HCPCS Codes

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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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