|  | | 07.00.14h | Low-LevelLaserTherapy07.00.14h | Medicine (07) | Low-Level Laser Therapy | 9218d81f-664c-4325-86e2-b7cdfee1f8d5 | 6600 | Low-Level Laser Therapy | 07.00.14 | |
|  | | 08.00.62q | Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62q | Pharmacy (08) | Abatacept (Orencia®) for Injection for Intravenous Use | 488dec00-d5ea-416c-86b2-e1e16d582e79 | 6641 | Abatacept (Orencia®) for Injection for Intravenous Use | 08.00.62 | {"6642": {"Id":6642,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8937,"PolicyAttachmentPageName":"615490c4-cfdc-4742-85d2-cd9e840106ed"},} |
|  | | 12.00.01i | Acupuncture12.00.01i | Miscellaneous (12) | Acupuncture | 982834a7-91a7-4cdf-a7a0-a9f78390e73f | 7134 | Acupuncture | 12.00.01 | {"7135": {"Id":7135,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":9445,"PolicyAttachmentPageName":"9a719f8e-39e5-41eb-9221-17243a66e283"},} |
|  | | 12.04.04b | AcuteCareFacilityInpatientTransfers12.04.04b | Miscellaneous (12) | Acute Care Facility Inpatient Transfers | ad65734f-8c9d-4c0a-b362-9b3677e62f35 | 6190 | Acute Care Facility Inpatient Transfers | 12.04.04 | |
|  | | 08.02.21 | ADAMTS13,recombinant-krhn(Adzynma)08.02.21 | Pharmacy (08) | ADAMTS13, recombinant-krhn (Adzynma) | d5e67f8a-f5e2-4997-8424-41e3b326d8b7 | 6515 | ADAMTS13, recombinant-krhn (Adzynma) | 08.02.21 | |
|  | | 08.01.11i | Ado-TrastuzumabEmtansine(Kadcyla®)08.01.11i | Pharmacy (08) | Ado-Trastuzumab Emtansine (Kadcyla®) | b2f741cb-d1fd-49a3-91e0-bf9f2d147f8d | 6105 | Ado-Trastuzumab Emtansine (Kadcyla®) | 08.01.11 | {"6106": {"Id":6106,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes and Narratives","MPPolicyAttachmentInternalSourceId":8429,"PolicyAttachmentPageName":"f3dcbb05-9707-4ad4-9b88-6be3d7172267"},} |
|  | | 08.02.32a | Afamitresgeneautoleucel(Tecelra®)08.02.32a | Pharmacy (08) | Afamitresgene autoleucel (Tecelra®) | 6df88e0d-d8e3-4162-93fb-7747badd3e30 | 7264 | Afamitresgene autoleucel (Tecelra®) | 08.02.32 | |
|  | | 08.00.69d | Agalsidasebeta(Fabrazyme®)andpegunigalsidasealfa-iwxj(Elfabrio)08.00.69d | Pharmacy (08) | Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) | 2e032683-3b7c-4677-a7c8-f74557ec2fab | 6616 | Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) | 08.00.69 | |
|  | | 12.04.03c | AirAmbulanceServices12.04.03c | Miscellaneous (12) | Air Ambulance Services | 245ffd2b-6443-450c-854f-d6716f6c1f0c | 6418 | Air Ambulance Services | 12.04.03 | |
|  | | 08.01.22d | Alemtuzumab(Lemtrada®)08.01.22d | Pharmacy (08) | Alemtuzumab (Lemtrada®) | 48642be3-8920-4056-9bc1-f3fa8eaafd73 | 7247 | Alemtuzumab (Lemtrada®) | 08.01.22 | |
|  | | 08.00.72l | Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)08.00.72l | Pharmacy (08) | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ ) | acd08093-ff2e-4a25-bd88-d5bba1956861 | 6240 | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ ) | 08.00.72 | |
|  | | 07.00.21j | AllergyImmunotherapy07.00.21j | Medicine (07) | Allergy Immunotherapy | f9143396-59dc-41c7-b0bd-3276abbd228c | 6262 | Allergy Immunotherapy | 07.00.21 | |
|  | | 08.01.88 | AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88 | Pharmacy (08) | Allogeneic Processed Thymus Tissue-agdc (Rethymic®) | 07a9501c-7555-435e-851a-cd30d2599ca7 | 7206 | Allogeneic Processed Thymus Tissue-agdc (Rethymic®) | 08.01.88 | |
|  | | 06.02.29g | AlloMap™MolecularExpressionTestingforHeartTransplantRejection(IndependenceAdministrators)06.02.29g | Pathology and Laboratory (06) | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators) | 441bf6fa-8d20-4f99-a633-1df6e903aadb | 7128 | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators) | 06.02.29 | |
|  | | 08.00.91e | Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C®,AralastNP®,Glassia®,Zemaira®)08.00.91e | Pharmacy (08) | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®) | d32eec72-479b-43a6-bdf3-cfe24dfa12b2 | 6266 | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®) | 08.00.91 | |
|  | | 00.01.52x | AlwaysBundledProcedureCodes00.01.52x | Administrative (00) | Always Bundled Procedure Codes | 18221a36-d1f4-43de-82c2-6f98b949fee1 | 7046 | Always Bundled Procedure Codes | 00.01.52 | {"7047": {"Id":7047,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":9400,"PolicyAttachmentPageName":"0b8420f1-12ed-4c99-ac20-ae9f3d7d4a5c"},"7048": {"Id":7048,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":9401,"PolicyAttachmentPageName":"39d00bff-ceb4-4b8f-9e1d-9b786d1def7e"},"7049": {"Id":7049,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (Indicator B)","MPPolicyAttachmentInternalSourceId":9402,"PolicyAttachmentPageName":"f53e865e-e70f-4458-9aac-5bdfc97aa952"},} |
|  | | 07.02.09j | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09j | Medicine (07) | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | eeb386be-be45-43cb-b8dd-5eaca1df97ee | 6660 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | 07.02.09 | |
|  | | 07.02.21q | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21q | Medicine (07) | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | ba42d838-ddc7-45b0-b065-6b90274bde77 | 7005 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | 07.02.21 | |
|  | | 08.01.90a | Amivantamab-vmjw(Rybrevant®)08.01.90a | Pharmacy (08) | Amivantamab-vmjw (Rybrevant®) | 22e3725e-1aab-4c4e-a86b-bd4cb90f60b2 | 6324 | Amivantamab-vmjw (Rybrevant®) | 08.01.90 | |
|  | | 01.00.12c | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12c | Anesthesia (01) | Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management | 142c8236-6430-4f8e-99d8-3cc44fc27dca | 6675 | Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management | 01.00.12 | {"6676": {"Id":6676,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9043,"PolicyAttachmentPageName":"9198205f-cc8f-4dc8-8637-891b21ef044c"},} |
|  | | 08.01.82c | Anifrolumab-fnia(Saphnelo®)08.01.82c | Pharmacy (08) | Anifrolumab-fnia (Saphnelo®) | d76f0864-8820-4305-aef9-042ca7cef74f | 6388 | Anifrolumab-fnia (Saphnelo®) | 08.01.82 | |
|  | | 05.00.39v | Ankle-Foot/Knee-Ankle-FootOrthoses05.00.39v | DME (05) | Ankle-Foot/Knee-Ankle-Foot Orthoses | a37cd522-7951-47b7-bbe2-ef62cfe0fe2f | 7171 | Ankle-Foot/Knee-Ankle-Foot Orthoses | 05.00.39 | {"7172": {"Id":7172,"MPAttachmentLetter":"A","Title":"HCPCS Codes","MPPolicyAttachmentInternalSourceId":9568,"PolicyAttachmentPageName":"27c011db-7e63-49db-8f93-043e0b7f97a0"},} |
|  | | 06.03.04o | ApheresisTherapy06.03.04o | Pathology and Laboratory (06) | Apheresis Therapy | f620f6fa-4a59-4450-a990-93e43257a6b1 | 6934 | Apheresis Therapy | 06.03.04 | |
|  | | 05.00.84 | Apos®biomechanicalshoesystem05.00.84 | DME (05) | Apos® biomechanical shoe system | d639cac9-8dad-420b-896d-b30fd48ea0e9 | 6859 | Apos® biomechanical shoe system | 05.00.84 | |
|  | | 11.08.05g | ApplicationandRemovalofTattoos11.08.05g | Surgery (11) | Application and Removal of Tattoos | 585fcd79-7a3a-47af-8791-80a5d1d21317 | 6047 | Application and Removal of Tattoos | 11.08.05 | |
|  | | 14.00.03a | AppliedBehaviorAnalysis(ABA)fortheTreatmentofAutismSpectrumDisorders(ASD)14.00.03a | Behavioral Health (14) | Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD) | b635799b-2e23-43e5-adc9-0dfcfe2217b9 | 6596 | Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD) | 14.00.03 | |
|  | | 11.05.16l | AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucoma11.05.16l | Surgery (11) | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | 313650d2-3c00-43a3-ad1b-36d6fd45655e | 6331 | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | 11.05.16 | {"6332": {"Id":6332,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8590,"PolicyAttachmentPageName":"e47bb55c-5b65-4d50-8799-56ca8fc7ba90"},} |
|  | | 11.14.19p | ArtificialIntervertebralCervicalDiscInsertion(IndependenceAdministrators)11.14.19p | Surgery (11) | Artificial Intervertebral Cervical Disc Insertion (Independence Administrators) | ca8705e7-f5e4-43fe-aba0-460c9e68fa27 | 6634 | Artificial Intervertebral Cervical Disc Insertion (Independence Administrators) | 11.14.19 | |
|  | | 08.01.35i | AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)08.01.35i | Pharmacy (08) | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | ee9b7ce0-a5ec-4384-96fc-8614abab3c08 | 7010 | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | 08.01.35 | |
|  | | 06.02.27p | AssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(IndependenceAdministrators)06.02.27p | Pathology and Laboratory (06) | Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators) | e81aedc0-6fee-4de8-bfe5-37273039c3b6 | 7138 | Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators) | 06.02.27 | |
|  | | 07.10.06j | AssistedReproductiveTechnologyforInfertilityandOocyteCryopreservation07.10.06j | Medicine (07) | Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation | b753c112-cb1c-4a31-a437-b39ee728998e | 6522 | Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation | 07.10.06 | |
|  | | 08.01.69e | Atezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybrezaTM)08.01.69e | Pharmacy (08) | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | cb80dba0-789a-48f8-97dd-908fdb3d4424 | 7190 | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | 08.01.69 | {"7191": {"Id":7191,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9571,"PolicyAttachmentPageName":"52ea1631-04db-4602-a498-1e464e7f662a"},} |
|  | | 08.02.24 | Atidarsageneautotemcel(Lenmeldy)08.02.24 | Pharmacy (08) | Atidarsagene autotemcel (Lenmeldy) | a327d3f7-485f-4db6-8738-01d56e324c2f | 6935 | Atidarsagene autotemcel (Lenmeldy) | 08.02.24 | |
|  | | 05.00.82 | AuricularProstheses05.00.82 | DME (05) | Auricular Prostheses | 854d35ec-1da5-4c9b-96c7-258cc052d5ff | 6321 | Auricular Prostheses | 05.00.82 | |
|  | | 11.14.06j | AutologousChondrocyteImplantation(ACI)andOtherCell-basedTreatmentsofFocalArticularCartilageLesions(IndependenceAdministrators)11.14.06j | Surgery (11) | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators) | 3bc5cc35-7f80-4494-84dd-eb645cad0fbc | 7279 | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators) | 11.14.06 | |
|  | | 05.00.29o | AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29o | DME (05) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | dd700951-87d5-4759-bb8e-af57f14e4a33 | 7232 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | 05.00.29 | {"7233": {"Id":7233,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9496,"PolicyAttachmentPageName":"2a12e22d-6c14-4428-89cd-6eadd3f170f8"},"7234": {"Id":7234,"MPAttachmentLetter":"A","Title":"ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9497,"PolicyAttachmentPageName":"b34b8bf3-f2f0-4ead-b9b4-2e7bea974064"},} |
|  | | 07.03.23g | AutonomicNervousSystemTesting07.03.23g | Medicine (07) | Autonomic Nervous System Testing | 2fbad6ab-e991-4724-b940-8fe96c5d52ad | 6696 | Autonomic Nervous System Testing | 07.03.23 | |
|  | | 08.01.64d | Avelumab(Bavencio®)08.01.64d | Pharmacy (08) | Avelumab (Bavencio®) | 3f713f51-a7e4-4470-876d-57b93f779c9d | 6950 | Avelumab (Bavencio®) | 08.01.64 | {"6951": {"Id":6951,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9267,"PolicyAttachmentPageName":"e06bd658-f9c9-41e2-8b59-c7306cab3eea"},} |
|  | | 11.16.06k | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisorRecurrentAcuteRhinosinusitis11.16.06k | Surgery (11) | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | 06478bb4-9c20-4f00-abbb-6302983f60f0 | 7209 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | 11.16.06 | |
|  | | 11.03.02v | BariatricSurgery11.03.02v | Surgery (11) | Bariatric Surgery | ceb10a20-5469-4ea9-a37a-ca619446cd4f | 7057 | Bariatric Surgery | 11.03.02 | {"7058": {"Id":7058,"MPAttachmentLetter":"A","Title":"Body Mass Index (BMI) Charts","MPPolicyAttachmentInternalSourceId":6615,"PolicyAttachmentPageName":"4ccedb4c-44db-424d-a304-7804c14280b2"},"7059": {"Id":7059,"MPAttachmentLetter":"B","Title":"Tanner Staging System Criteria for Adolescents","MPPolicyAttachmentInternalSourceId":6616,"PolicyAttachmentPageName":"16d586c6-803c-4e75-8539-5b89973a64c9"},} |
|  | | 08.00.99e | Belimumab(Benlysta®)forIntravenousUse08.00.99e | Pharmacy (08) | Belimumab (Benlysta®) for Intravenous Use | e31a657f-48be-4a73-9792-130bfcdf2d6c | 6312 | Belimumab (Benlysta®) for Intravenous Use | 08.00.99 | |
|  | | 08.02.10b | BeremageneGeperpavec(Vyjuvek™)08.02.10b | Pharmacy (08) | Beremagene Geperpavec (Vyjuvek™) | e6dbad62-468b-468f-b299-699bc381c4b9 | 6516 | Beremagene Geperpavec (Vyjuvek™) | 08.02.10 | |
|  | | 08.01.89a | BetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89a | Pharmacy (08) | Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)] | eaeb3ab5-7cc1-47ad-b9ed-89caee51d73b | 6454 | Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)] | 08.01.89 | |
|  | | 08.00.66w | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66w | Pharmacy (08) | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | 400bb492-f2c0-480e-be9e-f0604f9c8cf6 | 6952 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | 08.00.66 | {"6953": {"Id":6953,"MPAttachmentLetter":"A","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":9221,"PolicyAttachmentPageName":"0354602f-0ecd-45a0-94c5-e80d8aef3c70"},} |
|  | | 00.10.39q | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39q | Administrative (00) | Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus | 63b306b5-5ef4-41c4-9f81-66980713c4ae | 7061 | Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus | 00.10.39 | {"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"},} |
|  | | 00.10.38a | BillingRequirementsforMultipleBirthsforProfessionalProviders00.10.38a | Administrative (00) | Billing Requirements for Multiple Births for Professional Providers | 21ae79a9-3406-47c5-bb6d-1fae80367998 | 6302 | Billing Requirements for Multiple Births for Professional Providers | 00.10.38 | {"6303": {"Id":6303,"MPAttachmentLetter":"C","Title":"CODING SCENARIOS FOR REPORTING HIGH-ORDER MULTIPLE (TRIPLETS, QUADRUPLETS, ETC) BIRTHS WHEN ROUTINE OBSTETRIC (GLOBAL MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED","MPPolicyAttachmentInternalSourceId":8677,"PolicyAttachmentPageName":"eb66d5c6-6236-4d27-97a4-bcdd186ff868"},"6304": {"Id":6304,"MPAttachmentLetter":"A","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ROUTINE OBSTETRIC (GLOBALE MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED","MPPolicyAttachmentInternalSourceId":8678,"PolicyAttachmentPageName":"d50dbf13-85a1-46a6-ba08-f3aa39e2c495"},"6305": {"Id":6305,"MPAttachmentLetter":"D","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES WHEN ANTEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":8679,"PolicyAttachmentPageName":"e4baa2eb-649c-4057-b59a-482ec93d4622"},"6306": {"Id":6306,"MPAttachmentLetter":"B","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ANETEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":8680,"PolicyAttachmentPageName":"c6801920-f2e5-42bd-8e26-0f6161437f1b"},} |
|  | | 07.00.01n | BiofeedbackTherapy07.00.01n | Medicine (07) | Biofeedback Therapy | 1e2a3057-e8ea-49ef-92d4-e4ffaed58dca | 7106 | Biofeedback Therapy | 07.00.01 | |
|  | | 07.06.03b | BioimpedancefortheDetectionofLymphedema07.06.03b | Medicine (07) | Bioimpedance for the Detection of Lymphedema | f9a6a3eb-3e75-4270-bf9f-f6b8aff92631 | 6599 | Bioimpedance for the Detection of Lymphedema | 07.06.03 | |
|  | | 08.01.21g | Blinatumomab(Blincyto®)08.01.21g | Pharmacy (08) | Blinatumomab (Blincyto®) | 7edcdaa3-01b6-4362-9af3-7bf64042887e | 6850 | Blinatumomab (Blincyto®) | 08.01.21 | |
|  | | 11.01.06i | Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAids11.01.06i | Surgery (11) | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | 7316bfb1-5739-4d96-bf30-14352be2f4fe | 6235 | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | 11.01.06 | |
|  | | 09.00.04o | BoneMineralDensity(BMD)Testing09.00.04o | Radiology (09) | Bone Mineral Density (BMD) Testing | b8b33479-e906-4711-956a-d8c843e74322 | 6269 | Bone Mineral Density (BMD) Testing | 09.00.04 | |
|  | | 08.00.26ac | BotulinumToxinAgents08.00.26ac | Pharmacy (08) | Botulinum Toxin Agents | bed8434e-8b79-418e-b18e-118a5e7dccd8 | 6287 | Botulinum Toxin Agents | 08.00.26 | {"6288": {"Id":6288,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":8524,"PolicyAttachmentPageName":"6eb6cc97-2ca3-4705-b58b-51510cc7122e"},} |
|  | | 09.00.10z | BrachytherapyandAcceleratedWholeBreastIrradiationusingThree-DimensionalConformationRadiationTherapy09.00.10z | Radiology (09) | Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy | eb9a254e-73d9-4294-8eb7-de2cf6cb2057 | 6083 | Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy | 09.00.10 | |
|  | | 05.00.76h | BreastPumps05.00.76h | DME (05) | Breast Pumps | e6da8955-9faa-4c35-abba-8dd07b2e3392 | 6625 | Breast Pumps | 05.00.76 | |
|  | | 08.01.13k | BrentuximabVedotin(Adcetris®)08.01.13k | Pharmacy (08) | Brentuximab Vedotin (Adcetris®) | e1c8211b-a58b-4aae-b82f-c5212944874b | 6872 | Brentuximab Vedotin (Adcetris®) | 08.01.13 | {"6873": {"Id":6873,"MPAttachmentLetter":"A","Title":"ICD CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8995,"PolicyAttachmentPageName":"7ce85bb8-9600-4027-ba31-b1e4502bb940"},} |
|  | | 11.16.09 | BronchialValves11.16.09 | Surgery (11) | Bronchial Valves | cea694d5-0c4a-4a47-9848-473275304abd | 7122 | Bronchial Valves | 11.16.09 | |
|  | | 08.01.49b | Burosumab-twza(Crysvita®)08.01.49b | Pharmacy (08) | Burosumab-twza (Crysvita®) | ebee83c9-0d6f-4f49-9c7b-ac71d2a03bc8 | 6263 | Burosumab-twza (Crysvita®) | 08.01.49 | |
|  | | 08.01.51c | Canakinumab(Ilaris®)08.01.51c | Pharmacy (08) | Canakinumab (Ilaris®) | 6d68299b-c238-4530-a432-2136ee8cfa48 | 6945 | Canakinumab (Ilaris®) | 08.01.51 | {"6946": {"Id":6946,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9272,"PolicyAttachmentPageName":"117ae255-5a03-4640-bed7-5aaecf45f228"},} |
|  | | 10.01.01r | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)Programs10.01.01r | Rehabilitation Services (10) | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | 8af288c7-5ed3-48e7-89a3-f3c180c0e9bd | 7107 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | 10.01.01 | {"7108": {"Id":7108,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":9418,"PolicyAttachmentPageName":"7a889d8c-2334-4e54-88cb-a49fbe7581f3"},} |
|  | | 00.01.59o | CareManagementandCarePlanningServices00.01.59o | Administrative (00) | Care Management and Care Planning Services | 64391f7c-d9f5-47dd-937f-7a246ccc7aaf | 7045 | Care Management and Care Planning Services | 00.01.59 | |
|  | | 08.01.05l | Carfilzomib(Kyprolis®)08.01.05l | Pharmacy (08) | Carfilzomib (Kyprolis®) | b6fb4da7-10aa-4de1-b765-a97b6d6e8c6f | 6871 | Carfilzomib (Kyprolis®) | 08.01.05 | |
|  | | 08.02.14 | Casgevy™(exagamglogeneautotemcel)08.02.14 | Pharmacy (08) | Casgevy™ (exagamglogene autotemcel) | 713595c4-c9ab-4fea-8792-7e96084b0f34 | 6907 | Casgevy™ (exagamglogene autotemcel) | 08.02.14 | |
|  | | 00.10.15d | CastandSplintApplicationsandAssociatedSupplies00.10.15d | Administrative (00) | Cast and Splint Applications and Associated Supplies | f52f2efa-c59c-42e0-81cd-e6bf24c6cd3e | 6629 | Cast and Splint Applications and Associated Supplies | 00.10.15 | {"6630": {"Id":6630,"MPAttachmentLetter":"A","Title":"Procedure Codes Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":8996,"PolicyAttachmentPageName":"fd33be68-8e44-4b85-992e-1da428d46692"},} |
|  | | 11.01.07g | CataractSurgery11.01.07g | Surgery (11) | Cataract Surgery | a2ad5881-a3e9-4937-ae77-77d65bf7d834 | 6389 | Cataract Surgery | 11.01.07 | {"6390": {"Id":6390,"MPAttachmentLetter":"A","Title":"ICD 10 codes for Cataract Surgery","MPPolicyAttachmentInternalSourceId":8501,"PolicyAttachmentPageName":"59ad3d31-e989-4d36-a0e4-6a2913416a22"},} |
|  | | 11.02.06r | CatheterAblationofCardiacArrhythmias11.02.06r | Surgery (11) | Catheter Ablation of Cardiac Arrhythmias | 16476590-a27f-4cbe-ada7-cbae7f72ec66 | 6979 | Catheter Ablation of Cardiac Arrhythmias | 11.02.06 | |
|  | | 08.01.66d | Cemiplimab-rwlc(Libtayo®)08.01.66d | Pharmacy (08) | Cemiplimab-rwlc (Libtayo®) | 6b32b36f-1f58-42d1-b90e-32ddb34e2702 | 6876 | Cemiplimab-rwlc (Libtayo®) | 08.01.66 | |
|  | | 08.01.39d | Cerliponasealfa(Brineura®)08.01.39d | Pharmacy (08) | Cerliponase alfa (Brineura®) | a969b8f9-a858-4c56-9705-1e4c094fef97 | 6894 | Cerliponase alfa (Brineura®) | 08.01.39 | {"6895": {"Id":6895,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Cerliponase alfa (Brineura®)","MPPolicyAttachmentInternalSourceId":9269,"PolicyAttachmentPageName":"447514b5-e4b2-432a-ae7e-6945a44abadb"},} |
|  | | 05.00.61h | CervicalTractionDevicesforIn-homeUse05.00.61h | DME (05) | Cervical Traction Devices for In-home Use | eef2e9b2-aab5-4cca-ab3c-ed452e909887 | 7033 | Cervical Traction Devices for In-home Use | 05.00.61 | |
|  | | 08.00.67o | Cetuximab(Erbitux®)08.00.67o | Pharmacy (08) | Cetuximab (Erbitux®) | c6349587-f8ed-4988-af17-d7556abd45f7 | 6072 | Cetuximab (Erbitux®) | 08.00.67 | {"6073": {"Id":6073,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":8346,"PolicyAttachmentPageName":"9aabc33b-6deb-4111-b60b-c53feaa2873a"},"6074": {"Id":6074,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":8347,"PolicyAttachmentPageName":"48abba96-d1ea-441e-b9a7-92ebc0eefaa0"},} |
|  | | 11.08.08h | ChemicalPeels11.08.08h | Surgery (11) | Chemical Peels | fa54024b-27e8-4670-8cab-64dbc90cc3ce | 6742 | Chemical Peels | 11.08.08 | |
|  | | 08.01.43p | ChimericAntigenReceptor(CAR)Therapy08.01.43p | Pharmacy (08) | Chimeric Antigen Receptor (CAR) Therapy | 589bda9a-93e2-4d00-b888-34c929d207dc | 7113 | Chimeric Antigen Receptor (CAR) Therapy | 08.01.43 | |
|  | | 10.02.02k | ChiropracticSpinalandExtraspinalManipulationTherapy10.02.02k | Rehabilitation Services (10) | Chiropractic Spinal and Extraspinal Manipulation Therapy | a6a3818c-0215-4ef6-b633-abb5fd0d5924 | 6440 | Chiropractic Spinal and Extraspinal Manipulation Therapy | 10.02.02 | |
|  | | 08.00.92ai | CoagulationFactors08.00.92ai | Pharmacy (08) | Coagulation Factors | 22407481-f481-42a9-8ca9-02d6f2ba1672 | 7193 | Coagulation Factors | 08.00.92 | |
|  | | 06.02.54c | Cobalamin(VitaminB12),FolicAcid,andHomocysteineTesting06.02.54c | Pathology and Laboratory (06) | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | 84c1878f-0009-47d5-8883-e6a2090ddade | 6494 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | 06.02.54 | {"6495": {"Id":6495,"MPAttachmentLetter":"A","Title":"MEDICALLY NECESSARY ICD 10 CODES FOR COBALAMIN (VITAMIN B12) AND/OR FOLIC ACID TESTING (CPT CODES 82607, 82608, 82746, AND 82747)","MPPolicyAttachmentInternalSourceId":8879,"PolicyAttachmentPageName":"9dc800e1-edd4-4398-bbb2-ee5429c669d4"},} |
|  | | 11.01.02r | CochlearImplantation11.01.02r | Surgery (11) | Cochlear Implantation | 185c05ea-869a-40ce-8dd6-f9b76250041b | 6234 | Cochlear Implantation | 11.01.02 | |
|  | | 08.01.71 | Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)08.01.71 | Pharmacy (08) | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | 6b93ebde-1aec-4421-b9c8-1ccbc2354194 | 6053 | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | 08.01.71 | |
|  | | 11.03.12u | ColorectalCancerScreening11.03.12u | Surgery (11) | Colorectal Cancer Screening | 86537148-8562-4da7-87ef-9ebe5abed28b | 6541 | Colorectal Cancer Screening | 11.03.12 | |
|  | | 12.00.03h | ComplementaryandIntegrativeHealthServices12.00.03h | Miscellaneous (12) | Complementary and Integrative Health Services | bd65e1a4-f2f6-4bee-92f1-e5ace6a688d6 | 6308 | Complementary and Integrative Health Services | 12.00.03 | |
|  | | 07.06.01b | CompleteDecongestiveTherapy(CDT)07.06.01b | Medicine (07) | Complete Decongestive Therapy (CDT) | 380691f8-a783-41d2-9c89-5180c9877c3e | 6538 | Complete Decongestive Therapy (CDT) | 07.06.01 | |
|  | | 11.14.30 | CompositeTissueAllotransplantationoftheHand(s)andFace11.14.30 | Surgery (11) | Composite Tissue Allotransplantation of the Hand(s) and Face | 2b5ef5e6-615c-4d34-8f9e-8e49c34dcdfb | 6151 | Composite Tissue Allotransplantation of the Hand(s) and Face | 11.14.30 | |
|  | | 05.00.37j | CompressionGarments05.00.37j | DME (05) | Compression Garments | d2119750-381b-413e-a14f-c6b03d6c4d86 | 7265 | Compression Garments | 05.00.37 | |
|  | | 09.00.42d | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographs09.00.42d | Radiology (09) | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | 7ddb691f-96da-4a27-8844-7dea1647eacf | 6614 | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | 09.00.42 | |
|  | | 11.14.17e | Computer-assistedMusculoskeletalSurgicalNavigationalOrthopedicProcedure11.14.17e | Surgery (11) | Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | 34a2f226-750f-40db-a9d0-44decc11aea8 | 6080 | Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | 11.14.17 | |
|  | | 00.01.69b | ConsultationServices00.01.69b | Administrative (00) | Consultation Services | 6b345f32-5fc3-4d8f-b455-be8e91900cb5 | 6315 | Consultation Services | 00.01.69 | |
|  | | 07.13.11k | ContactLensesfortheTreatmentofPersistent(Corneal)EpithelialDefects07.13.11k | Medicine (07) | Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects | afc99979-3413-4a85-b648-62fe9a7ee219 | 6533 | Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects | 07.13.11 | {"6534": {"Id":6534,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":8891,"PolicyAttachmentPageName":"008ec9e5-6f90-4469-8add-4589230fd5d3"},} |
|  | | 09.00.11e | ContrastAgentsUsedinConjunctionwithEchocardiography09.00.11e | Radiology (09) | Contrast Agents Used in Conjunction with Echocardiography | d7def89b-2c58-49c2-b6c4-4281d66bb663 | 7136 | Contrast Agents Used in Conjunction with Echocardiography | 09.00.11 | |
|  | | 07.13.07l | CornealPachymetryUsingUltrasound07.13.07l | Medicine (07) | Corneal Pachymetry Using Ultrasound | ccbf392a-076f-491f-81a7-7c009973654a | 6421 | Corneal Pachymetry Using Ultrasound | 07.13.07 | {"6422": {"Id":6422,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":8841,"PolicyAttachmentPageName":"3feca23c-4a29-4511-9186-8c5a3d9fe191"},} |
|  | | 09.00.58 | CoronaryArteryCalcium(CAC)TestingUsingComputedTomography(IndependenceAdministrators)09.00.58 | Radiology (09) | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (Independence Administrators) | 16a6341d-dae7-4e4c-9304-35dfd83a1dcd | 6205 | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (Independence Administrators) | 09.00.58 | |
|  | | 12.01.03b | CosmeticProcedures12.01.03b | Miscellaneous (12) | Cosmetic Procedures | db363d81-2a6f-410c-93a0-2683359b4855 | 7051 | Cosmetic Procedures | 12.01.03 | |
|  | | 08.01.08t | CoverageofAnticancerPrescriptionOralandInjectableDrugsandBiologicsandSupportiveAgents08.01.08t | Pharmacy (08) | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | b463e0d4-cc67-4b23-a012-38a027097061 | 7194 | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | 08.01.08 | {} |
|  | | 05.00.04e | CoverageofMedicalDevices05.00.04e | DME (05) | Coverage of Medical Devices | aa807c48-d1a3-4b18-bad0-2b8f3e3f8dc0 | 6825 | Coverage of Medical Devices | 05.00.04 | |
|  | | 05.00.80d | CranialElectrotherapyStimulation05.00.80d | DME (05) | Cranial Electrotherapy Stimulation | e09e0da7-d349-4852-8d61-0dbc6ecd6b83 | 6378 | Cranial Electrotherapy Stimulation | 05.00.80 | |
|  | | 05.00.25j | CranialRemoldingOrthoses(Helmets)05.00.25j | DME (05) | Cranial Remolding Orthoses (Helmets) | 3ac82d0c-32e3-4a54-be0e-fc60783c4108 | 7052 | Cranial Remolding Orthoses (Helmets) | 05.00.25 | |
|  | | 00.10.03l | CriteriaforReimbursementofEmergencyRoomServices00.10.03l | Administrative (00) | Criteria for Reimbursement of Emergency Room Services | dfd4ab70-1b25-4431-9e64-8919d5b988ea | 6877 | Criteria for Reimbursement of Emergency Room Services | 00.10.03 | |
|  | | 08.00.04a | crizanlizumab-tmca(Adakveo®)08.00.04a | Pharmacy (08) | crizanlizumab-tmca (Adakveo®) | f3947580-94ff-4833-9972-eae6958cb8ca | 6336 | crizanlizumab-tmca (Adakveo®) | 08.00.04 | |
|  | | 08.02.31 | Crovalimab-akkz(Piasky)08.02.31 | Pharmacy (08) | Crovalimab-akkz (Piasky) | d897877c-e6c6-4015-bb59-e60c538c3ec9 | 6944 | Crovalimab-akkz (Piasky) | 08.02.31 | |
|  | | 11.11.03d | CryosurgicalAblationoftheProstateGland11.11.03d | Surgery (11) | Cryosurgical Ablation of the Prostate Gland | 772de3ff-5ca6-4596-9258-6266ee2c4bfc | 7249 | Cryosurgical Ablation of the Prostate Gland | 11.11.03 | |
|  | | 08.01.29l | Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)08.01.29l | Pharmacy (08) | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | 370f27b0-7c52-4adb-a6b5-badb05e0aea2 | 6570 | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | 08.01.29 | |
|  | | 10.00.02c | DayRehabilitation10.00.02c | Rehabilitation Services (10) | Day Rehabilitation | 428fce04-72cd-4183-803d-dd7bc0f01d5d | 6795 | Day Rehabilitation | 10.00.02 | |
|  | | 11.08.17k | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToenails11.08.17k | Surgery (11) | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails | 3a694b1d-646f-4bfd-8ca3-ffd9740e57e0 | 7224 | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails | 11.08.17 | {"7225": {"Id":7225,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":9486,"PolicyAttachmentPageName":"a1adf17e-24b4-4ec6-94da-201193bfdd17"},"7226": {"Id":7226,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":9487,"PolicyAttachmentPageName":"be268b19-c2ec-469b-8a05-21e36092f7b5"},"7227": {"Id":7227,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":9488,"PolicyAttachmentPageName":"d6f91d4e-1174-459a-a667-714ea4fa1381"},"7228": {"Id":7228,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":9489,"PolicyAttachmentPageName":"24330fcc-9652-415a-ba12-b7cd20f4aeb0"},"7229": {"Id":7229,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":9490,"PolicyAttachmentPageName":"40540ab7-a983-4b85-9de3-b2a795f23e98"},} |