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07.00.14h​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-LevelLaserTherapy07.00.14hMedicine (07)​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy9218d81f-664c-4325-86e2-b7cdfee1f8d56600​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy07.00.14
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08.00.62qAbatacept(Orencia®)forInjectionforIntravenousUse08.00.62qPharmacy (08)Abatacept (Orencia®) for Injection for Intravenous Use488dec00-d5ea-416c-86b2-e1e16d582e796641Abatacept (Orencia®) for Injection for Intravenous Use08.00.62
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12.00.01iAcupuncture12.00.01iMiscellaneous (12)Acupuncture982834a7-91a7-4cdf-a7a0-a9f78390e73f7134Acupuncture12.00.01
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12.04.04bAcuteCareFacilityInpatientTransfers12.04.04bMiscellaneous (12)Acute Care Facility Inpatient Transfersad65734f-8c9d-4c0a-b362-9b3677e62f356190Acute Care Facility Inpatient Transfers12.04.04
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08.02.21ADAMTS13,recombinant-krhn(Adzynma)08.02.21Pharmacy (08)ADAMTS13, recombinant-krhn (Adzynma)d5e67f8a-f5e2-4997-8424-41e3b326d8b76515ADAMTS13, recombinant-krhn (Adzynma)08.02.21
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08.01.11iAdo-TrastuzumabEmtansine(Kadcyla®)08.01.11iPharmacy (08)Ado-Trastuzumab Emtansine (Kadcyla®)b2f741cb-d1fd-49a3-91e0-bf9f2d147f8d6105Ado-Trastuzumab Emtansine (Kadcyla®)08.01.11
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08.02.32aAfamitresgeneautoleucel(Tecelra®)08.02.32aPharmacy (08)Afamitresgene autoleucel (Tecelra®)6df88e0d-d8e3-4162-93fb-7747badd3e307264Afamitresgene autoleucel (Tecelra®)08.02.32
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08.00.69dAgalsidasebeta(Fabrazyme®)andpegunigalsidasealfa-iwxj(Elfabrio)08.00.69dPharmacy (08)Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) 2e032683-3b7c-4677-a7c8-f74557ec2fab6616Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) 08.00.69
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12.04.03cAirAmbulanceServices12.04.03cMiscellaneous (12)Air Ambulance Services245ffd2b-6443-450c-854f-d6716f6c1f0c6418Air Ambulance Services12.04.03
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08.00.72lAlglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)08.00.72lPharmacy (08)Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )acd08093-ff2e-4a25-bd88-d5bba19568616240Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )08.00.72
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08.01.88AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88Pharmacy (08)Allogeneic Processed Thymus Tissue-agdc (Rethymic®)07a9501c-7555-435e-851a-cd30d2599ca77206Allogeneic Processed Thymus Tissue-agdc (Rethymic®)08.01.88
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06.02.29gAlloMap™MolecularExpressionTestingforHeartTransplantRejection(IndependenceAdministrators)06.02.29gPathology and Laboratory (06)AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)441bf6fa-8d20-4f99-a633-1df6e903aadb7128AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)06.02.29
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08.00.91eAlpha1-AntitrypsinTherapy(e.g.,Prolastin-C®,AralastNP®,Glassia®,Zemaira®)08.00.91ePharmacy (08)Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)d32eec72-479b-43a6-bdf3-cfe24dfa12b26266Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)08.00.91
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00.01.52xAlwaysBundledProcedureCodes00.01.52xAdministrative (00)Always Bundled Procedure Codes18221a36-d1f4-43de-82c2-6f98b949fee17046Always Bundled Procedure Codes00.01.52
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07.02.09jAmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09jMedicine (07)Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Deviceseeb386be-be45-43cb-b8dd-5eaca1df97ee6660Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices07.02.09
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07.02.21qAmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21qMedicine (07)Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoringba42d838-ddc7-45b0-b065-6b90274bde777005Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21
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08.01.90aAmivantamab-vmjw(Rybrevant®)08.01.90aPharmacy (08)Amivantamab-vmjw (Rybrevant®)22e3725e-1aab-4c4e-a86b-bd4cb90f60b26324Amivantamab-vmjw (Rybrevant®)08.01.90
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01.00.12cAnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12cAnesthesia (01)Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management142c8236-6430-4f8e-99d8-3cc44fc27dca6675Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management01.00.12
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08.01.82cAnifrolumab-fnia(Saphnelo®)08.01.82cPharmacy (08)Anifrolumab-fnia (Saphnelo®)d76f0864-8820-4305-aef9-042ca7cef74f6388Anifrolumab-fnia (Saphnelo®)08.01.82
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05.00.39vAnkle-Foot/Knee-Ankle-FootOrthoses05.00.39vDME (05)Ankle-Foot/Knee-Ankle-Foot Orthosesa37cd522-7951-47b7-bbe2-ef62cfe0fe2f7171Ankle-Foot/Knee-Ankle-Foot Orthoses05.00.39
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06.03.04oApheresisTherapy06.03.04oPathology and Laboratory (06)Apheresis Therapyf620f6fa-4a59-4450-a990-93e43257a6b16934Apheresis Therapy06.03.04
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05.00.84Apos®biomechanicalshoesystem05.00.84DME (05)Apos® biomechanical shoe systemd639cac9-8dad-420b-896d-b30fd48ea0e96859Apos® biomechanical shoe system05.00.84
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11.08.05gApplicationandRemovalofTattoos11.08.05gSurgery (11)Application and Removal of Tattoos585fcd79-7a3a-47af-8791-80a5d1d213176047Application and Removal of Tattoos11.08.05
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14.00.03aAppliedBehaviorAnalysis(ABA)fortheTreatmentofAutismSpectrumDisorders(ASD)14.00.03aBehavioral Health (14)Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)b635799b-2e23-43e5-adc9-0dfcfe2217b96596Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)14.00.03
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11.05.16lAqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucoma11.05.16lSurgery (11)Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma313650d2-3c00-43a3-ad1b-36d6fd45655e6331Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma11.05.16
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11.14.19pArtificialIntervertebralCervicalDiscInsertion(IndependenceAdministrators)11.14.19pSurgery (11)Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)ca8705e7-f5e4-43fe-aba0-460c9e68fa276634Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)11.14.19
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08.01.35iAsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)08.01.35iPharmacy (08)Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)ee9b7ce0-a5ec-4384-96fc-8614abab3c087010Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)08.01.35
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06.02.27pAssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(IndependenceAdministrators)06.02.27pPathology and Laboratory (06)Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)e81aedc0-6fee-4de8-bfe5-37273039c3b67138Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)06.02.27
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07.10.06jAssistedReproductiveTechnologyforInfertilityandOocyteCryopreservation07.10.06jMedicine (07)Assisted Reproductive Technology for Infertility and Oocyte Cryopreservationb753c112-cb1c-4a31-a437-b39ee728998e6522Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation07.10.06
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08.01.69eAtezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybrezaTM)08.01.69ePharmacy (08)Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)cb80dba0-789a-48f8-97dd-908fdb3d44247190Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)08.01.69
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08.02.24Atidarsageneautotemcel(Lenmeldy)08.02.24Pharmacy (08)Atidarsagene autotemcel (Lenmeldy)a327d3f7-485f-4db6-8738-01d56e324c2f6935Atidarsagene autotemcel (Lenmeldy)08.02.24
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05.00.82AuricularProstheses05.00.82DME (05)Auricular Prostheses854d35ec-1da5-4c9b-96c7-258cc052d5ff6321Auricular Prostheses05.00.82
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05.00.29oAutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29oDME (05)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)dd700951-87d5-4759-bb8e-af57f14e4a337232Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)05.00.29
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08.01.64dAvelumab(Bavencio®)08.01.64dPharmacy (08)Avelumab (Bavencio®)3f713f51-a7e4-4470-876d-57b93f779c9d6950Avelumab (Bavencio®)08.01.64
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11.03.02vBariatricSurgery11.03.02vSurgery (11)Bariatric Surgeryceb10a20-5469-4ea9-a37a-ca619446cd4f7057Bariatric Surgery11.03.02
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08.00.99eBelimumab(Benlysta®)forIntravenousUse08.00.99ePharmacy (08)Belimumab (Benlysta®) for Intravenous Usee31a657f-48be-4a73-9792-130bfcdf2d6c6312Belimumab (Benlysta®) for Intravenous Use08.00.99
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08.02.10bBeremageneGeperpavec(Vyjuvek™)08.02.10bPharmacy (08)Beremagene Geperpavec (Vyjuvek™)e6dbad62-468b-468f-b299-699bc381c4b96516Beremagene Geperpavec (Vyjuvek™)08.02.10
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08.01.89aBetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89aPharmacy (08)Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]eaeb3ab5-7cc1-47ad-b9ed-89caee51d73b6454Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]08.01.89
400bb492-f2c0-480e-be9e-f0604f9c8cf6.aspx
  
08.00.66wBevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66wPharmacy (08)Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use400bb492-f2c0-480e-be9e-f0604f9c8cf66952Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use08.00.66
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00.10.39qBillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39qAdministrative (00)Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus63b306b5-5ef4-41c4-9f81-66980713c4ae7061Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus00.10.39
{"7062": {"Id":7062,"MPAttachmentLetter":"A","Title":"Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus","MPPolicyAttachmentInternalSourceId":9408,"PolicyAttachmentPageName":"d649740c-1747-4e88-994c-0736d063563e"},}
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00.10.38aBillingRequirementsforMultipleBirthsforProfessionalProviders00.10.38aAdministrative (00)Billing Requirements for Multiple Births for Professional Providers21ae79a9-3406-47c5-bb6d-1fae803679986302Billing Requirements for Multiple Births for Professional Providers00.10.38
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07.00.01nBiofeedbackTherapy07.00.01nMedicine (07)Biofeedback Therapy1e2a3057-e8ea-49ef-92d4-e4ffaed58dca7106Biofeedback Therapy07.00.01
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12.00.03hComplementaryandIntegrativeHealthServices12.00.03hMiscellaneous (12)Complementary and Integrative Health Servicesbd65e1a4-f2f6-4bee-92f1-e5ace6a688d66308Complementary and Integrative Health Services12.00.03
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05.00.37jCompressionGarments05.00.37jDME (05)Compression Garmentsd2119750-381b-413e-a14f-c6b03d6c4d867265Compression Garments05.00.37
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34a2f226-750f-40db-a9d0-44decc11aea8.aspx
  
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00.01.69bConsultationServices00.01.69bAdministrative (00)Consultation Services6b345f32-5fc3-4d8f-b455-be8e91900cb56315Consultation Services00.01.69
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07.13.11kContactLensesfortheTreatmentofPersistent(Corneal)EpithelialDefects07.13.11kMedicine (07)Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defectsafc99979-3413-4a85-b648-62fe9a7ee2196533Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects07.13.11
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3ac82d0c-32e3-4a54-be0e-fc60783c4108.aspx
  
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08.01.29lDaratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)08.01.29lPharmacy (08)Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)370f27b0-7c52-4adb-a6b5-badb05e0aea26570Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)08.01.29
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10.00.02cDayRehabilitation10.00.02cRehabilitation Services (10)Day Rehabilitation428fce04-72cd-4183-803d-dd7bc0f01d5d6795Day Rehabilitation10.00.02
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11.08.17kDebridementofMycoticandSymptomaticNon-MycoticHypertrophicToenails11.08.17kSurgery (11)Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails3a694b1d-646f-4bfd-8ca3-ffd9740e57e07224Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails11.08.17
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