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07.00.14h​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-LevelLaserTherapy07.00.14hMedicine (07)​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapye0af15c1-d79a-4644-a497-85dee052f6235919​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy07.00.14
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08.00.62pAbatacept(Orencia®)forInjectionforIntravenousUse08.00.62pPharmacy (08)Abatacept (Orencia®) for Injection for Intravenous Useb54e7ec4-dc44-418c-8fd0-1e1c2ad712f55543Abatacept (Orencia®) for Injection for Intravenous Use08.00.62
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12.00.01hAcupuncture12.00.01hMiscellaneous (12)Acupuncture06ffc3eb-f745-408c-ae63-cf0ba3ecbbdc6059Acupuncture12.00.01
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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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08.01.11iAdo-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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08.00.69cAgalsidasebeta(Fabrazyme®)08.00.69cPharmacy (08)Agalsidase beta (Fabrazyme®)62f7ab0b-f175-47c9-a8c3-1b9de01b65215088Agalsidase beta (Fabrazyme®)08.00.69
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12.04.03cAirAmbulanceServices12.04.03cMiscellaneous (12)Air Ambulance Services3db4601a-995f-4459-b142-6f30f15b670a5358Air Ambulance Services12.04.03
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08.01.22dAlemtuzumab(Lemtrada®)08.01.22dPharmacy (08)Alemtuzumab (Lemtrada®)8ff701a8-0577-4eaa-be05-2bb2131430a66215Alemtuzumab (Lemtrada®)08.01.22
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08.00.72kAlglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®)08.00.72kPharmacy (08)Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )55b349d1-264d-43aa-9a17-4ece583a69235281Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )08.00.72
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07.00.21iAllergyImmunotherapy07.00.21iMedicine (07)Allergy Immunotherapyb21f722e-0b08-4277-b2be-520a504e36f75689Allergy Immunotherapy07.00.21
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08.01.88AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88Pharmacy (08)Allogeneic Processed Thymus Tissue-agdc (Rethymic®)aacfb39b-5245-40ea-9144-83238a559ae36077Allogeneic Processed Thymus Tissue-agdc (Rethymic®)08.01.88
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06.02.29dAlloMap™MolecularExpressionTestingforHeartTransplantRejection(IndependenceAdministrators)06.02.29dPathology and Laboratory (06)AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)5e8e88d4-c3f6-49aa-a4b4-8048806aaad26056AlloMap™ 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®)1b5f038c-0f20-4a75-98b9-9166968f50865154Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)08.00.91
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00.01.52uAlwaysBundledProcedureCodes00.01.52uAdministrative (00)Always Bundled Procedure Codes7be3a8f1-c67d-4e4e-8337-f5430b8412636008Always Bundled Procedure Codes00.01.52
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07.02.09iAmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09iMedicine (07)Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices776d7278-6f90-453d-a8df-7cfdc81170446081Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices07.02.09
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07.02.21oAmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21oMedicine (07)Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoringec9f9a69-16bf-457c-b7ea-9eb8fda627545905Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21
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08.01.90Amivantamab-vmjw(Rybrevant™)08.01.90Pharmacy (08)Amivantamab-vmjw (Rybrevant™)3d651f8b-35fc-4d1a-be1f-df333d2805105890Amivantamab-vmjw (Rybrevant™)08.01.90
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01.00.12bAnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12bAnesthesia (01)Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Managementd106c24d-bf01-4f50-8f0f-3e0547ca3f895591Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management01.00.12
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08.01.82bAnifrolumab-fnia(Saphnelo®)08.01.82bPharmacy (08)Anifrolumab-fnia (Saphnelo®)1f28d243-9551-4828-b937-721f7e6de07a5349Anifrolumab-fnia (Saphnelo®)08.01.82
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05.00.39uAnkle-Foot/Knee-Ankle-FootOrthoses05.00.39uDME (05)Ankle-Foot/Knee-Ankle-Foot Orthosesfe722ca4-78d7-45f4-b87b-93327b0f1be16161Ankle-Foot/Knee-Ankle-Foot Orthoses05.00.39
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06.03.04nApheresisTherapy06.03.04nPathology and Laboratory (06)Apheresis Therapyfecd240a-368a-41a9-b5bd-3a444f0cf66d5811Apheresis Therapy06.03.04
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05.00.84Apos®biomechanicalshoesystem05.00.84DME (05)Apos® biomechanical shoe systemfa430b3c-36f7-432f-93c9-91524119145b5871Apos® 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)b0b7c940-7b0f-4b12-a290-55c6ca1442a25898Applied 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 Glaucoma247cb6c3-4717-4406-9763-45a7e18e97434928Aqueous 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)ec54656d-1d31-41b0-b458-e1a4358b0ed75233Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)11.14.19
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11.15.31bArtificialIntervertebralLumbarDiscInsertion11.15.31bSurgery (11)Artificial Intervertebral Lumbar Disc Insertion5e7b1367-fc83-4e3e-b80b-d19ed56c3b375719Artificial Intervertebral Lumbar Disc Insertion11.15.31
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08.01.35gAsparaginaseErwiniaChrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze®)08.01.35gPharmacy (08)Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)5caa8913-7c03-4a9a-a9df-9b90a880523a5371Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)08.01.35
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06.02.27nAssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(IndependenceAdministrators)06.02.27nPathology and Laboratory (06)Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)07b6094a-2341-4bed-a1b8-841e3fe33dcc5474Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)06.02.27
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07.10.06iAssistedReproductiveTechnologyforInfertilityandOocyteCryopreservation07.10.06iMedicine (07)Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation76727854-57be-4f5a-a359-c836ddd2fe124795Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation07.10.06
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08.01.69cAtezolizumab(Tecentriq®)08.01.69cPharmacy (08)Atezolizumab (Tecentriq®)ab4a9746-3c0a-4512-bd38-0b178d74977d5045Atezolizumab (Tecentriq®)08.01.69
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11.14.06jAutologousChondrocyteImplantation(ACI)andOtherCell-basedTreatmentsofFocalArticularCartilageLesions(IndependenceAdministrators)11.14.06jSurgery (11)Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators)561dc9ad-1c1e-407e-9e75-bd02a965bf105162Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators)11.14.06
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05.00.29oAutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29oDME (05)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)de68459f-cd9d-4108-a14e-398f4455f8a85596Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)05.00.29
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07.03.23fAutonomicNervousSystemTesting07.03.23fMedicine (07)Autonomic Nervous System Testingeee0b048-7dd4-4ed0-b156-650003b88cf46206Autonomic Nervous System Testing07.03.23
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08.01.64cAvelumab(Bavencio®)08.01.64cPharmacy (08)Avelumab (Bavencio®)9499af12-5287-4d71-85ef-b16bcb9e683a5994Avelumab (Bavencio®)08.01.64
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11.16.06jBalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitis11.16.06jSurgery (11)Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis24f38e25-4fbe-4329-b23f-2b507113624c5021Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis11.16.06
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11.03.02tBariatricSurgery11.03.02tSurgery (11)Bariatric Surgerye2e22104-ada2-4d84-9c71-c600f1ea170e2791Bariatric Surgery11.03.02
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08.00.99eBelimumab(Benlysta®)forIntravenousUse08.00.99ePharmacy (08)Belimumab (Benlysta®) for Intravenous Useb9da618c-f1df-4a91-bdec-7d467008d14f5225Belimumab (Benlysta®) for Intravenous Use08.00.99
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08.02.10BeremageneGeperpavec(Vyjuvek™)08.02.10Pharmacy (08)Beremagene Geperpavec (Vyjuvek™)5835bdef-e015-458a-83ed-3ad35061c1b55528Beremagene Geperpavec (Vyjuvek™)08.02.10
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08.01.89BetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89Pharmacy (08)Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]93458270-ef50-4292-88ad-09f3685a0b005822Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]08.01.89
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08.00.66uBevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66uPharmacy (08)Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use4f5fba6f-e0af-4ca7-ae67-ee9a82fff8e65313Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use08.00.66
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00.10.39pBillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39pAdministrative (00)Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus0c8d2564-3861-4119-a5ac-33bc514ae8ab5794Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus00.10.39
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00.10.38aBillingRequirementsforMultipleBirthsforProfessionalProviders00.10.38aAdministrative (00)Billing Requirements for Multiple Births for Professional Providers7467b7be-328a-4664-89ab-13b4c08598393051Billing Requirements for Multiple Births for Professional Providers00.10.38
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07.00.01lBiofeedbackTherapy07.00.01lMedicine (07)Biofeedback Therapyd5679661-b07c-41f9-9ca7-c261d99ce30d6144Biofeedback Therapy07.00.01
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07.06.03bBioimpedancefortheDetectionofLymphedema07.06.03bMedicine (07)Bioimpedance for the Detection of Lymphedema22aac614-96fa-41c6-a170-e06cf45fb8765705Bioimpedance for the Detection of Lymphedema07.06.03
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11.05.02jBlepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/Canthopexy11.05.02jSurgery (11)Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy0004caa3-4725-461b-a8f6-5dc4564e1a274779Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy11.05.02
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08.01.21fBlinatumomab(Blincyto®)08.01.21fPharmacy (08)Blinatumomab (Blincyto®)210e5872-ee1f-4197-bbec-c07c8d759d255039Blinatumomab (Blincyto®)08.01.21
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63ff1f25-460c-41d0-ac3f-8a39a904535e.aspx
  
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a8bbd22a-8279-42e6-bce7-e23c36601e5f.aspx
  
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{"5771": {"Id":5771,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7611,"PolicyAttachmentPageName":"5bb1131e-64fd-4d1c-b5c8-89064792c1d3"},}
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08.00.92agCoagulationFactors08.00.92agPharmacy (08)Coagulation Factors1bbe9c18-3706-4e0f-96f6-aab8d62484b65984Coagulation Factors08.00.92
c5499930-95f2-444b-a13e-1ac4defdf91b.aspx
  
06.02.54cCobalamin(VitaminB12),FolicAcid,andHomocysteineTesting06.02.54cPathology and Laboratory (06)Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testingc5499930-95f2-444b-a13e-1ac4defdf91b4993Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing06.02.54
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11.01.02qCochlearImplantation11.01.02qSurgery (11)Cochlear Implantation635e99c0-9163-4b87-861e-42825b57bab95452Cochlear Implantation11.01.02
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08.01.71Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)08.01.71Pharmacy (08)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)6b93ebde-1aec-4421-b9c8-1ccbc23541946053Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)08.01.71
45899e80-2832-429f-8301-c238cda32dab.aspx
  
11.03.12tColorectalCancerScreening11.03.12tSurgery (11)Colorectal Cancer Screening45899e80-2832-429f-8301-c238cda32dab6216Colorectal Cancer Screening11.03.12
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2b5ef5e6-615c-4d34-8f9e-8e49c34dcdfb.aspx
  
11.14.30CompositeTissueAllotransplantationoftheHand(s)andFace11.14.30Surgery (11)Composite Tissue Allotransplantation of the Hand(s) and Face2b5ef5e6-615c-4d34-8f9e-8e49c34dcdfb6151Composite Tissue Allotransplantation of the Hand(s) and Face11.14.30
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34a2f226-750f-40db-a9d0-44decc11aea8.aspx
  
11.14.17eComputer-assistedMusculoskeletalSurgicalNavigationalOrthopedicProcedure11.14.17eSurgery (11)Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure34a2f226-750f-40db-a9d0-44decc11aea86080Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure11.14.17
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00.01.69bConsultationServices00.01.69bAdministrative (00)Consultation Serviceseb4b646a-6ce3-45f1-9096-23e49da996df5009Consultation Services00.01.69
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09.00.11eContrastAgentsUsedinConjunctionwithEchocardiography09.00.11eRadiology (09)Contrast Agents Used in Conjunction with Echocardiography7c8e4bb0-6f66-4f72-84b4-1014281324975063Contrast Agents Used in Conjunction with Echocardiography09.00.11
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07.13.07lCornealPachymetryUsingUltrasound07.13.07lMedicine (07)Corneal Pachymetry Using Ultrasoundfd6dafcb-2177-4721-b0e7-ea63c4a87e325498Corneal Pachymetry Using Ultrasound07.13.07
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09.00.58CoronaryArteryCalcium(CAC)TestingUsingComputedTomography(IndependenceAdministrators)09.00.58Radiology (09)Coronary Artery Calcium (CAC) Testing Using Computed Tomography (Independence Administrators)16a6341d-dae7-4e4c-9304-35dfd83a1dcd6205Coronary Artery Calcium (CAC) Testing Using Computed Tomography (Independence Administrators)09.00.58
fb6694bb-0c14-4e23-a1d8-d9709f7ff567.aspx
  
12.01.03bCosmeticProcedures12.01.03bMiscellaneous (12)Cosmetic Proceduresfb6694bb-0c14-4e23-a1d8-d9709f7ff5676062Cosmetic Procedures12.01.03
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05.00.04eCoverageofMedicalDevices05.00.04eDME (05)Coverage of Medical Devices0e5a3246-799b-4df3-bc4a-9a5c0ec821663665Coverage of Medical Devices05.00.04
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05.00.25jCranialRemoldingOrthoses(Helmets)05.00.25jDME (05)Cranial Remolding Orthoses (Helmets)1e846c90-26ad-42a3-a022-87051c8827306024Cranial Remolding Orthoses (Helmets)05.00.25
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ba1abd4b-b82f-4158-a09f-f27031b2634f.aspx
  
08.00.04acrizanlizumab-tmca(Adakveo®)08.00.04aPharmacy (08)crizanlizumab-tmca (Adakveo®)ba1abd4b-b82f-4158-a09f-f27031b2634f5640crizanlizumab-tmca (Adakveo®)08.00.04
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11.11.03dCryosurgicalAblationoftheProstateGland11.11.03dSurgery (11)Cryosurgical Ablation of the Prostate Gland6dd19b6e-0699-4eee-94b3-98a33164c41f5805Cryosurgical Ablation of the Prostate Gland11.11.03
1a6bddc6-a618-4287-8360-450516d7023b.aspx
  
08.01.29kDaratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)08.01.29kPharmacy (08)Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)1a6bddc6-a618-4287-8360-450516d7023b5514Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)08.01.29
1381b984-d385-4d3d-91a9-8daa23bf024f.aspx
  
10.00.02cDayRehabilitation10.00.02cRehabilitation Services (10)Day Rehabilitation1381b984-d385-4d3d-91a9-8daa23bf024f5297Day Rehabilitation10.00.02
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11.08.17kDebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNails11.08.17kSurgery (11)Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails9aaa0244-d519-4cc2-b31f-9604c858383c5050Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails11.08.17
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11.15.20tDeepBrainStimulation(DBS)11.15.20tSurgery (11)Deep Brain Stimulation (DBS)2a15c7db-3a42-453d-b606-3eb3ee680bde5957Deep Brain Stimulation (DBS)11.15.20
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11.15.09pDenervationoftheSpinalNervesforChronicPain(IndependenceAdministrators)11.15.09pSurgery (11)Denervation of the Spinal Nerves for Chronic Pain (Independence Administrators)a62acc79-9c13-49a6-a11c-c6ff9a9402195163Denervation of the Spinal  Nerves for Chronic Pain (Independence Administrators)11.15.09
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08.00.94rDenosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)08.00.94rPharmacy (08)Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)0dcf5808-4e75-42c3-8117-8ba62809870c5992Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)08.00.94
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