walker no wheels Heavy duty wheeled walker Forearm crutch platform atta Walker platform attachment Walker wheel attachment,pair Walker seat attachment Walker crutch attachment Walker leg extenders set of4 23 E0159 E0160 E0161 E0162 E0163 E0164 E0165 E0166 E0167 E0168 E0175 E0176 E0177 E0178 E0179 E0180 E0181 E0182 E0184 E0185 E0186 E0187 E0188 E0189 E0191 E0192 E0193 E0194 E0196 E0197 E0198 E0199 E0200 E0202 E0205 E0210 E0215 E0217 E0218 E0220 E0225 E0230 E0235 E0236 E0238 E0239 E0241 E0242 E0243 E0244 E0245 E0246 Brake for wheeled walker Sitz type bath or equipment Sitz bath/equipment w/faucet Sitz bath chair Commode chair stationry fxd Commode chair mobile fixed a Commode chair stationry det Commode chair mobile detach Commode chair pail or pan Heavyduty/wide commode chair Commode chair foot rest Air pressre pad/cushion nonp Water press pad/cushion nonp Gel pressre pad/cushion nonp Dry pressre pad/cushion nonp Press pad alternating w pump Press pad alternating w/ pum Pressure pad alternating pum Dry pressure mattress Gel pressure mattress pad Air pressure mattress Water pressure mattress Synthetic sheepskin pad Lambswool sheepskin pad Protector heel or elbow Pad wheelchr low press/posit Powered air flotation bed Air fluidized bed Gel pressure mattress Air pressure pad for mattres Water pressure pad for mattr Dry pressure pad for mattres Heat lamp without stand Phototherapy light w/ photom Heat lamp with stand Electric heat pad standard Electric heat pad moist Water circ heat pad w pump Water circ cold pad w pump Hot water bottle Hydrocollator unit Ice cap or collar Paraffin bath unit portable Pump for water circulating p Heat pad non-electric moist Hydrocollator unit portable Bath tub wall rail Bath tub rail floor Toilet rail Toilet seat raised Tub stool or bench Transfer tub rail attachment 24 E0249 E0250 E0251 E0255 E0256 E0260 E0261 E0265 E0266 E0270 E0271 E0272 E0273 E0274 E0275 E0276 E0277 E0280 E0290 E0291 E0292 E0293 E0294 E0295 E0296 E0297 E0298 E0305 E0310 E0315 E0325 E0326 E0350 E0352 E0370 E0371 E0372 E0373 E0424 E0425 E0430 E0431 E0434 E0435 E0439 E0440 E0441 E0442 E0443 E0444 E0450 E0455 Pad water circulating heat u Hosp bed fixed ht w/ mattres Hosp bed fixd ht w/o mattres Hospital bed var ht w/ mattr Hospital bed var ht w/o matt Hosp bed semi-electr w/ matt Hosp bed semi-electr w/o mat Hosp bed total electr w/ mat Hosp bed total elec w/o matt Hospital bed institutional t Mattress innerspring Mattress foam rubber Bed board Over-bed table Bed pan standard Bed pan fracture Powered pres-redu air mattrs Bed cradle Hosp bed fx ht w/o rails w/m Hosp bed fx ht w/o rail w/o Hosp bed var ht w/o rail w/o Hosp bed var ht w/o rail w/ Hosp bed semi-elect w/ mattr Hosp bed semi-elect w/o matt Hosp bed total elect w/ matt Hosp bed total elect w/o mat Heavyduty/xtra wide hosp bed Rails bed side half length Rails bed side full length Bed accessory brd/tbl/supprt Urinal male jug-type Urinal female jug-type Control unit bowel system Disposable pack w/bowel syst Air elevator for heel Nonpower mattress overlay Powered air mattress overlay Nonpowered pressure mattress Stationary compressed gas 02 Gas system stationary compre Oxygen system gas portable Portable gaseous 02 Portable liquid 02 Oxygen system liquid portabl Stationary liquid 02 Oxygen system liquid station Oxygen contents, gaseous Oxygen contents, liquid Portable 02 contents, gas Portable 02 contents, liquid Volume vent stationary/porta Oxygen tent excl croup/ped t 25 E0457 E0459 E0460 E0462 E0480 E0500 E0550 E0555 E0560 E0565 E0570 E0571 E0572 E0574 E0575 E0580 E0585 E0590 E0600 E0601 E0602 E0605 E0606 E0607 E0608 E0609 E0610 E0615 E0616 E0617 E0621 E0625 E0627 E0628 E0629 E0630 E0635 E0650 E0651 E0652 E0655 E0660 E0665 E0666 E0667 E0668 E0669 E0671 E0672 E0673 E0690 E0700 Chest shell Chest wrap Neg press vent portabl/statn Rocking bed w/ or w/o side r Percussor elect/pneum home m Ippb all types Humidif extens supple w ippb Humidifier for use w/ regula Humidifier supplemental w/ i Compressor air power source Nebulizer with compression Aerosol compressor for svneb Aerosol compressor adjust pr Ultrasonic generator w svneb Nebulizer ultrasonic Nebulizer for use w/ regulat Nebulizer w/ compressor & he Dispensing fee dme neb drug Suction pump portab hom modl Cont airway pressure device Breast pump Vaporizer room type Drainage board postural Blood glucose monitor home Apnea monitor Blood gluc mon w/special fea Pacemaker monitr audible/vis Pacemaker monitr digital/vis Cardiac event recorder Automatic ext defibrillator Patient lift sling or seat Patient lift bathroom or toi Seat lift incorp lift-chair Seat lift for pt furn-electr Seat lift for pt furn-non-el Patient lift hydraulic Patient lift electric Pneuma compresor non-segment Pneum compressor segmental Pneum compres w/cal pressure Pneumatic appliance half arm Pneumatic appliance full leg Pneumatic appliance full arm Pneumatic appliance half leg Seg pneumatic appl full leg Seg pneumatic appl full arm Seg pneumatic appli half leg Pressure pneum appl full leg Pressure pneum appl full arm Pressure pneum appl half leg Ultraviolet cabinet Safety equipment 26 E0710 E0720 E0730 E0731 E0740 E0744 E0745 E0746 E0747 E0748 E0749 E0753 E0755 E0756 E0757 E0758 E0760 E0765 E0776 E0779 E0780 E0781 E0782 E0783 E0784 E0785 E0786 E0791 E0830 E0840 E0850 E0855 E0860 E0870 E0880 E0890 E0900 E0910 E0920 E0930 E0935 E0940 E0941 E0942 E0943 E0944 E0945 E0946 E0947 E0948 E0950 E0951 Restraints any type Tens two lead Tens four lead Conductive garment for tens/ Incontinence treatment systm Neuromuscular stim for scoli Neuromuscular stim for shock Electromyograph biofeedback Elec osteogen stim not spine Elec osteogen stim spinal Elec osteogen stim implanted Neurostimulator electrodes Electronic salivary reflex s Implantable pulse generator Implantable RF receiver External RF transmitter Osteogen ultrasound stimltor Nerve stimulator for tx n&v Iv pole Amb infusion pump mechanical Mech amb infusion pump <8hrs External ambulatory infus pu Non-programble infusion pump Programmable infusion pump Ext amb infusn pump insulin Replacement impl pump cathet Implantable pump replacement Parenteral infusion pump sta Ambulatory traction device Tract frame attach headboard Traction stand free standing Cervical traction equipment Tract equip cervical tract Tract frame attach footboard Trac stand free stand extrem Traction frame attach pelvic Trac stand free stand pelvic Trapeze bar attached to bed Fracture frame attached to b Fracture frame free standing Exercise device passive moti Trapeze bar free standing Gravity assisted traction de Cervical head harness/halter Cervical pillow Pelvic belt/harness/boot Belt/harness extremity Fracture frame dual w cross Fracture frame attachmnts pe Fracture frame attachmnts ce Tray Loop heel 27 E0952 E0953 E0954 E0958 E0959 E0961 E0962 E0963 E0964 E0965 E0966 E0967 E0968 E0969 E0970 E0971 E0972 E0973 E0974 E0975 E0976 E0977 E0978 E0979 E0980 E0990 E0991 E0992 E0993 E0994 E0995 E0996 E0997 E0998 E0999 E1000 E1001 E1031 E1035 E1050 E1060 E1065 E1066 E1069 E1070 E1083 E1084 E1085 E1086 E1087 E1088 E1089 Loop tie Pneumatic tire Wheelchair semi-pneumatic ca Whlchr att- conv 1 arm drive Amputee adapter Wheelchair brake extension Wheelchair 1 inch cushion Wheelchair 2 inch cushion Wheelchair 3 inch cushion Wheelchair 4 inch cushion Wheelchair head rest extensi Wheelchair hand rims Wheelchair commode seat Wheelchair narrowing device Wheelchair no. 2 footplates Wheelchair anti-tipping devi Transfer board or device Wheelchair adjustabl height Wheelchair grade-aid Wheelchair reinforced seat u Wheelchair reinforced back u Wheelchair wedge cushion Wheelchair belt w/airplane b Wheelchair belt with velcro Wheelchair safety vest Whellchair elevating leg res Wheelchair upholstry seat Wheelchair solid seat insert Wheelchair back upholstery Wheelchair arm rest Wheelchair calf rest Wheelchair tire solid Wheelchair caster w/ a fork Wheelchair caster w/o a fork Wheelchr pneumatic tire w/wh Wheelchair tire pneumatic ca Wheelchair wheel Rollabout chair with casters Patient transfer system Whelchr fxd full length arms Wheelchair detachable arms Wheelchair power attachment Wheelchair battery charger Wheelchair deep cycle batter Wheelchair detachable foot r Hemi-wheelchair fixed arms Hemi-wheelchair detachable a Hemi-wheelchair fixed arms Hemi-wheelchair detachable a Wheelchair lightwt fixed arm Wheelchair lightweight det a Wheelchair lightwt fixed arm 28 E1090 E1091 E1092 E1093 E1100 E1110 E1130 E1140 E1150 E1160 E1170 E1171 E1172 E1180 E1190 E1195 E1200 E1210 E1211 E1212 E1213 E1220 E1221 E1222 E1223 E1224 E1225 E1226 E1227 E1228 E1230 E1240 E1250 E1260 E1270 E1280 E1285 E1290 E1295 E1296 E1297 E1298 E1300 E1310 E1340 E1353 E1355 E1372 E1390 E1399 E1405 E1406 Wheelchair lightweight det a Wheelchair youth Wheelchair wide w/ leg rests Wheelchair wide w/ foot rest Whchr s-recl fxd arm leg res Wheelchair semi-recl detach Whlchr stand fxd arm ft rest Wheelchair standard detach a Wheelchair standard w/ leg r Wheelchair fixed arms Whlchr ampu fxd arm leg rest Wheelchair amputee w/o leg r Wheelchair amputee detach ar Wheelchair amputee w/ foot r Wheelchair amputee w/ leg re Wheelchair amputee heavy dut Wheelchair amputee fixed arm Whlchr moto ful arm leg rest Wheelchair motorized w/ det Wheelchair motorized w full Wheelchair motorized w/ det Whlchr special size/constrc Wheelchair spec size w foot Wheelchair spec size w/ leg Wheelchair spec size w foot Wheelchair spec size w/ leg Wheelchair spec sz semi-recl Wheelchair spec sz full-recl Wheelchair spec sz spec ht a Wheelchair spec sz spec ht b Power operated vehicle Whchr litwt det arm leg rest Wheelchair lightwt fixed arm Wheelchair lightwt foot rest Wheelchair lightweight leg r Whchr h-duty det arm leg res Wheelchair heavy duty fixed Wheelchair hvy duty detach a Wheelchair heavy duty fixed Wheelchair special seat heig Wheelchair special seat dept Wheelchair spec seat depth/w Whirlpool portable Whirlpool non-portable Repair for DME, per 15 min Oxygen supplies regulator Oxygen supplies stand/rack Oxy suppl heater for nebuliz Oxygen concentrator Durable medical equipment mi O2/water vapor enrich w/heat O2/water vapor enrich w/o he 29 E1510 E1520 E1530 E1540 E1550 E1560 E1570 E1575 E1580 E1590 E1592 E1594 E1600 E1610 E1615 E1620 E1625 E1630 E1632 E1635 E1636 E1640 E1699 E1700 E1701 E1702 E1800 E1805 E1810 E1815 E1820 E1825 E1830 E1900 G0001 G0002 G0004 G0005 G0006 G0007 G0008 G0009 G0010 G0015 G0016 G0025 G0026 G0027 G0030 G0031 G0032 G0033 Kidney dialysate delivry sys Heparin infusion pump for di Air bubble detector for dial Pressure alarm for dialysis Bath conductivity meter Blood leak detector for dial Adjustable chair for esrd pt Transducer protector/fluid b Unipuncture control system Hemodialysis machine Auto interm peritoneal dialy Cycler dialysis machine Deliv/install equip for dial Reverse osmosis water purifi Deionizer water purification Blood pump for dialysis Water softening system Reciprocating peritoneal dia Wearable artificial kidney Compact travel hemodialyzer Sorbent cartridges for dialy Replacement components for d Dialysis equipment unspecifi Jaw motion rehab system Repl cushions for jaw motion Repl measr scales jaw motion Adjust elbow ext/flex device Adjust wrist ext/flex device Adjust knee ext/flex device Adjust ankle ext/flex device Soft interface material Adjust finger ext/flex devc Adjust toe ext/flex device Speech communication device Drawing blood for specimen Temporary urinary catheter ECG transm phys review & int ECG 24 hour recording ECG transmission & analysis ECG phy review & interpret Admin influenza virus vac Admin pneumococcal vaccine Admin hepatitis b vaccine Post symptom ECG tracing Post symptom ECG md review Collagen skin test kit Fecal leukocyte examination Semen analysis PET imaging prev PET single PET imaging prev PET multple PET follow SPECT 78464 singl PET follow SPECT 78464 mult 30 G0034 G0035 G0036 G0037 G0038 G0039 G0040 G0041 G0042 G0043 G0044 G0045 G0046 G0047 G0050 G0101 G0102 G0103 G0104 G0105 G0106 G0107 G0108 G0109 G0110 G0111 G0112 G0113 G0114 G0115 G0116 G0120 G0121 G0122 G0123 G0124 G0125 G0126 G0127 G0128 G0129 G0130 G0131 G0132 G0141 G0143 G0144 G0145 G0147 G0148 G0151 G0152 PET follow SPECT 76865 singl PET follow SPECT 78465 mult PET follow cornry angio sing PET follow cornry angio mult PET follow myocard perf sing PET follow myocard perf mult PET follow stress echo singl PET follow stress echo mult PET follow ventriculogm sing PET follow ventriculogm mult PET following rest ECG singl PET following rest ECG mult PET follow stress ECG singl PET follow stress ECG mult Residual urine by ultrasound CA screen;pelvic/breast exam Prostate ca screening; dre Psa, total screening CA screen;flexi sigmoidscope Colorectal scrn; hi risk ind Colon CA screen;barium enema CA screen; fecal blood test Diab manage trn per indiv Diab manage trn ind/group Nett pulm-rehab educ; ind Nett pulm-rehab educ; group Nett;nutrition guid, initial Nett;nutrition guid,subseqnt Nett; psychosocial consult Nett; psychological testing Nett; psychosocial counsel Colon ca scrn; barium enema Colon ca scrn not hi rsk ind Colon ca scrn; barium enema Screen cerv/vag thin layer Screen c/v thin layer by MD Lung image (PET) Lung image (PET) staging Trim nail(s) CORF skilled nursing service Partial hosp prog service Single energy x-ray study CT scan, bone density study CT scan, bone density study Scr c/v cyto,autosys and md Scr c/v cyto,thinlayer,rescr Scr c/v cyto,thinlayer,rescr Scr c/v cyto,thinlayer,rescr Scr c/v cyto, automated sys Scr c/v cyto, autosys, rescr HHCP-serv of pt,ea 15 min HHCP-serv of ot,ea 15 min 31 G0153 G0154 G0155 G0156 G0163 G0164 G0165 G0166 G0167 G0168 G0173 G0174 G0175 G0176 G0177 G0178 G0179 G0180 G0181 G0182 G0183 G0184 G0185 G0186 G0187 G0188 G0190 G0191 G0192 G0193 G0194 G0195 G0196 G0197 G0198 G0199 G0200 G0201 G9001 G9002 G9003 G9004 G9005 G9006 G9007 G9008 G9016 H0001 H0002 H0003 H0004 H0005 HHCP-svs of s/l path,ea 15mn HHCP-svs of rn,ea 15 min HHCP-svs of csw,ea 15 min HHCP-svs of aide,ea 15 min Pet for rec of colorectal ca Pet for lymphoma staging Pet,rec of melanoma/met ca Extrnl counterpulse, per tx Hyperbaric oz tx;no md reqrd Wound closure by adhesive Stereo radoisurgery,complete Intensitymodulatedradiation OPPS Service,sched team conf OPPS/PHP;activity therapy OPPS/PHP; train & educ serv Intensitymodulatedradiation Intensitymodulatedradiation MD certification HHA patient Home health care supervision Hospice care supervision Ocular photodynamic therapy Ocular photocoagulation Transpuppillary thermotx Dstry eye lesn,fdr vssl tech Dstry mclr drusen,photocoag Xray lwr extrmty-full lngth Immunization administration Immunization admin,each add Immunization oral/intranasal Endoscopicstudyswallowfunctn Sensorytestingendoscopicstud Clinicalevalswallowingfunct Evalofswallowingwithradioopa Evalofptforprescipspeechdevi Patientadapation&trainforspe Reevaluationofpatientusespec Evalofpatientprescipofvoicep Modifortraininginusevoicepro MCCD, initial rate MCCD,maintenance rate MCCD, risk adj hi, initial MCCD, risk adj lo, initial MCCD, risk adj, maintenance MCCD, Home monitoring MCCD, sch team conf Mccd,phys coor-care ovrsght Demo-smoking cessation coun Alcohol and/or drug assess Alcohol and/or drug screenin Alcohol and/or drug screenin Alcohol and/or drug services Alcohol and/or drug services 32 H0006 H0007 H0008 H0009 H0010 H0011 H0012 H0013 H0014 H0015 H0016 H0017 H0018 H0019 H0020 H0021 H0022 H0023 H0024 H0025 H0026 H0027 H0028 H0029 H0030 J0120 J0130 J0150 J0151 J0170 J0190 J0200 J0205 J0207 J0210 J0256 J0270 J0275 J0280 J0282 J0285 J0286 J0290 J0295 J0300 J0330 J0340 J0350 J0360 J0380 J0390 J0395 Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug services Alcohol and/or drug training Alcohol and/or drug interven Alcohol and/or drug outreach Alcohol and/or drug preventi Alcohol and/or drug preventi Alcohol and/or drug preventi Alcohol and/or drug preventi Alcohol and/or drug preventi Alcohol and/or drug preventi Alcohol and/or drug hotline Tetracyclin injection Abciximab injection Injection adenosine 6 MG Adenosine injection Adrenalin epinephrin inject Inj biperiden lactate/5 mg Alatrofloxacin mesylate Alglucerase injection Amifostine Methyldopate hcl injection Alpha 1 proteinase inhibitor Alprostadil for injection Alprostadil urethral suppos Aminophyllin 250 MG inj Amiodarone HCl Amphotericin B Amphotericin B lipid complex Ampicillin 500 MG inj Ampicillin sodium per 1.5 gm Amobarbital 125 MG inj Succinycholine chloride inj Nandrolon phenpropionate inj Injection anistreplase 30 u Hydralazine hcl injection Inj metaraminol bitartrate Chloroquine injection Arbutamine HCl injection 33 J0400 J0456 J0460 J0470 J0475 J0476 J0500 J0510 J0515 J0520 J0530 J0540 J0550 J0560 J0570 J0580 J0585 J0590 J0600 J0610 J0620 J0630 J0635 J0640 J0670 J0690 J0694 J0695 J0696 J0697 J0698 J0702 J0704 J0710 J0713 J0715 J0720 J0725 J0730 J0735 J0740 J0743 J0745 J0760 J0770 J0780 J0800 J0810 J0835 J0850 J0895 J0900 Inj trimethaphan camsylate Azithromycin Atropine sulfate injection Dimecaprol injection Baclofen 10 MG injection Baclofen intrathecal trial Dicyclomine injection Benzquinamide injection Inj benztropine mesylate Bethanechol chloride inject Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Botulinum toxin a per unit Ethylnorepinephrine hcl inj Edetate calcium disodium inj Calcium gluconate injection Calcium glycer & lact/10 ML Calcitonin salmon injection Calcitriol injection Leucovorin calcium injection Inj mepivacaine HCL/10 ml Cefazolin sodium injection Cefoxitin sodium injection Cefonocid sodium injection Ceftriaxone sodium injection Sterile cefuroxime injection Cefotaxime sodium injection Betamethasone acet&sod phosp Betamethasone sod phosp/4 MG Cephapirin sodium injection Inj ceftazidime per 500 mg Ceftizoxime sodium / 500 MG Chloramphenicol sodium injec Chorionic gonadotropin/1000u Chlorpheniramin maleate inj Clonidine hydrochloride Cidofovir injection Cilastatin sodium injection Inj codeine phosphate /30 MG Colchicine injection Colistimethate sodium inj Prochlorperazine injection Corticotropin injection Cortisone injection Inj cosyntropin per 0.25 MG Cytomegalovirus imm IV /vial Deferoxamine mesylate inj Testosterone enanthate inj 34 J0945 J0970 J1000 J1020 J1030 J1040 J1050 J1055 J1060 J1070 J1080 J1090 J1095 J1100 J1110 J1120 J1160 J1165 J1170 J1180 J1190 J1200 J1205 J1212 J1230 J1240 J1245 J1250 J1260 J1320 J1325 J1327 J1330 J1362 J1364 J1380 J1390 J1410 J1435 J1436 J1438 J1440 J1441 J1450 J1452 J1455 J1460 J1470 J1480 J1490 J1500 J1510 Brompheniramine maleate inj Estradiol valerate injection Depo-estradiol cypionate inj Methylprednisolone 20 MG inj Methylprednisolone 40 MG inj Methylprednisolone 80 MG inj Medroxyprogesterone inj Medrxyprogester acetate inj Testosterone cypionate 1 ML Testosterone cypionat 100 MG Testosterone cypionat 200 MG Testosterone cypionate 50 MG Inj dexamethasone acetate Dexamethasone sodium phos Inj dihydroergotamine mesylt Acetazolamid sodium injectio Digoxin injection Phenytoin sodium injection Hydromorphone injection Dyphylline injection Dexrazoxane HCl injection Diphenhydramine hcl injectio Chlorothiazide sodium inj Dimethyl sulfoxide 50% 50 ML Methadone injection Dimenhydrinate injection Dipyridamole injection Inj dobutamine HCL/250 mg Dolasetron mesylate Amitriptyline injection Epoprostenol injection Eptifibatide injection Ergonovine maleate injection Erythromycin glucep / 250 MG Erythro lactobionate /500 MG Estradiol valerate 10 MG inj Estradiol valerate 20 MG inj Inj estrogen conjugate 25 MG Injection estrone per 1 MG Etidronate disodium inj Etanercept injection Filgrastim 300 mcg injeciton Filgrastim 480 mcg injection Fluconazole Intraocular Fomivirsen na Foscarnet sodium injection Gamma globulin 1 CC inj Gamma globulin 2 CC inj Gamma globulin 3 CC inj Gamma globulin 4 CC inj Gamma globulin 5 CC inj Gamma globulin 6 CC inj 35 J1520 J1530 J1540 J1550 J1560 J1561 J1563 J1565 J1570 J1580 J1600 J1610 J1620 J1626 J1630 J1631 J1642 J1644 J1645 J1650 J1670 J1690 J1700 J1710 J1720 J1730 J1739 J1741 J1742 J1745 J1750 J1785 J1790 J1800 J1810 J1820 J1825 J1830 J1840 J1850 J1885 J1890 J1910 J1930 J1940 J1950 J1955 J1956 J1960 J1970 J1980 J1990 Gamma globulin 7 CC inj Gamma globulin 8 CC inj Gamma globulin 9 CC inj Gamma globulin 10 CC inj Gamma globulin > 10 CC inj Immune globulin 500 mg IV immune globulin RSV-ivig Ganciclovir sodium injection Garamycin gentamicin inj Gold sodium thiomaleate inj Glucagon hydrochloride/1 MG Gonadorelin hydroch/ 100 mcg Granisetron HCl injection Haloperidol injection Haloperidol decanoate inj Inj heparin sodium per 10 u Inj heparin sodium per 1000u Dalteparin sodium Inj enoxaparin sodium Tetanus immune globulin inj Prednisolone tebutate inj Hydrocortisone acetate inj Hydrocortisone sodium ph inj Hydrocortisone sodium succ i Diazoxide injection Hydroxyprogesterone cap 125 Hydroxyprogesterone cap 250 Ibutilide fumarate injection Infliximab injection Iron dextran Injection imiglucerase /unit Droperidol injection Propranolol injection Droperidol/fentanyl inj Insulin injection Interferon beta-1a Interferon beta-1b / .25 MG Kanamycin sulfate 500 MG inj Kanamycin sulfate 75 MG inj Ketorolac tromethamine inj Cephalothin sodium injection Kutapressin injection Propiomazine injection Furosemide injection Leuprolide acetate /3.75 MG Inj levocarnitine per 1 gm Levofloxacin injection Levorphanol tartrate inj Methotrimeprazine injection Hyoscyamine sulfate inj Chlordiazepoxide injection 36 J2000 J2010 J2060 J2150 J2175 J2180 J2210 J2240 J2250 J2260 J2270 J2271 J2275 J2300 J2310 J2320 J2321 J2322 J2330 J2350 J2352 J2355 J2360 J2370 J2400 J2405 J2410 J2430 J2440 J2460 J2480 J2500 J2510 J2512 J2515 J2540 J2543 J2545 J2550 J2560 J2590 J2597 J2640 J2650 J2670 J2675 J2680 J2690 J2700 J2710 J2720 J2725 Lidocaine injection Lincomycin injection Lorazepam injection Mannitol injection Meperidine hydrochl /100 MG Meperidine/promethazine inj Methylergonovin maleate inj Metocurine iodide injection Inj midazolam hydrochloride Inj milrinone lactate / 5 ML Morphine sulfate injection Morphine so4 injection 100mg Morphine sulfate injection Inj nalbuphine hydrochloride Inj naloxone hydrochloride Nandrolone decanoate 50 MG Nandrolone decanoate 100 MG Nandrolone decanoate 200 MG Thiothixene injection Niacinamide/niacin injection Octreotide acetate injection Oprelvekin injection Orphenadrine injection Phenylephrine hcl injection Chloroprocaine hcl injection Ondansetron hcl injection Oxymorphone hcl injection Pamidronate disodium /30 MG Papaverin hcl injection Oxytetracycline injection Hydrochlorides of opium inj Paricalcitol Penicillin g procaine inj Inj pentagastrin per 2 ML Pentobarbital sodium inj Penicillin g potassium inj Piperacillin/tazobactam Pentamidine isethionte/300mg Promethazine hcl injection Phenobarbital sodium inj Oxytocin injection Inj desmopressin acetate Prednisolone sodium ph inj Prednisolone acetate inj Totazoline hcl injection Inj progesterone per 50 MG Fluphenazine decanoate 25 MG Procainamide hcl injection Oxacillin sodium injeciton Neostigmine methylslfte inj Inj protamine sulfate/10 MG Inj protirelin per 250 mcg 37 J2730 J2760 J2765 J2770 J2780 J2790 J2792 J2795 J2800 J2810 J2820 J2860 J2910 J2912 J2915 J2920 J2930 J2950 J2970 J2993 J2995 J2997 J3000 J3010 J3030 J3070 J3080 J3105 J3120 J3130 J3140 J3150 J3230 J3240 J3245 J3250 J3260 J3265 J3270 J3280 J3301 J3302 J3303 J3305 J3310 J3320 J3350 J3360 J3364 J3365 J3370 J3390 Pralidoxime chloride inj Phentolaine mesylate inj Metoclopramide hcl injection Quinupristin/dalfopristin Ranitidine hydrochloride inj Rho d immune globulin inj Rho(D) immune globulin h, sd Ropivacaine HCl injection Methocarbamol injection Inj theophylline per 40 MG Sargramostim injection Secobarbital sodium inj Aurothioglucose injeciton Sodium chloride injection NA Ferric Gluconate Complex Methylprednisolone injection Methylprednisolone injection Promazine hcl injeciton Methicillin sodium injection Reteplase injection Inj streptokinase /250000 IU Alteplase recombinant Streptomycin injection Fentanyl citrate injeciton Sumatriptan succinate / 6 MG Pentazocine hcl injeciton Chlorprothixene injection Terbutaline sulfate inj Testosterone enanthate inj Testosterone enanthate inj Testosterone suspension inj Testosteron propionate inj Chlorpromazine hcl injection Thyrotropin injection Tirofiban hydrochloride Trimethobenzamide hcl inj Tobramycin sulfate injection Injection torsemide 10 mg/ml Imipramine hcl injection Thiethylperazine maleate inj Triamcinolone acetonide inj Triamcinolone diacetate inj Triamcinolone hexacetonl inj Inj trimetrexate glucoronate Perphenazine injeciton Spectinomycn di-hcl inj Urea injection Diazepam injection Urokinase 5000 IU injection Urokinase 250,000 IU inj Vancomycin hcl injeciton Methoxamine injection 38 J3400 J3410 J3420 J3430 J3450 J3470 J3475 J3480 J3485 J3490 J3520 J3530 J3535 J3570 J7030 J7040 J7042 J7050 J7051 J7060 J7070 J7100 J7110 J7120 J7130 J7190 J7191 J7192 J7194 J7197 J7198 J7199 J7300 J7310 J7315 J7320 J7330 J7500 J7501 J7502 J7504 J7505 J7506 J7507 J7508 J7509 J7510 J7513 J7515 J7516 J7517 J7520 Triflupromazine hcl inj Hydroxyzine hcl injeciton Vitamin b12 injection Vitamin k phytonadione inj Mephentermine sulfate inj Hyaluronidase injection Inj magnesium sulfate Inj potassium chloride Zidovudine Drugs unclassified injection Edetate disodium per 150 mg Nasal vaccine inhalation Metered dose inhaler drug Laetrile amygdalin vit B17 Normal saline solution infus Normal saline solution infus 5% dextrose/normal saline Normal saline solution infus Sterile saline/water 5% dextrose/water D5w infusion Dextran 40 infusion Dextran 75 infusion Ringers lactate infusion Hypertonic saline solution Factor viii Factor VIII (porcine) Factor viii recombinant Factor ix complex Antithrombin iii injection Anti-inhibitor Hemophilia clot factor noc Intraut copper contraceptive Ganciclovir long act implant Sodium hyaluronate injection Hylan G-F 20 injection Cultured chondrocytes implnt Azathioprine oral 50mg Azathioprine parenteral Cyclosporine oral 100 mg Lymphocyte immune globulin Monoclonal antibodies Prednisone oral Tacrolimus oral per 1 MG Tacrolimus oral per 5 MG Methylprednisolone oral Prednisolone oral per 5 mg Daclizumab, parenteral Cyclosporine oral 25 mg Cyclosporin parenteral 250mg Mycophenolate mofetil oral Sirolimus, oral 39 J7525 J7599 J7608 J7618 J7619 J7628 J7629 J7631 J7635 J7636 J7637 J7638 J7639 J7642 J7643 J7644 J7648 J7649 J7658 J7659 J7668 J7669 J7680 J7681 J7682 J7683 J7684 J7699 J7799 J8499 J8510 J8520 J8521 J8530 J8560 J8600 J8610 J8700 J8999 J9000 J9001 J9015 J9020 J9031 J9040 J9045 J9050 J9060 J9062 J9065 J9070 J9080 Tacrolimus injection Immunosuppressive drug noc Acetylcysteine inh sol u d Albuterol inh sol con Albuterol inh sol u d Bitolterol mes inhal sol con Bitolterol mes inh sol u d Cromolyn sodium inh sol u d Atropine inhal sol con Atropine inhal sol unit dose Dexamethasone inhal sol con Dexamethasone inhal sol u d Dornase alpha inhal sol u d Glycopyrrolate inhal sol con Glycopyrrolate inhal sol u d Ipratropium brom inh sol u d Isoetharine hcl inh sol con Isoetharine hcl inh sol u d Isoproterenolhcl inh sol con Isoproterenol hcl inh sol ud Metaproterenol inh sol con Metaproterenol inh sol u d Terbutaline so4 inh sol con Terbutaline so4 inh sol u d Tobramycin inhalation sol Triamcinolone inh sol con Triamcinolone inh sol u d Inhalation solution for DME Non-inhalation drug for DME Oral prescrip drug non chemo Oral busulfan Capecitabine, oral, 150 mg Capecitabine, oral, 500 mg Cyclophosphamide oral 25 MG Etoposide oral 50 MG Melphalan oral 2 MG Methotrexate oral 2.5 MG Temozolmide Oral prescription drug chemo Doxorubic hcl 10 MG vl chemo Doxorubicin hcl liposome inj Aldesleukin/single use vial Asparaginase injection Bcg live intravesical vac Bleomycin sulfate injection Carboplatin injection Carmus bischl nitro inj Cisplatin 10 MG injeciton Cisplatin 50 MG injeciton Inj cladribine per 1 MG Cyclophosphamide 100 MG inj Cyclophosphamide 200 MG inj 40 J9090 J9091 J9092 J9093 J9094 J9095 J9096 J9097 J9100 J9110 J9120 J9130 J9140 J9150 J9151 J9160 J9165 J9170 J9180 J9181 J9182 J9185 J9190 J9200 J9201 J9202 J9206 J9208 J9209 J9211 J9212 J9213 J9214 J9215 J9216 J9217 J9218 J9219 J9230 J9245 J9250 J9260 J9265 J9266 J9268 J9270 J9280 J9290 J9291 J9293 J9310 J9320 Cyclophosphamide 500 MG inj Cyclophosphamide 1.0 grm inj Cyclophosphamide 2.0 grm inj Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cytarabine hcl 100 MG inj Cytarabine hcl 500 MG inj Dactinomycin actinomycin d Dacarbazine 10 MG inj Dacarbazine 200 MG inj Daunorubicin Daunorubicin citrate liposom Denileukin diftitox, 300 mcg Diethylstilbestrol injection Docetaxel Epirubicin HCl injection Etoposide 10 MG inj Etoposide 100 MG inj Fludarabine phosphate inj Fluorouracil injection Floxuridine injection Gemcitabine HCl Goserelin acetate implant Irinotecan injection Ifosfomide injection Mesna injection Idarubicin hcl injeciton Interferon alfacon-1 Interferon alfa-2a inj Interferon alfa-2b inj Interferon alfa-n3 inj Interferon gamma 1-b inj Leuprolide acetate suspnsion Leuprolide acetate injeciton Leuprolide acetate implant Mechlorethamine hcl inj Inj melphalan hydrochl 50 MG Methotrexate sodium inj Methotrexate sodium inj Paclitaxel injection Pegaspargase/singl dose vial Pentostatin injection Plicamycin (mithramycin) inj Mitomycin 5 MG inj Mitomycin 20 MG inj Mitomycin 40 MG inj Mitoxantrone hydrochl / 5 MG Rituximab cancer treatment Streptozocin injection 41 J9340 J9350 J9355 J9357 J9360 J9370 J9375 J9380 J9390 J9600 J9999 K0001 K0002 K0003 K0004 K0005 K0006 K0007 K0008 K0009 K0010 K0011 K0012 K0013 K0014 K0015 K0016 K0017 K0018 K0019 K0020 K0021 K0022 K0023 K0024 K0025 K0026 K0027 K0028 K0029 K0030 K0031 K0032 K0033 K0034 K0035 K0036 K0037 K0038 K0039 K0040 K0041 Thiotepa injection Topotecan Trastuzumab Valrubicin, 200 mg Vinblastine sulfate inj Vincristine sulfate 1 MG inj Vincristine sulfate 2 MG inj Vincristine sulfate 5 MG inj Vinorelbine tartrate/10 mg Porfimer sodium Chemotherapy drug Standard wheelchair Stnd hemi (low seat) whlchr Lightweight wheelchair High strength ltwt whlchr Ultralightweight wheelchair Heavy duty wheelchair Extra heavy duty wheelchair Cstm manual wheelchair/base Other manual wheelchair/base Stnd wt frame power whlchr Stnd wt pwr whlchr w control Ltwt portbl power whlchr Custom power whlchr base Other power whlchr base Detach non-adjus hght armrst Detach adjust armrst cmplete Detach adjust armrest base Detach adjust armrst upper Arm pad each Fixed adjust armrest pair Anti-tipping device each Reinforced back upholstery Planr back insrt foam w/strp Plnr back insrt foam w/hrdwr Hook-on headrest extension Back upholst lgtwt whlchr Back upholst other whlchr Manual fully reclining back Reinforced seat upholstery Solid plnr seat sngl dnsfoam Safety belt/pelvic strap Seat uphols lgtwt whlchr Seat upholstery other whlchr Heel loop each Heel loop with ankle strap Toe loop each High mount flip-up footrest Leg strap each Leg strap h style each Adjustable angle footplate Large size footplate each 42 K0042 K0043 K0044 K0045 K0046 K0047 K0048 K0049 K0050 K0051 K0052 K0053 K0054 K0055 K0056 K0057 K0058 K0059 K0060 K0061 K0062 K0063 K0064 K0065 K0066 K0067 K0068 K0069 K0070 K0071 K0072 K0073 K0074 K0075 K0076 K0077 K0078 K0079 K0080 K0081 K0082 K0083 K0084 K0085 K0086 K0087 K0088 K0089 K0090 K0091 K0092 K0093 Standard size footplate each Ftrst lower extension tube Ftrst upper hanger bracket Footrest complete assembly Elevat legrst low extension Elevat legrst up hangr brack Elevate legrest complete Calf pad each Ratchet assembly Cam relese assem ftrst/lgrst Swingaway detach footrest Elevate footrest articulate Seat wdth 10-12/15/17/20 wc Seat dpth 15/17/18 ltwt wc Seat ht <17 or >=21 ltwt wc Seat wdth 19/20 hvy dty wc Seat dpth 17/18 power wc Plastic coated handrim each Steel handrim each Aluminum handrim each Handrim 8-10 vert/obliq proj Hndrm 12-16 vert/obliq proj Zero pressure tube flat free Spoke protectors Solid tire any size each Pneumatic tire any size each Pneumatic tire tube each Rear whl complete solid tire Rear whl compl pneum tire Front castr compl pneum tire Frnt cstr cmpl sem-pneum tir Caster pin lock each Pneumatic caster tire each Semi-pneumatic caster tire Solid caster tire each Front caster assem complete Pneumatic caster tire tube Wheel lock extension pair Anti-rollback device pair Wheel lock assembly complete 22 nf deep cycl acid battery 22 nf gel cell battery each Grp 24 deep cycl acid battry Group 24 gel cell battery U-1 lead acid battery each U-1 gel cell battery each Battry chrgr acid/gel cell Battery charger dual mode Rear tire power wheelchair Rear tire tube power whlchr Rear assem cmplt powr whlchr Rear zero pressure tire tube 43 K0094 K0095 K0096 K0097 K0098 K0099 K0100 K0101 K0102 K0103 K0104 K0105 K0106 K0107 K0108 K0112 K0113 K0114 K0115 K0116 K0183 K0184 K0185 K0186 K0187 K0188 K0189 K0195 K0268 K0415 K0416 K0452 K0455 K0460 K0461 K0462 K0531 K0532 K0533 K0534 K0538 K0539 K0540 K0541 K0542 K0543 K0544 K0545 K0546 K0547 L0100 L0110 Wheel tire for power base Wheel tire tube each base Wheel assem powr base complt Wheel zero presure tire tube Drive belt power wheelchair Pwr wheelchair front caster Amputee adapter pair One-arm drive attachment Crutch and cane holder Transfer board < 25" Cylinder tank carrier Iv hanger Arm trough each Wheelchair tray W/c component-accessory NOS Trunk vest supprt innr frame Trunk vest suprt w/o inr frm Whlchr back suprt inr frame Back module orthotic system Back & seat modul orthot sys Nasal application device Nasal pillows/seals pair Pos airway pressure headgear Pos airway prssure chinstrap Pos airway pressure tubing Pos airway pressure filter Filter nondisposable w PAP Elevating whlchair leg rests Humidifier nonheated w PAP RX antiemetic drg, oral NOS Rx antiemetic drg,rectal NOS Wheelchair bearings Pump uninterrupted infusion WC power add-on joystick WC power add-on tiller cntrl Temporary replacement eqpmnt Heated humidifier used w pap Noninvasive assist wo backup Noninvasive assist w backup Invasive assist w backup Neg pressure wnd thrpy pump Neg pres wnd thrpy dsg set Neg pres wnd thrp canister Speech generating device Speech generating device Speech generating device Speech generating device Speech generating software Accessory for sgd,mntng syst Accessory for sgd,not clasfd Cerv craniosten helmet mold Cerv craniostenosis hel non- 44 L0120 L0130 L0140 L0150 L0160 L0170 L0172 L0174 L0180 L0190 L0200 L0210 L0220 L0300 L0310 L0315 L0317 L0320 L0330 L0340 L0350 L0360 L0370 L0380 L0390 L0400 L0410 L0420 L0430 L0440 L0500 L0510 L0515 L0520 L0530 L0540 L0550 L0560 L0565 L0600 L0610 L0620 L0700 L0710 L0810 L0820 L0830 L0860 L0900 L0910 L0920 L0930 Cerv flexible non-adjustable Flex thermoplastic collar mo Cervical semi-rigid adjustab Cerv semi-rig adj molded chn Cerv semi-rig wire occ/mand Cervical collar molded to pt Cerv col thermplas foam 2 pi Cerv col foam 2 piece w thor Cer post col occ/man sup adj Cerv collar supp adj cerv ba Cerv col supp adj bar & thor Thoracic rib belt Thor rib belt custom fabrica TLSO flex surgical support Tlso flexible custom fabrica Tlso flex elas rigid post pa Tlso flex hypext elas post p Tlso a-p contrl w apron frnt Tlso ant-pos-lateral control Tlso a-p-l-rotary with apron Tlso flex compress jacket cu Tlso flex compress jacket mo Tlso a-p-l-rotary hyperexten Tlso a-p-l-rot w/ pos extens Tlso a-p-l control molded Tlso a-p-l w interface mater Tlso a-p-l two piece constr Tlso a-p-l 2 piece w interfa Tlso a-p-l w interface custm Tlso a-p-l overlap frnt cust Lso flex surgical support Lso flexible custom fabricat Lso flex elas w/ rig post pa Lso a-p-l control with apron Lso ant-pos control w apron Lso lumbar flexion a-p-l Lso a-p-l control molded Lso a-p-l w interface Lso a-p-l control custom Sacroiliac flex surg support Sacroiliac flexible custm fa Sacroiliac semi-rig w apron Ctlso a-p-l control molded Ctlso a-p-l control w/ inter Halo cervical into jckt vest Halo cervical into body jack Halo cerv into milwaukee typ Magnetic resonanc image comp Torso/ptosis support Torso & ptosis supp custm fa Torso/pendulous abd support Pendulous abdomen supp custm 45 L0940 L0950 L0960 L0970 L0972 L0974 L0976 L0978 L0980 L0982 L0984 L0999 L1000 L1010 L1020 L1025 L1030 L1040 L1050 L1060 L1070 L1080 L1085 L1090 L1100 L1110 L1120 L1200 L1210 L1220 L1230 L1240 L1250 L1260 L1270 L1280 L1290 L1300 L1310 L1499 L1500 L1510 L1520 L1600 L1610 L1620 L1630 L1640 L1650 L1660 L1680 L1685 Torso/postsurgical support Post surg support custom fab Post surgical support pads Tlso corset front Lso corset front Tlso full corset Lso full corset Axillary crutch extension Peroneal straps pair Stocking supp grips set of f Protective body sock each Add to spinal orthosis NOS Ctlso milwauke initial model Ctlso axilla sling Kyphosis pad Kyphosis pad floating Lumbar bolster pad Lumbar or lumbar rib pad Sternal pad Thoracic pad Trapezius sling Outrigger Outrigger bil w/ vert extens Lumbar sling Ring flange plastic/leather Ring flange plas/leather mol Covers for upright each Furnsh initial orthosis only Lateral thoracic extension Anterior thoracic extension Milwaukee type superstructur Lumbar derotation pad Anterior asis pad Anterior thoracic derotation Abdominal pad Rib gusset (elastic) each Lateral trochanteric pad Body jacket mold to patient Post-operative body jacket Spinal orthosis NOS Thkao mobility frame Thkao standing frame Thkao swivel walker Abduct hip flex frejka w cvr Abduct hip flex frejka covr Abduct hip flex pavlik harne Abduct control hip semi-flex Pelv band/spread bar thigh c HO abduction hip adjustable HO abduction static plastic Pelvic & hip control thigh c Post-op hip abduct custom fa 46 L1686 L1690 L1700 L1710 L1720 L1730 L1750 L1755 L1800 L1810 L1815 L1820 L1825 L1830 L1832 L1834 L1840 L1843 L1844 L1845 L1846 L1847 L1850 L1855 L1858 L1860 L1870 L1880 L1885 L1900 L1902 L1904 L1906 L1910 L1920 L1930 L1940 L1945 L1950 L1960 L1970 L1980 L1990 L2000 L2010 L2020 L2030 L2035 L2036 L2037 L2038 L2039 HO post-op hip abduction Combination bilateral HO Leg perthes orth toronto typ Legg perthes orth newington Legg perthes orthosis trilat Legg perthes orth scottish r Legg perthes sling Legg perthes patten bottom t Knee orthoses elas w stays Ko elastic with joints Elastic with condylar pads Ko elas w/ condyle pads & jo Ko elastic knee cap Ko immobilizer canvas longit KO adj jnt pos rigid support Ko w/0 joint rigid molded to Ko derot ant cruciate custom KO single upright custom fit Ko w/adj jt rot cntrl molded Ko w/ adj flex/ext rotat cus Ko w adj flex/ext rotat mold KO adjustable w air chambers Ko swedish type Ko plas doub upright jnt mol Ko polycentric pneumatic pad Ko supracondylar socket mold Ko doub upright lacers molde Ko doub upright cuffs/lacers Knee upright w/resistance Afo sprng wir drsflx calf bd Afo ankle gauntlet Afo molded ankle gauntlet Afo multiligamentus ankle su Afo sing bar clasp attach sh Afo sing upright w/ adjust s Afo plastic Afo molded to patient plasti Afo molded plas rig ant tib Afo spiral molded to pt plas Afo pos solid ank plastic mo Afo plastic molded w/ankle j Afo sing solid stirrup calf Afo doub solid stirrup calf Kafo sing fre stirr thi/calf Kafo sng solid stirrup w/o j Kafo dbl solid stirrup band/ Kafo dbl solid stirrup w/o j KAFO plastic pediatric size Kafo plas doub free knee mol Kafo plas sing free knee mol Kafo w/o joint multi-axis an KAFO,plstic,medlat rotat con 47 L2040 L2050 L2060 L2070 L2080 L2090 L2102 L2104 L2106 L2108 L2112 L2114 L2116 L2122 L2124 L2126 L2128 L2132 L2134 L2136 L2180 L2182 L2184 L2186 L2188 L2190 L2192 L2200 L2210 L2220 L2230 L2240 L2250 L2260 L2265 L2270 L2275 L2280 L2300 L2310 L2320 L2330 L2335 L2340 L2350 L2360 L2370 L2375 L2380 L2385 L2390 L2395 Hkafo torsion bil rot straps Hkafo torsion cable hip pelv Hkafo torsion ball bearing j Hkafo torsion unilat rot str Hkafo unilat torsion cable Hkafo unilat torsion ball br Afo tibial fx cast plstr mol Afo tib fx cast synthetic mo Afo tib fx cast plaster mold Afo tib fx cast molded to pt Afo tibial fracture soft Afo tib fx semi-rigid Afo tibial fracture rigid Kafo fem fx cast plaster mol Kafo fem fx cast synthet mol Kafo fem fx cast thermoplas Kafo fem fx cast molded to p Kafo femoral fx cast soft Kafo fem fx cast semi-rigid Kafo femoral fx cast rigid Plas shoe insert w ank joint Drop lock knee Limited motion knee joint Adj motion knee jnt lerman t Quadrilateral brim Waist belt Pelvic band & belt thigh fla Limited ankle motion ea jnt Dorsiflexion assist each joi Dorsi & plantar flex ass/res Split flat caliper stirr & p Round caliper and plate atta Foot plate molded stirrup at Reinforced solid stirrup Long tongue stirrup Varus/valgus strap padded/li Plastic mod low ext pad/line Molded inner boot Abduction bar jointed adjust Abduction bar-straight Non-molded lacer Lacer molded to patient mode Anterior swing band Pre-tibial shell molded to p Prosthetic type socket molde Extended steel shank Patten bottom Torsion ank & half solid sti Torsion straight knee joint Straight knee joint heavy du Offset knee joint each Offset knee joint heavy duty 48 L2397 L2405 L2415 L2425 L2430 L2435 L2492 L2500 L2510 L2520 L2525 L2526 L2530 L2540 L2550 L2570 L2580 L2600 L2610 L2620 L2622 L2624 L2627 L2628 L2630 L2640 L2650 L2660 L2670 L2680 L2750 L2755 L2760 L2770 L2780 L2785 L2795 L2800 L2810 L2820 L2830 L2840 L2850 L2860 L2999 L3000 L3001 L3002 L3003 L3010 L3020 L3030 Suspension sleeve lower ext Knee joint drop lock ea jnt Knee joint cam lock each joi Knee disc/dial lock/adj flex Knee jnt ratchet lock ea jnt Knee joint polycentric joint Knee lift loop drop lock rin Thi/glut/ischia wgt bearing Th/wght bear quad-lat brim m Th/wght bear quad-lat brim c Th/wght bear nar m-l brim mo Th/wght bear nar m-l brim cu Thigh/wght bear lacer non-mo Thigh/wght bear lacer molded Thigh/wght bear high roll cu Hip clevis type 2 posit jnt Pelvic control pelvic sling Hip clevis/thrust bearing fr Hip clevis/thrust bearing lo Pelvic control hip heavy dut Hip joint adjustable flexion Hip adj flex ext abduct cont Plastic mold recipro hip & c Metal frame recipro hip & ca Pelvic control band & belt u Pelvic control band & belt b Pelv & thor control gluteal Thoracic control thoracic ba Thorac cont paraspinal uprig Thorac cont lat support upri Plating chrome/nickel pr bar Carbon graphite lamination Extension per extension per Low ext orthosis per bar/jnt Non-corrosive finish Drop lock retainer each Knee control full kneecap Knee cap medial or lateral p Knee control condylar pad Soft interface below knee se Soft interface above knee se Tibial length sock fx or equ Femoral lgth sock fx or equa Torsion mechanism knee/ankle Lower extremity orthosis NOS Ft insert ucb berkeley shell Foot insert remov molded spe Foot insert plastazote or eq Foot insert silicone gel eac Foot longitudinal arch suppo Foot longitud/metatarsal sup Foot arch support remov prem 49 L3040 L3050 L3060 L3070 L3080 L3090 L3100 L3140 L3150 L3160 L3170 L3201 L3202 L3203 L3204 L3206 L3207 L3208 L3209 L3211 L3212 L3213 L3214 L3215 L3216 L3217 L3218 L3219 L3221 L3222 L3223 L3224 L3225 L3230 L3250 L3251 L3252 L3253 L3254 L3255 L3257 L3260 L3265 L3300 L3310 L3320 L3330 L3332 L3334 L3340 L3350 L3360 Ft arch suprt premold longit Foot arch supp premold metat Foot arch supp longitud/meta Arch suprt att to sho longit Arch supp att to shoe metata Arch supp att to shoe long/m Hallus-valgus nght dynamic s Abduction rotation bar shoe Abduct rotation bar w/o shoe Shoe styled positioning dev Foot plastic heel stabilizer Oxford w supinat/pronat inf Oxford w/ supinat/pronator c Oxford w/ supinator/pronator Hightop w/ supp/pronator inf Hightop w/ supp/pronator chi Hightop w/ supp/pronator jun Surgical boot each infant Surgical boot each child Surgical boot each junior Benesch boot pair infant Benesch boot pair child Benesch boot pair junior Orthopedic ftwear ladies oxf Orthoped ladies shoes dpth i Ladies shoes hightop depth i Ladies surgical boot each Orthopedic mens shoes oxford Orthopedic mens shoes dpth i Mens shoes hightop depth inl Mens surgical boot each Woman's shoe oxford brace Man's shoe oxford brace Custom shoes depth inlay Custom mold shoe remov prost Shoe molded to pt silicone s Shoe molded plastazote cust Shoe molded plastazote cust Orth foot non-stndard size/w Orth foot non-standard size/ Orth foot add charge split s Ambulatory surgical boot eac Plastazote sandal each Sho lift taper to metatarsal Shoe lift elev heel/sole neo Shoe lift elev heel/sole cor Lifts elevation metal extens Shoe lifts tapered to one-ha Shoe lifts elevation heel /i Shoe wedge sach Shoe heel wedge Shoe sole wedge outside sole 50 L3370 L3380 L3390 L3400 L3410 L3420 L3430 L3440 L3450 L3455 L3460 L3465 L3470 L3480 L3485 L3500 L3510 L3520 L3530 L3540 L3550 L3560 L3570 L3580 L3590 L3595 L3600 L3610 L3620 L3630 L3640 L3649 L3650 L3660 L3670 L3675 L3700 L3710 L3720 L3730 L3740 L3760 L3800 L3805 L3807 L3810 L3815 L3820 L3825 L3830 L3835 L3840 Shoe sole wedge between sole Shoe clubfoot wedge Shoe outflare wedge Shoe metatarsal bar wedge ro Shoe metatarsal bar between Full sole/heel wedge btween Sho heel count plast reinfor Heel leather reinforced Shoe heel sach cushion type Shoe heel new leather standa Shoe heel new rubber standar Shoe heel thomas with wedge Shoe heel thomas extend to b Shoe heel pad & depress for Shoe heel pad removable for Ortho shoe add leather insol Orthopedic shoe add rub insl O shoe add felt w leath insl Ortho shoe add half sole Ortho shoe add full sole O shoe add standard toe tap O shoe add horseshoe toe tap O shoe add instep extension O shoe add instep velcro clo O shoe convert to sof counte Ortho shoe add march bar Trans shoe calip plate exist Trans shoe caliper plate new Trans shoe solid stirrup exi Trans shoe solid stirrup new Shoe dennis browne splint bo Orthopedic shoe modifica NOS Shlder fig 8 abduct restrain Abduct restrainer canvas&web Acromio/clavicular canvas&we Canvas vest SO Elbow orthoses elas w stays Elbow elastic with metal joi Forearm/arm cuffs free motio Forearm/arm cuffs ext/flex a Cuffs adj lock w/ active con EO withjoint, Prefabricated Whfo short opponen no attach Whfo long opponens no attach WHFO,no joint, prefabricated Whfo thumb abduction bar Whfo second m.p. abduction a Whfo ip ext asst w/ mp ext s Whfo m.p. extension stop Whfo m.p. extension assist Whfo m.p. spring extension a Whfo spring swivel thumb 51 L3845 L3850 L3855 L3860 L3890 L3900 L3901 L3902 L3904 L3906 L3907 L3908 L3910 L3912 L3914 L3916 L3918 L3920 L3922 L3923 L3924 L3926 L3928 L3930 L3932 L3934 L3936 L3938 L3940 L3942 L3944 L3946 L3948 L3950 L3952 L3954 L3956 L3960 L3962 L3963 L3964 L3965 L3966 L3968 L3969 L3970 L3972 L3974 L3980 L3982 L3984 L3985 Whfo thumb ip ext ass w/ mp Action wrist w/ dorsiflex as Whfo adj m.p. flexion contro Whfo adj m.p. flex ctrl & i. Torsion mechanism wrist/elbo Hinge extension/flex wrist/f Hinge ext/flex wrist finger Whfo ext power compress gas Whfo electric custom fitted Wrist gauntlet molded to pt Whfo wrst gauntlt thmb spica Wrist cock-up non-molded Whfo swanson design Flex glove w/elastic finger WHO wrist extension cock-up Whfo wrist extens w/ outrigg HFO knuckle bender Knuckle bender with outrigge Knuckle bend 2 seg to flex j HFO, no joint, prefabricated Oppenheimer Thomas suspension Finger extension w/ clock sp Finger extension with wrist Safety pin spring wire Safety pin modified Palmer Dorsal wrist Dorsal wrist w/ outrigger at Reverse knuckle bender Reverse knuckle bend w/ outr HFO composite elastic Finger knuckle bender Oppenheimer w/ knuckle bend Oppenheimer w/ rev knuckle 2 Spreading hand Add joint upper ext orthosis Sewho airplan desig abdu pos Sewho erbs palsey design abd Molded w/ articulating elbow Seo mobile arm sup att to wc Arm supp att to wc rancho ty Mobile arm supports reclinin Friction dampening arm supp Monosuspension arm/hand supp Elevat proximal arm support Offset/lat rocker arm w/ ela Mobile arm support supinator Upp ext fx orthosis humeral Upper ext fx orthosis rad/ul Upper ext fx orthosis wrist Forearm hand fx orth w/ wr h 52 L3986 L3995 L3999 L4000 L4010 L4020 L4030 L4040 L4045 L4050 L4055 L4060 L4070 L4080 L4090 L4100 L4110 L4130 L4205 L4210 L4350 L4360 L4370 L4380 L4392 L4394 L4396 L4398 L5000 L5010 L5020 L5050 L5060 L5100 L5105 L5150 L5160 L5200 L5210 L5220 L5230 L5250 L5270 L5280 L5300 L5310 L5320 L5330 L5340 L5400 L5410 L5420 Humeral rad/ulna wrist fx or Sock fracture or equal each Upper limb orthosis NOS Repl girdle milwaukee orth Replace trilateral socket br Replace quadlat socket brim Replace socket brim cust fit Replace molded thigh lacer Replace non-molded thigh lac Replace molded calf lacer Replace non-molded calf lace Replace high roll cuff Replace prox & dist upright Repl met band kafo-afo prox Repl met band kafo-afo calf/ Repl leath cuff kafo prox th Repl leath cuff kafo-afo cal Replace pretibial shell Ortho dvc repair per 15 min Orth dev repair/repl minor p Pneumatic ankle cntrl splint Pneumatic walking splint Pneumatic full leg splint Pneumatic knee splint Replace AFO soft interface Replace foot drop spint Static AFO Foot drop splint recumbent Sho insert w arch toe filler Mold socket ank hgt w/ toe f Tibial tubercle hgt w/ toe f Ank symes mold sckt sach ft Symes met fr leath socket ar Molded socket shin sach foot Plast socket jts/thgh lacer Mold sckt ext knee shin sach Mold socket bent knee shin s Kne sing axis fric shin sach No knee/ankle joints w/ ft b No knee joint with artic ali Fem focal defic constant fri Hip canad sing axi cons fric Tilt table locking hip sing Hemipelvect canad sing axis Bk sach soft cover & finish Knee disart sach soft cv/fin Ak open end sach soft cv/fin Hip canadian sach sft cv/fin Hemipelvectomy canad cv/fin Postop dress & 1 cast chg bk Postop dsg bk ea add cast ch Postop dsg & 1 cast chg ak/d 53 L5430 L5450 L5460 L5500 L5505 L5510 L5520 L5530 L5535 L5540 L5560 L5570 L5580 L5585 L5590 L5595 L5600 L5610 L5611 L5613 L5614 L5616 L5617 L5618 L5620 L5622 L5624 L5626 L5628 L5629 L5630 L5631 L5632 L5634 L5636 L5637 L5638 L5639 L5640 L5642 L5643 L5644 L5645 L5646 L5647 L5648 L5649 L5650 L5651 L5652 L5653 L5654 Postop dsg ak ea add cast ch Postop app non-wgt bear dsg Postop app non-wgt bear dsg Init bk ptb plaster direct Init ak ischal plstr direct Prep BK ptb plaster molded Perp BK ptb thermopls direct Prep BK ptb thermopls molded Prep BK ptb open end socket Prep BK ptb laminated socket Prep AK ischial plast molded Prep AK ischial direct form Prep AK ischial thermo mold Prep AK ischial open end Prep AK ischial laminated Hip disartic sach thermopls Hip disart sach laminat mold Above knee hydracadence Ak 4 bar link w/fric swing Ak 4 bar ling w/hydraul swig 4-bar link above knee w/swng Ak univ multiplex sys frict AK/BK self-aligning unit ea Test socket symes Test socket below knee Test socket knee disarticula Test socket above knee Test socket hip disarticulat Test socket hemipelvectomy Below knee acrylic socket Syme typ expandabl wall sckt Ak/knee disartic acrylic soc Symes type ptb brim design s Symes type poster opening so Symes type medial opening so Below knee total contact Below knee leather socket Below knee wood socket Knee disarticulat leather so Above knee leather socket Hip flex inner socket ext fr Above knee wood socket Ak flexibl inner socket ext Below knee air cushion socke Below knee suction socket Above knee air cushion socke Isch containmt/narrow m-l so Tot contact ak/knee disart s Ak flex inner socket ext fra Suction susp ak/knee disart Knee disart expand wall sock Socket insert symes 54 L5655 L5656 L5658 L5660 L5661 L5662 L5663 L5664 L5665 L5666 L5667 L5668 L5669 L5670 L5672 L5674 L5675 L5676 L5677 L5678 L5680 L5682 L5684 L5686 L5688 L5690 L5692 L5694 L5695 L5696 L5697 L5698 L5699 L5700 L5701 L5702 L5704 L5705 L5706 L5707 L5710 L5711 L5712 L5714 L5716 L5718 L5722 L5724 L5726 L5728 L5780 L5785 Socket insert below knee Socket insert knee articulat Socket insert above knee Sock insrt syme silicone gel Multi-durometer symes Socket insert bk silicone ge Sock knee disartic silicone Socket insert ak silicone ge Multi-durometer below knee Below knee cuff suspension Socket insert w lock lower Socket insert w/o lock lower Below knee socket w/o lock Bk molded supracondylar susp Bk removable medial brim sus Bk suspension sleeve Bk heavy duty susp sleeve Bk knee joints single axis p Bk knee joints polycentric p Bk joint covers pair Bk thigh lacer non-molded Bk thigh lacer glut/ischia m Bk fork strap Bk back check Bk waist belt webbing Bk waist belt padded and lin Ak pelvic control belt light Ak pelvic control belt pad/l Ak sleeve susp neoprene/equa Ak/knee disartic pelvic join Ak/knee disartic pelvic band Ak/knee disartic silesian ba Shoulder harness Replace socket below knee Replace socket above knee Replace socket hip Custom shape covr below knee Custm shape cover above knee Custm shape cvr knee disart Custm shape cover hip disart Kne-shin exo sng axi mnl loc Knee-shin exo mnl lock ultra Knee-shin exo frict swg & st Knee-shin exo variable frict Knee-shin exo mech stance ph Knee-shin exo frct swg & sta Knee-shin pneum swg frct exo Knee-shin exo fluid swing ph Knee-shin ext jnts fld swg e Knee-shin fluid swg & stance Knee-shin pneum/hydra pneum Exoskeletal bk ultralt mater 55 L5790 L5795 L5810 L5811 L5812 L5814 L5816 L5818 L5822 L5824 L5826 L5828 L5830 L5840 L5845 L5846 L5850 L5855 L5910 L5920 L5925 L5930 L5940 L5950 L5960 L5962 L5964 L5966 L5968 L5970 L5972 L5974 L5975 L5976 L5978 L5979 L5980 L5981 L5982 L5984 L5985 L5986 L5987 L5988 L5999 L6000 L6010 L6020 L6050 L6055 L6100 L6110 Exoskeletal ak ultra-light m Exoskel hip ultra-light mate Endoskel knee-shin mnl lock Endo knee-shin mnl lck ultra Endo knee-shin frct swg & st Endo knee-shin hydral swg ph Endo knee-shin polyc mch sta Endo knee-shin frct swg & st Endo knee-shin pneum swg frc Endo knee-shin fluid swing p Miniature knee joint Endo knee-shin fluid swg/sta Endo knee-shin pneum/swg pha Multi-axial knee/shin system Knee-shin sys stance flexion Knee-shin sys microprocessor Endo ak/hip knee extens assi Mech hip extension assist Endo below knee alignable sy Endo ak/hip alignable system Above knee manual lock High activity knee frame Endo bk ultra-light material Endo ak ultra-light material Endo hip ultra-light materia Below knee flex cover system Above knee flex cover system Hip flexible cover system Multiaxial ankle w dorsiflex Foot external keel sach foot Flexible keel foot Foot single axis ankle/foot Combo ankle/foot prosthesis Energy storing foot Ft prosth multiaxial ankl/ft Multi-axial ankle/ft prosth Flex foot system Flex-walk sys low ext prosth Exoskeletal axial rotation u Endoskeletal axial rotation Lwr ext dynamic prosth pylon Multi-axial rotation unit Shank ft w vert load pylon Vertical shock reducing pylo Lowr extremity prosthes NOS Par hand robin-aids thum rem Hand robin-aids little/ring Part hand robin-aids no fing Wrst MLd sck flx hng tri pad Wrst mold sock w/exp interfa Elb mold sock flex hinge pad Elbow mold sock suspension t 56 L6120 L6130 L6200 L6205 L6250 L6300 L6310 L6320 L6350 L6360 L6370 L6380 L6382 L6384 L6386 L6388 L6400 L6450 L6500 L6550 L6570 L6580 L6582 L6584 L6586 L6588 L6590 L6600 L6605 L6610 L6615 L6616 L6620 L6623 L6625 L6628 L6629 L6630 L6632 L6635 L6637 L6640 L6641 L6642 L6645 L6650 L6655 L6660 L6665 L6670 L6672 L6675 Elbow mold doub splt soc ste Elbow stump activated lock h Elbow mold outsid lock hinge Elbow molded w/ expand inter Elbow inter loc elbow forarm Shlder disart int lock elbow Shoulder passive restor comp Shoulder passive restor cap Thoracic intern lock elbow Thoracic passive restor comp Thoracic passive restor cap Postop dsg cast chg wrst/elb Postop dsg cast chg elb dis/ Postop dsg cast chg shlder/t Postop ea cast chg & realign Postop applicat rigid dsg on Below elbow prosth tiss shap Elb disart prosth tiss shap Above elbow prosth tiss shap Shldr disar prosth tiss shap Scap thorac prosth tiss shap Wrist/elbow bowden cable mol Wrist/elbow bowden cbl dir f Elbow fair lead cable molded Elbow fair lead cable dir fo Shdr fair lead cable molded Shdr fair lead cable direct Polycentric hinge pair Single pivot hinge pair Flexible metal hinge pair Disconnect locking wrist uni Disconnect insert locking wr Flexion-friction wrist unit Spring-ass rot wrst w/ latch Rotation wrst w/ cable lock Quick disconn hook adapter o Lamination collar w/ couplin Stainless steel any wrist Latex suspension sleeve each Lift assist for elbow Nudge control elbow lock Shoulder abduction joint pai Excursion amplifier pulley t Excursion amplifier lever ty Shoulder flexion-abduction j Shoulder universal joint Standard control cable extra Heavy duty control cable Teflon or equal cable lining Hook to hand cable adapter Harness chest/shlder saddle Harness figure of 8 sing con 57 L6676 L6680 L6682 L6684 L6686 L6687 L6688 L6689 L6690 L6691 L6692 L6693 L6700 L6705 L6710 L6715 L6720 L6725 L6730 L6735 L6740 L6745 L6750 L6755 L6765 L6770 L6775 L6780 L6790 L6795 L6800 L6805 L6806 L6807 L6808 L6809 L6810 L6825 L6830 L6835 L6840 L6845 L6850 L6855 L6860 L6865 L6867 L6868 L6870 L6872 L6873 L6875 Harness figure of 8 dual con Test sock wrist disart/bel e Test sock elbw disart/above Test socket shldr disart/tho Suction socket Frame typ socket bel elbow/w Frame typ sock above elb/dis Frame typ socket shoulder di Frame typ sock interscap-tho Removable insert each Silicone gel insert or equal Lockingelbow forearm cntrbal Terminal device model #3 Terminal device model #5 Terminal device model #5x Terminal device model #5xa Terminal device model #6 Terminal device model #7 Terminal device model #7lo Terminal device model #8 Terminal device model #8x Terminal device model #88x Terminal device model #10p Terminal device model #10x Terminal device model #12p Terminal device model #99x Terminal device model#555 Terminal device model #ss555 Hooks-accu hook or equal Hooks-2 load or equal Hooks-aprl vc or equal Modifier wrist flexion unit Trs grip vc or equal Term device grip1/2 or equal Term device infant or child Trs super sport passive Pincher tool otto bock or eq Hands dorrance vo Hand aprl vc Hand sierra vo Hand becker imperial Hand becker lock grip Term dvc-hand becker plylite Hand robin-aids vo Hand robin-aids vo soft Hand passive hand Hand detroit infant hand Passive inf hand steeper/hos Hand child mitt Hand nyu child hand Hand mech inf steeper or equ Hand bock vc 58 L6880 L6890 L6895 L6900 L6905 L6910 L6915 L6920 L6925 L6930 L6935 L6940 L6945 L6950 L6955 L6960 L6965 L6970 L6975 L7010 L7015 L7020 L7025 L7030 L7035 L7040 L7045 L7170 L7180 L7185 L7186 L7190 L7191 L7260 L7261 L7266 L7272 L7274 L7360 L7362 L7364 L7366 L7499 L7500 L7510 L7520 L7900 L8000 L8010 L8015 L8020 L8030 Hand bock vo Production glove Custom glove Hand restorat thumb/1 finger Hand restoration multiple fi Hand restoration no fingers Hand restoration replacmnt g Wrist disarticul switch ctrl Wrist disart myoelectronic c Below elbow switch control Below elbow myoelectronic ct Elbow disarticulation switch Elbow disart myoelectronic c Above elbow switch control Above elbow myoelectronic ct Shldr disartic switch contro Shldr disartic myoelectronic Interscapular-thor switch ct Interscap-thor myoelectronic Hand otto back steeper/eq sw Hand sys teknik village swit Electronic greifer switch ct Electron hand myoelectronic Hand sys teknik vill myoelec Electron greifer myoelectro Prehensile actuator hosmer s Electron hook child michigan Electronic elbow hosmer swit Electronic elbow utah myoele Electron elbow adolescent sw Electron elbow child switch Elbow adolescent myoelectron Elbow child myoelectronic ct Electron wrist rotator otto Electron wrist rotator utah Servo control steeper or equ Analogue control unb or equa Proportional ctl 12 volt uta Six volt bat otto bock/eq ea Battery chrgr six volt otto Twelve volt battery utah/equ Battery chrgr 12 volt utah/e Upper extremity prosthes NOS Prosthetic dvc repair hourly Prosthetic device repair rep Repair prosthesis per 15 min Vacuum erection system Mastectomy bra Mastectomy sleeve Ext breastprosthesis garment Mastectomy form Breast prosthesis silicone/e 59 L8035 L8039 L8040 L8041 L8042 L8043 L8044 L8045 L8046 L8047 L8048 L8049 L8100 L8110 L8120 L8130 L8140 L8150 L8160 L8170 L8180 L8190 L8195 L8200 L8210 L8220 L8230 L8239 L8300 L8310 L8320 L8330 L8400 L8410 L8415 L8417 L8420 L8430 L8435 L8440 L8460 L8465 L8470 L8480 L8485 L8490 L8499 L8500 L8501 L8600 L8603 L8606 Custom breast prosthesis Breast prosthesis NOS Nasal prosthesis Midfacial prosthesis Orbital prosthesis Upper facial prosthesis Hemi-facial prosthesis Auricular prosthesis Partial facial prosthesis Nasal septal prosthesis Unspec maxillofacial prosth Repair maxillofacial prosth Compression stocking BK18-30 Compression stocking BK30-40 Compression stocking BK40-50 Gc stocking thighlngth 18-30 Gc stocking thighlngth 30-40 Gc stocking thighlngth 40-50 Gc stocking full lngth 18-30 Gc stocking full lngth 30-40 Gc stocking full lngth 40-50 Gc stocking waistlngth 18-30 Gc stocking waistlngth 30-40 Gc stocking waistlngth 40-50 Gc stocking custom made Gc stocking lymphedema Gc stocking garter belt G compression stocking NOS Truss single w/ standard pad Truss double w/ standard pad Truss addition to std pad wa Truss add to std pad scrotal Sheath below knee Sheath above knee Sheath upper limb Pros sheath/sock w gel cushn Prosthetic sock multi ply BK Prosthetic sock multi ply AK Pros sock multi ply upper lm Shrinker below knee Shrinker above knee Shrinker upper limb Pros sock single ply BK Pros sock single ply AK Pros sock single ply upper l Air seal suction reten systm Unlisted misc prosthetic ser Artificial larynx Tracheostomy speaking valve Implant breast silicone/eq Collagen imp urinary 2.5 ml Synthetic implnt urinary 1ml 60 L8610 L8612 L8613 L8614 L8619 L8630 L8641 L8642 L8658 L8670 L8699 L9900 M0064 M0075 M0076 M0100 M0300 M0301 M0302 P2028 P2029 P2031 P2033 P2038 P3000 P3001 P7001 P9010 P9011 P9012 P9016 P9017 P9019 P9020 P9021 P9022 P9023 P9031 P9032 P9033 P9034 P9035 P9036 P9037 P9038 P9039 P9040 P9041 P9042 P9043 P9044 P9603 Ocular implant Aqueous shunt prosthesis Ossicular implant Cochlear device/system Replace cochlear processor Metacarpophalangeal implant Metatarsal joint implant Hallux implant Interphalangeal joint implnt Vascular graft, synthetic Prosthetic implant NOS O&P supply/accessory/service Visit for drug monitoring Cellular therapy Prolotherapy Intragastric hypothermia IV chelationtherapy Fabric wrapping of aneurysm Assessment of cardiac output Cephalin floculation test Congo red blood test Hair analysis Blood thymol turbidity Blood mucoprotein Screen pap by tech w md supv Screening pap smear by phys Culture bacterial urine Whole blood for transfusion Blood split unit Cryoprecipitate each unit RBC leukocytes reduced One donor fresh frozn plasma Platelets, each unit Plaelet rich plasma unit Red blood cells unit Washed red blood cells unit Frozen plasma, pooled, sd Platelets leukocytes reduced Platelets, irradiated Platelets leukoreduced irrad Platelets, pheresis Platelet pheres leukoreduced Platelet pheresis irradiated Plate pheres leukoredu irrad RBC irradiated RBC deglycerolized RBC leukoreduced irradiated Albumin(human), 5% Albumin (human), 25% Plasma protein fraction Cryoprecipitatereducedplasma One-way allow prorated miles 61 P9604 P9612 P9615 Q0035 Q0081 Q0083 Q0084 Q0085 Q0086 Q0091 Q0092 Q0111 Q0112 Q0113 Q0114 Q0115 Q0136 Q0144 Q0160 Q0161 Q0163 Q0164 Q0165 Q0166 Q0167 Q0168 Q0169 Q0170 Q0171 Q0172 Q0173 Q0174 Q0175 Q0176 Q0177 Q0178 Q0179 Q0180 Q0181 Q0183 Q0184 Q0185 Q0187 Q1001 Q1002 Q1003 Q1004 Q1005 Q2001 Q2002 Q2003 Q2004 One-way allow prorated trip Catheterize for urine spec Urine specimen collect mult Cardiokymography Infusion ther other than che Chemo by other than infusion Chemotherapy by infusion Chemo by both infusion and o Physical therapy evaluation/ Obtaining screen pap smear Set up port xray equipment Wet mounts/ w preparations Potassium hydroxide preps Pinworm examinations Fern test Post-coital mucous exam Non esrd epoetin alpha inj Azithromycin dihydrate, oral Factor IX non-recombinant Factor IX recombinant Diphenhydramine HCl 50mg Prochlorperazine maleate 5mg Prochlorperazine maleate10mg Granisetron HCl 1 mg oral Dronabinol 2.5mg oral Dronabinol 5mg oral Promethazine HCl 12.5mg oral Promethazine HCl 25 mg oral Chlorpromazine HCl 10mg oral Chlorpromazine HCl 25mg oral Trimethobenzamide HCl 250mg Thiethylperazine maleate10mg Perphenazine 4mg oral Perphenazine 8mg oral Hydroxyzine pamoate 25mg Hydroxyzine pamoate 50mg Ondansetron HCl 8mg oral Dolasetron mesylate oral Unspecified oral anti-emetic Nonmetabolic active tissue Metabolically active tissue Metabolic active D/E tissue Factor viia recombinant Ntiol category 1 Ntiol category 2 Ntiol category 3 Ntiol category 4 Ntiol category 5 Oral cabergoline 0.5 mg Elliotts b solution per ml Aprotinin, 10,000 kiu Bladder calculi irrig sol 62 Q2005 Q2006 Q2007 Q2008 Q2009 Q2010 Q2011 Q2012 Q2013 Q2014 Q2015 Q2016 Q2017 Q2018 Q2019 Q2020 Q2021 Q2022 Q3001 Q3002 Q3003 Q3004 Q3005 Q3006 Q3007 Q3008 Q3009 Q3010 Q3011 Q3012 Q9920 Q9921 Q9922 Q9923 Q9924 Q9925 Q9926 Q9927 Q9928 Q9929 Q9930 Q9931 Q9932 Q9933 Q9934 Q9935 Q9936 Q9937 Q9938 Q9939 Q9940 R0070 Corticorelin ovine triflutat Digoxin immune fab (ovine) Ethanolamine oleate 100 mg Fomepizole, 1.5 mg Fosphenytoin, 50 mg Glatiramer acetate, per dose Hemin, per 1 mg Pegademase bovine, 25 iu Pentastarch 10% solution Sermorelin acetate, 0.5 mg Somatrem, 5 mg Somatropin, 1 mg Teniposide, 50 mg Urofollitropin, 75 iu Basiliximab Histrelin acetate Lepirudin VonWillebrandFactrCmplxperIU Brachytherapy Radioelements Gallium ga 67 Technetium tc99m bicisate Xenon xe 133 Technetium tc99m mertiatide Technetium tc99m glucepatate Sodium phosphate p32 Indium 111-in pentetreotide Technetium tc99m oxidronate Technetium tc99mlabeledrbcs Chromic phosphate p32 Cyanocobalamin cobalt co57 Epoetin with hct <= 20 Epoetin with hct = 21 Epoetin with hct = 22 Epoetin with hct = 23 Epoetin with hct = 24 Epoetin with hct = 25 Epoetin with hct = 26 Epoetin with hct = 27 Epoetin with hct = 28 Epoetin with hct = 29 Epoetin with hct = 30 Epoetin with hct = 31 Epoetin with hct = 32 Epoetin with hct = 33 Epoetin with hct = 34 Epoetin with hct = 35 Epoetin with hct = 36 Epoetin with hct = 37 Epoetin with hct = 38 Epoetin with hct = 39 Epoetin with hct >= 40 Transport portable x-ray 63 R0075 R0076 S0009 S0012 S0014 S0016 S0017 S0020 S0021 S0023 S0024 S0028 S0029 S0030 S0032 S0034 S0039 S0040 S0071 S0072 S0073 S0074 S0077 S0078 S0080 S0081 S0085 S0086 S0090 S0096 S0156 S0157 S0220 S0221 S0601 S0605 S0610 S0612 S0620 S0621 S0630 S0800 S0810 S0820 S0830 S1015 S1016 S2052 S2053 S2054 S2055 S2060 Transport port x-ray multipl Transport portable EKG Injection, butorphanol tartr Butorphanol tartrate, nasal Tacrine hydrochloride, 10 mg Injection, amikacin sulfate Injection, aminocaproic acid Injection, bupivicaine hydro Injection, cefoperazone sod Injection, cimetidine hydroc Injection, ciprofloxacin Injection, famotidine, 20 mg Injection, fluconazole Injection, metronidazole Injection, nafcillin sodium Injection, ofloxacin, 400 mg Injection, sulfamethoxazole Injection, ticarcillin disod Injection, acyclovir sodium Injection, amikacin sulfate Injection, aztreonam, 500 mg Injection, cefotetan disodiu Injection, clindamycin phosp Injection, fosphenytoin sodi Injection, pentamidine iseth Injection, piperacillin sodi injection, gatifloxacin Injection, verteporfin, 15mg Sildenafil citrate, 25 mg Injection, itraconazole, 200 Exemestane, 25 mg Becaplermin gel 1%, 0.5 gm Medical conference by physic Medical conference, 60 min Screening proctoscopy Digital rectal examination, Annual gynecological examina Annual gynecological examina Routine ophthalmological exa Routine ophthalmological exa Removal of sutures Laser in situ keratomileusis Photorefractive keratectomy Computerized corneal topogra Ultrasound pachymetry IV tubing extension set Non-pvc intravenous administ Transplantation of small int Transplantation of small int Transplantation of multivisc Harvesting of donor multivis Lobar lung transplantation 64 S2061 S2102 S2103 S2120 S2140 S2142 S2180 S2202 S2205 S2206 S2207 S2208 S2209 S2210 S2220 S2300 S2340 S2350 S2351 S2370 S2371 S3620 S3645 S3650 S3652 S3700 S3708 S3902 S3904 S3906 S5000 S5001 S5002 S5003 S5010 S5011 S5012 S5013 S5014 S5016 S5017 S5018 S5019 S5020 S5021 S5022 S5025 S5503 S8001 S8035 S8040 S8049 Donor lobectomy (lung) Islet cell tissue transplant Adrenal tissue transplant Low density lipoprotein(LDL) Cord blood harvesting Cord blood-derived stem-cell Donor leukocyte infusion Echosclerotherapy Minimally invasive direct co Minimally invasive direct co Minimally invasive direct co Minimally invasive direct co Minimally invasive direct co Cryosurgical ablation (in si Thrombectomy, coronary Arthroscopy, shoulder, surgi Chemodenervation of abductor Diskectomy, anterior, with d Diskectomy, anterior, with d Intradiscal electrothermal Each additional interspace Newborn metabolic screening HIV-1 antibody testing of or Saliva test, hormone level; Saliva test, hormone level; Bladder tumor-associated Gastrointestinal fat absorpt Ballistocardiogram Masters two step Transfusion, direct, blood Prescription drug, generic Prescription drug,brand name Fat emulsion 10% in 250 ml Fat emulsion 20% in 250 ml 5% dextrose and 45% saline 5% dextrose in lactated ring 5% dextrose with potassium 5% dextrose/45%saline,1000ml 5% dextrose/45%saline,1500ml Antibiotic admin supplies w/ Antibiotic adminsupplies w/o Pain therapy admin supplies Chemotherapy admin supplies Chemotherapy admin supplies Hydration therapy admin supp Growth hormone therapy Infusion pump rental,perdiem Maintenance of implanted vas Radiofrequency stimulation Magnetic source imaging Topographic brain mapping Intraoperative radiation the 65 S8080 S8085 S8092 S8095 S8096 S8105 S8110 S8200 S8205 S8210 S8260 S8400 S8402 S8405 S8950 S8999 S9001 S9007 S9015 S9022 S9023 S9024 S9025 S9035 S9055 S9056 S9061 S9075 S9085 S9088 S9090 S9122 S9123 S9124 S9125 S9126 S9127 S9128 S9129 S9140 S9141 S9200 S9210 S9220 S9225 S9230 S9300 S9308 S9310 S9395 S9420 S9423 Scintimammography Fluorine-18 fluorodeoxygluco Electron beam computed tomog Wig (for medically-induced h Portable peak flow meter Oximeter for measuring blood Peak expiratory flow rate (p Chest compression vest Chest compression system gen Mucus trap Oral orthotic for treatment Incontinence pants, each Diapers, each Incontinence liners, each Complex lymphedema therapy, Resuscitation bag Home uterine monitor with or Ultrafiltration monitor Automated EEG monitoring Digital subtraction angiogra Xenon regional cerebral bloo Paranasal sinus ultrasound Omnicardiogram/cardiointegra Medical equipment or supplie Procuren or other growth fac Coma stimulation per diem Medical supplies and equipme Smoking cessation treatment Meniscal allograft transplan Services provided in urgent Vertebral axial decompressio Home health aide or certifie Nursing care, in the home; b Nursing care, in the home; b Respite care, in the home, p Hospice care, in the home, p Social work visit, in the ho Speech therapy, in the home, Occupational therapy, in the Diabetic Management Program, Diabetic Management Program, Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services and all nec Nursing services, patient as 66 S9425 S9435 S9455 S9460 S9465 S9470 S9472 S9473 S9474 S9475 S9480 S9485 S9524 S9526 S9527 S9528 S9533 S9535 S9539 S9543 S9545 S9550 S9555 S9990 S9991 S9992 S9994 S9996 S9999 V2020 V2025 V2100 V2101 V2102 V2103 V2104 V2105 V2106 V2107 V2108 V2109 V2110 V2111 V2112 V2113 V2114 V2115 V2116 V2117 V2118 V2199 V2200 Nursing services and all nec Medical foods for inborn err Diabetic Management Program, Diabetic Management Program, Diabetic Management Program, Nutritional counseling, diet Cardiac rehabilitation progr Pulmonary rehabilitation pro Enterostomal therapy by a re Ambulatory setting substance Intensive outpatient psychia Crisis intervention mental h Nursing services related to Skilled nursing visits for Insertion of a peripherally Insertion of midline central Pain management, intravenous Administration of hematopoie Administration of antibiotic Administration of medication Administration of immune glo Home IV therapy, hydration Additional home infusion Services provided as part of Services provided as part of Transportation costs to and Lodging costs (e.g. hotel ch Meals for clinical trial par Sales tax Vision svcs frames purchases Eyeglasses delux frames Lens spher single plano 4.00 Single visn sphere 4.12-7.00 Singl visn sphere 7.12-20.00 Spherocylindr 4.00d/12-2.00d Spherocylindr 4.00d/2.12-4d Spherocylinder 4.00d/4.25-6d Spherocylinder 4.00d/>6.00d Spherocylinder 4.25d/12-2d Spherocylinder 4.25d/2.12-4d Spherocylinder 4.25d/4.25-6d Spherocylinder 4.25d/over 6d Spherocylindr 7.25d/.25-2.25 Spherocylindr 7.25d/2.25-4d Spherocylindr 7.25d/4.25-6d Spherocylinder over 12.00d Lens lenticular bifocal Nonaspheric lens bifocal Aspheric lens bifocal Lens aniseikonic single Lens single vision not oth c Lens spher bifoc plano 4.00d 67 V2201 V2202 V2203 V2204 V2205 V2206 V2207 V2208 V2209 V2210 V2211 V2212 V2213 V2214 V2215 V2216 V2217 V2218 V2219 V2220 V2299 V2300 V2301 V2302 V2303 V2304 V2305 V2306 V2307 V2308 V2309 V2310 V2311 V2312 V2313 V2314 V2315 V2316 V2317 V2318 V2319 V2320 V2399 V2410 V2430 V2499 V2500 V2501 V2502 V2503 V2510 V2511 Lens sphere bifocal 4.12-7.0 Lens sphere bifocal 7.12-20. Lens sphcyl bifocal 4.00d/.1 Lens sphcy bifocal 4.00d/2.1 Lens sphcy bifocal 4.00d/4.2 Lens sphcy bifocal 4.00d/ove Lens sphcy bifocal 4.25-7d/. Lens sphcy bifocal 4.25-7/2. Lens sphcy bifocal 4.25-7/4. Lens sphcy bifocal 4.25-7/ov Lens sphcy bifo 7.25-12/.25Lens sphcyl bifo 7.25-12/2.2 Lens sphcyl bifo 7.25-12/4.2 Lens sphcyl bifocal over 12. Lens lenticular bifocal Lens lenticular nonaspheric Lens lenticular aspheric bif Lens aniseikonic bifocal Lens bifocal seg width over Lens bifocal add over 3.25d Lens bifocal speciality Lens sphere trifocal 4.00d Lens sphere trifocal 4.12-7. Lens sphere trifocal 7.12-20 Lens sphcy trifocal 4.0/.12Lens sphcy trifocal 4.0/2.25 Lens sphcy trifocal 4.0/4.25 Lens sphcyl trifocal 4.00/>6 Lens sphcy trifocal 4.25-7/. Lens sphc trifocal 4.25-7/2. Lens sphc trifocal 4.25-7/4. Lens sphc trifocal 4.25-7/>6 Lens sphc trifo 7.25-12/.25Lens sphc trifo 7.25-12/2.25 Lens sphc trifo 7.25-12/4.25 Lens sphcyl trifocal over 12 Lens lenticular trifocal Lens lenticular nonaspheric Lens lenticular aspheric tri Lens aniseikonic trifocal Lens trifocal seg width > 28 Lens trifocal add over 3.25d Lens trifocal speciality Lens variab asphericity sing Lens variable asphericity bi Variable asphericity lens Contact lens pmma spherical Cntct lens pmma-toric/prism Contact lens pmma bifocal Cntct lens pmma color vision Cntct gas permeable sphericl Cntct toric prism ballast 68 V2512 V2513 V2520 V2521 V2522 V2523 V2530 V2531 V2599 V2600 V2610 V2615 V2623 V2624 V2625 V2626 V2627 V2628 V2629 V2630 V2631 V2632 V2700 V2710 V2715 V2718 V2730 V2740 V2741 V2742 V2743 V2744 V2750 V2755 V2760 V2770 V2780 V2781 V2785 V2790 V2799 V5008 V5010 V5011 V5014 V5020 V5030 V5040 V5050 V5060 V5070 V5080 Cntct lens gas permbl bifocl Contact lens extended wear Contact lens hydrophilic Cntct lens hydrophilic toric Cntct lens hydrophil bifocl Cntct lens hydrophil extend Contact lens gas impermeable Contact lens gas permeable Contact lens/es other type Hand held low vision aids Single lens spectacle mount Telescop/othr compound lens Plastic eye prosth custom Polishing artifical eye Enlargemnt of eye prosthesis Reduction of eye prosthesis Scleral cover shell Fabrication & fitting Prosthetic eye other type Anter chamber intraocul lens Iris support intraoclr lens Post chmbr intraocular lens Balance lens Glass/plastic slab off prism Prism lens/es Fresnell prism press-on lens Special base curve Rose tint plastic Non-rose tint plastic Rose tint glass Non-rose tint glass Tint photochromatic lens/es Anti-reflective coating UV lens/es Scratch resistant coating Occluder lens/es Oversize lens/es Progressive lens per lens Corneal tissue processing Amniotic membrane Miscellaneous vision service Hearing screening Assessment for hearing aid Hearing aid fitting/checking Hearing aid repair/modifying Conformity evaluation Body-worn hearing aid air Body-worn hearing aid bone Hearing aid monaural in ear Behind ear hearing aid Glasses air conduction Glasses bone conduction 69 V5090 V5100 V5110 V5120 V5130 V5140 V5150 V5160 V5170 V5180 V5190 V5200 V5210 V5220 V5230 V5240 V5299 V5336 V5362 V5363 V5364 Hearing aid dispensing fee Body-worn bilat hearing aid Hearing aid dispensing fee Body-worn binaur hearing aid In ear binaural hearing aid Behind ear binaur hearing ai Glasses binaural hearing aid Dispensing fee binaural Within ear cros hearing aid Behind ear cros hearing aid Glasses cros hearing aid Cros hearing aid dispens fee In ear bicros hearing aid Behind ear bicros hearing ai Glasses bicros hearing aid Dispensing fee bicros Hearing service Repair communication device Speech screening Language screening Dysphagia screening
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