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97732f74-96a1-4bb1-afbb-1545f50fc384.aspx
  
08.00.62nAbatacept(Orencia®)forInjectionforIntravenousUse08.00.62nPharmacy (08)Abatacept (Orencia®) for Injection for Intravenous Use97732f74-96a1-4bb1-afbb-1545f50fc3844255Abatacept (Orencia®) for Injection for Intravenous Use08.00.62
{"4256": {"Id":4256,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6281,"PolicyAttachmentPageName":"c2a486e7-2984-4e36-ac6e-51e8cf5f261c"},}
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12.00.01gAcupuncture(Independence)12.00.01gMiscellaneous (12)Acupuncture (Independence)fc255320-d8a8-4ee8-9b33-79422324d3a84498Acupuncture (Independence)12.00.01
{"4499": {"Id":4499,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":6540,"PolicyAttachmentPageName":"26935b19-41a8-4395-87dc-ba4d13ff9757"},}
196a372b-a2c6-4a5e-9500-c722bf5a13da.aspx
  
12.04.04bAcuteCareFacilityInpatientTransfers12.04.04bMiscellaneous (12)Acute Care Facility Inpatient Transfers196a372b-a2c6-4a5e-9500-c722bf5a13da4701Acute Care Facility Inpatient Transfers12.04.04
839b21f4-dacb-4c09-ab51-ee66bbe07f5f.aspx
  
08.01.11hAdo-TrastuzumabEmtansine(Kadcyla®)08.01.11hPharmacy (08)Ado-Trastuzumab Emtansine (Kadcyla®)839b21f4-dacb-4c09-ab51-ee66bbe07f5f4879Ado-Trastuzumab Emtansine (Kadcyla®)08.01.11
{"4880": {"Id":4880,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes and Narratives","MPPolicyAttachmentInternalSourceId":6792,"PolicyAttachmentPageName":"5ec33a2f-b084-411c-a40a-e217523ca6a2"},}
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08.01.93Aducanumab(Aduhelm)forAlzheimerDisease08.01.93Pharmacy (08)Aducanumab (Aduhelm) for Alzheimer Disease69ef36af-da99-4769-9736-f75c7098f22f4365Aducanumab (Aduhelm) for Alzheimer Disease08.01.93
8d58c8ea-0ea8-4718-8161-db431f914dfd.aspx
  
08.00.69cAgalsidasebeta(Fabrazyme®)08.00.69cPharmacy (08)Agalsidase beta (Fabrazyme®)8d58c8ea-0ea8-4718-8161-db431f914dfd4113Agalsidase beta (Fabrazyme®)08.00.69
f52d73b7-5d77-4eb0-9121-f79f7ba84412.aspx
  
12.04.03cAirAmbulanceServices12.04.03cMiscellaneous (12)Air Ambulance Servicesf52d73b7-5d77-4eb0-9121-f79f7ba844124971Air Ambulance Services12.04.03
c99cc1c3-d7ce-455d-a834-7e6172ae9fad.aspx
  
08.01.22dAlemtuzumab(Lemtrada®)08.01.22dPharmacy (08)Alemtuzumab (Lemtrada®)c99cc1c3-d7ce-455d-a834-7e6172ae9fad4243Alemtuzumab (Lemtrada®)08.01.22
9aeb8b06-a5ea-47a1-8879-3dca44c51dd9.aspx
  
08.00.72kAlglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®)08.00.72kPharmacy (08)Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )9aeb8b06-a5ea-47a1-8879-3dca44c51dd94204Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )08.00.72
aa555f38-c3ef-429e-990c-f633f79e8ada.aspx
  
07.00.21jAllergyImmunotherapy07.00.21jMedicine (07)Allergy Immunotherapyaa555f38-c3ef-429e-990c-f633f79e8ada4754Allergy Immunotherapy07.00.21
87fbd717-0d87-4e63-b5c6-86d241ad32d6.aspx
  
08.01.88AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88Pharmacy (08)Allogeneic Processed Thymus Tissue-agdc (Rethymic®)87fbd717-0d87-4e63-b5c6-86d241ad32d64140Allogeneic Processed Thymus Tissue-agdc (Rethymic®)08.01.88
d04fc2b5-4ae4-48bb-9c70-154178ffb3ee.aspx
  
06.02.29dAlloMap™MolecularExpressionTestingforHeartTransplantRejection(IndependenceAdministrators)06.02.29dPathology and Laboratory (06)AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)d04fc2b5-4ae4-48bb-9c70-154178ffb3ee4426AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)06.02.29
cd609c07-1e33-4d4a-8c08-24fb11b0ecea.aspx
  
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®)cd609c07-1e33-4d4a-8c08-24fb11b0ecea4244Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)08.00.91
edc1e758-8fc8-48ff-a282-ffeae40028ee.aspx
  
00.01.52rAlwaysBundledProcedureCodes00.01.52rAdministrative (00)Always Bundled Procedure Codesedc1e758-8fc8-48ff-a282-ffeae40028ee4977Always Bundled Procedure Codes00.01.52
{"4978": {"Id":4978,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":7148,"PolicyAttachmentPageName":"81f27da3-41aa-4847-a440-a65b4c9560ce"},"4979": {"Id":4979,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (Indicator B)","MPPolicyAttachmentInternalSourceId":7149,"PolicyAttachmentPageName":"0464e5ef-36e4-4667-9672-9e4eb83a84d9"},"4980": {"Id":4980,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":7150,"PolicyAttachmentPageName":"c6170f71-54cf-4562-8821-5ed046f758e0"},}
4a322af8-4167-4e02-afbd-8599b1656895.aspx
  
07.02.09hAmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09hMedicine (07)Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices4a322af8-4167-4e02-afbd-8599b16568954807Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices07.02.09
05e1f864-5736-4586-addf-3987bbec25fc.aspx
  
07.02.21kAmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21kMedicine (07)Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring05e1f864-5736-4586-addf-3987bbec25fc4910Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21
69487ca2-3405-418a-86be-2ac389c4e82e.aspx
  
01.00.12aAnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12aAnesthesia (01)Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management69487ca2-3405-418a-86be-2ac389c4e82e4563Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management01.00.12
{"4564": {"Id":4564,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":6737,"PolicyAttachmentPageName":"8f5b1bc9-bb95-4fa0-8662-8284e93e68cf"},}
2fdd9022-2641-49f8-ae4f-b09593402c69.aspx
  
08.01.82bAnifrolumab-fnia(Saphnelo™)08.01.82bPharmacy (08)Anifrolumab-fnia (Saphnelo™)2fdd9022-2641-49f8-ae4f-b09593402c694246Anifrolumab-fnia (Saphnelo™)08.01.82
cf9faf96-487d-47c2-bd76-bc70fd056a33.aspx
  
05.00.39rAnkle-Foot/Knee-Ankle-FootOrthoses05.00.39rDME (05)Ankle-Foot/Knee-Ankle-Foot Orthosescf9faf96-487d-47c2-bd76-bc70fd056a333409Ankle-Foot/Knee-Ankle-Foot Orthoses05.00.39
{"3410": {"Id":3410,"MPAttachmentLetter":"A","Title":"HCPCS Codes","MPPolicyAttachmentInternalSourceId":5437,"PolicyAttachmentPageName":"5f6e2c31-1bcc-46e6-9727-fc05459b2621"},}
36aee0bb-d271-4e94-8256-eafdfce45397.aspx
  
06.03.04nApheresisTherapy06.03.04nPathology and Laboratory (06)Apheresis Therapy36aee0bb-d271-4e94-8256-eafdfce453972774Apheresis Therapy06.03.04
f0e9fbf8-0357-4a99-8c55-0e6a960173ce.aspx
  
11.08.05gApplicationandRemovalofTattoos11.08.05gSurgery (11)Application and Removal of Tattoosf0e9fbf8-0357-4a99-8c55-0e6a960173ce4193Application and Removal of Tattoos11.08.05
8e21f681-8261-4b8d-924b-59e9f4a8b449.aspx
  
14.00.03AppliedBehaviorAnalysis(ABA)fortheTreatmentofAutismSpectrumDisorders(ASD)14.00.03Behavioral Health (14)Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)8e21f681-8261-4b8d-924b-59e9f4a8b4494967Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)14.00.03
68b0db08-bc36-4791-bc21-24234f4c1097.aspx
  
08.01.41eAprepitant(Cinvanti™),FosaprepitantDimeglumine(Emend®),Granisetron(Sustol®),andRolapitant(Varubi®)08.01.41ePharmacy (08)Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)68b0db08-bc36-4791-bc21-24234f4c10974923Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)08.01.41
{"4924": {"Id":4924,"MPAttachmentLetter":"A","Title":"Risk of Emesis Without Prophylaxis: Intravenous and Oral Antineoplastic Agents","MPPolicyAttachmentInternalSourceId":7122,"PolicyAttachmentPageName":"fe7db1ca-7fea-41ca-8b4d-26bae30635bf"},}
247cb6c3-4717-4406-9763-45a7e18e9743.aspx
  
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
{"4929": {"Id":4929,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":7061,"PolicyAttachmentPageName":"a0d68167-5052-4bab-8ea3-c25cff7e560b"},}
9c0d7079-1523-4cbe-af8e-2ef84e1d7d33.aspx
  
11.14.19pArtificialIntervertebralCervicalDiscInsertion(IndependenceAdministrators)11.14.19pSurgery (11)Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)9c0d7079-1523-4cbe-af8e-2ef84e1d7d334375Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)11.14.19
1a1546d8-2f70-47e9-80e8-be03e5acd487.aspx
  
11.15.31bArtificialIntervertebralLumbarDiscInsertion11.15.31bSurgery (11)Artificial Intervertebral Lumbar Disc Insertion1a1546d8-2f70-47e9-80e8-be03e5acd4874919Artificial Intervertebral Lumbar Disc Insertion11.15.31
6160580f-3e49-4886-a470-2c0b3f1203a0.aspx
  
08.01.35fAsparaginaseErwiniaChrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze™)08.01.35fPharmacy (08)Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)6160580f-3e49-4886-a470-2c0b3f1203a04488Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)08.01.35
faea9ca0-5aaf-4df6-b345-ecb509a725f6.aspx
  
06.02.27nAssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(IndependenceAdministrators)06.02.27nPathology and Laboratory (06)Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)faea9ca0-5aaf-4df6-b345-ecb509a725f64445Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)06.02.27
76727854-57be-4f5a-a359-c836ddd2fe12.aspx
  
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
676d5b29-8a79-4b13-b40b-0c52774693ce.aspx
  
08.01.69bAtezolizumab(Tecentriq®)08.01.69bPharmacy (08)Atezolizumab (Tecentriq®)676d5b29-8a79-4b13-b40b-0c52774693ce4053Atezolizumab (Tecentriq®)08.01.69
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db20c39f-0d2d-4390-9513-9744d833bc29.aspx
  
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)db20c39f-0d2d-4390-9513-9744d833bc294376Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators)11.14.06
148bea2e-d96c-412f-a00c-62599efec1ea.aspx
  
05.00.29nAutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29nDME (05)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)148bea2e-d96c-412f-a00c-62599efec1ea4804Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)05.00.29
{"4805": {"Id":4805,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":6577,"PolicyAttachmentPageName":"1029c90a-ad3b-4599-ba3e-31bee5b3f07e"},"4806": {"Id":4806,"MPAttachmentLetter":"A","Title":"ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":6578,"PolicyAttachmentPageName":"db6d5721-d139-4eed-bd31-29417ff0f7a8"},}
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07.03.23fAutonomicNervousSystemTesting07.03.23fMedicine (07)Autonomic Nervous System Testingecef3304-1ce0-4dd0-b3cf-e53e85a6e35d4573Autonomic Nervous System Testing07.03.23
89f5a884-1725-46ed-91bb-b7944b71287c.aspx
  
08.01.64bAvelumab(Bavencio®)08.01.64bPharmacy (08)Avelumab (Bavencio®)89f5a884-1725-46ed-91bb-b7944b71287c4888Avelumab (Bavencio®)08.01.64
{"4889": {"Id":4889,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7008,"PolicyAttachmentPageName":"dd583577-e9f1-40f6-8c23-ea98e3eaedbc"},}
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11.16.06jBalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitis11.16.06jSurgery (11)Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis1823d7f2-68b0-42bc-96f0-91216f11d56c4311Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis11.16.06
e2e22104-ada2-4d84-9c71-c600f1ea170e.aspx
  
11.03.02tBariatricSurgery11.03.02tSurgery (11)Bariatric Surgerye2e22104-ada2-4d84-9c71-c600f1ea170e2791Bariatric Surgery11.03.02
{"2792": {"Id":2792,"MPAttachmentLetter":"A","Title":"Body Mass Index (BMI) Charts","MPPolicyAttachmentInternalSourceId":4907,"PolicyAttachmentPageName":"292a20ba-ec48-442c-a624-40100880cb31"},"2793": {"Id":2793,"MPAttachmentLetter":"B","Title":"Tanner Staging System Criteria for Adolescents","MPPolicyAttachmentInternalSourceId":4908,"PolicyAttachmentPageName":"1b6da816-a2b6-4583-807a-5430c89f8392"},"2794": {"Id":2794,"MPAttachmentLetter":"C","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":4909,"PolicyAttachmentPageName":"b9184a36-7491-498e-aac9-ed1933abf92b"},}
2a68daca-621e-4826-8bcf-e5212ad5e2c1.aspx
  
08.01.70bBelantamabmafodotin-blmf(Blenrep)08.01.70bPharmacy (08)Belantamab mafodotin-blmf (Blenrep)2a68daca-621e-4826-8bcf-e5212ad5e2c14215Belantamab mafodotin-blmf (Blenrep)08.01.70
8c46c2a1-8be6-46cd-971b-b127d019b296.aspx
  
08.00.99eBelimumab(Benlysta®)forIntravenousUse08.00.99ePharmacy (08)Belimumab (Benlysta®) for Intravenous Use8c46c2a1-8be6-46cd-971b-b127d019b2964687Belimumab (Benlysta®) for Intravenous Use08.00.99
a621d3f8-8991-44aa-9f0c-83bd74ddb3aa.aspx
  
08.01.89BetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89Pharmacy (08)Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]a621d3f8-8991-44aa-9f0c-83bd74ddb3aa4900Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]08.01.89
c0575320-e42b-4c4e-bf06-06bfad373ddf.aspx
  
08.00.66sBevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66sPharmacy (08)Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Usec0575320-e42b-4c4e-bf06-06bfad373ddf4933Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use08.00.66
{"4934": {"Id":4934,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":7070,"PolicyAttachmentPageName":"efcf0c3f-5d7e-4ba2-b9c8-df1f8fa87f3c"},}
51aaf4af-1813-47af-95b8-8602dee4fdf0.aspx
  
00.10.39oBillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39oAdministrative (00)Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus51aaf4af-1813-47af-95b8-8602dee4fdf03975Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus00.10.39
{"3976": {"Id":3976,"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":6119,"PolicyAttachmentPageName":"9e4f9d52-c926-4fc8-81c9-1f2f4cc888d5"},}
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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
{"3052": {"Id":3052,"MPAttachmentLetter":"A","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ROUTINE OBSTETRIC (GLOBALE MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED","MPPolicyAttachmentInternalSourceId":5340,"PolicyAttachmentPageName":"d157b661-7eea-46ea-ab0f-b6ec2bd15a87"},"3053": {"Id":3053,"MPAttachmentLetter":"B","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ANETEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":5341,"PolicyAttachmentPageName":"5d22c25e-12c7-42e4-a127-e50b59895309"},"3054": {"Id":3054,"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":5342,"PolicyAttachmentPageName":"d0a0d176-67d6-4d41-9e52-2cbec1ebff3d"},"3055": {"Id":3055,"MPAttachmentLetter":"D","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES WHEN ANTEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":5343,"PolicyAttachmentPageName":"74d58125-3d75-4d7b-8d89-cbaebd03cc03"},}
02e82507-4553-452a-95c7-d63400bb489e.aspx
  
07.00.01jBiofeedbackTherapy07.00.01jMedicine (07)Biofeedback Therapy02e82507-4553-452a-95c7-d63400bb489e4333Biofeedback Therapy07.00.01
003a2876-c32d-49ee-acdf-0694a0faee57.aspx
  
07.06.03bBioimpedencefortheDetectionofLymphedema07.06.03bMedicine (07)Bioimpedence for the Detection of Lymphedema003a2876-c32d-49ee-acdf-0694a0faee574307Bioimpedence for the Detection of Lymphedema07.06.03
0004caa3-4725-461b-a8f6-5dc4564e1a27.aspx
  
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
{"4780": {"Id":4780,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6997,"PolicyAttachmentPageName":"192874a4-9925-4785-8097-96d4fd434cf0"},}
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08.01.21eBlinatumomab(Blincyto®)08.01.21ePharmacy (08)Blinatumomab (Blincyto®)92a12a39-2356-431e-9323-ff9db3f3d0394314Blinatumomab (Blincyto®)08.01.21
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1d2fc37e-88d7-431a-9aca-e9f20e57b894.aspx
  
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08.00.92aeCoagulationFactors08.00.92aePharmacy (08)Coagulation Factors22bc84c7-5553-4fa7-b5d3-be57e0cc24a34737Coagulation Factors08.00.92
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08.01.71Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo™)08.01.71Pharmacy (08)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)3f702bf1-690c-4e4c-864b-84143358b8774117Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)08.01.71
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12.00.03gComplementaryandIntegrativeHealthServices12.00.03gMiscellaneous (12)Complementary and Integrative Health Services979c27fb-de3f-4cf5-82ba-0053b59f78b84301Complementary and Integrative Health Services12.00.03
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07.13.11kContactLensesfortheTreatmentofPersistent(Corneal)EpithelialDefects07.13.11kMedicine (07)Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defectsbaa8983f-e0b4-42d1-a513-6cf4810e723e4221Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects07.13.11
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09.00.11eContrastAgentsUsedinConjunctionwithEchocardiography09.00.11eRadiology (09)Contrast Agents Used in Conjunction with Echocardiography486b7833-e733-47e1-a5a2-1fb22d3530843091Contrast Agents Used in Conjunction with Echocardiography09.00.11
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07.13.07lCornealPachymetryUsingUltrasound07.13.07lMedicine (07)Corneal Pachymetry Using Ultrasoundc53caf21-625e-421f-bca8-41cf258425ee4321Corneal Pachymetry Using Ultrasound07.13.07
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12.01.03aCosmeticProcedures12.01.03aMiscellaneous (12)Cosmetic Procedures5196725f-47be-4c15-b422-5e38270922a74792Cosmetic Procedures12.01.03
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08.01.08kCoverageofAnticancerPrescriptionOralandInjectableDrugsandBiologicsandSupportiveAgents08.01.08kPharmacy (08)Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents8176384d-886a-4f63-8361-4978f3617f594898Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08
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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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00.10.03kCriteriaforReimbursementofEmergencyRoomServices00.10.03kAdministrative (00)Criteria for Reimbursement of Emergency Room Services1adfb9b5-6ec1-41a1-ab70-0ec7069d62d94962Criteria for Reimbursement of Emergency Room Services00.10.03
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08.01.29jDaratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro®)08.01.29jPharmacy (08)Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)d5ec64eb-6e3a-4e18-ae7a-2e1f3d824f864494Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)08.01.29
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10.00.02cDayRehabilitation10.00.02cRehabilitation Services (10)Day Rehabilitation7a262c6f-5e1b-4248-b04e-71513e5cb0aa4514Day Rehabilitation10.00.02
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11.08.17kDebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNails11.08.17kSurgery (11)Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails632e2bb9-de0d-495a-95a7-af123cf8f6ce4398Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails11.08.17
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11.15.20qDeepBrainStimulation(DBS)11.15.20qSurgery (11)Deep Brain Stimulation (DBS)726a9987-2a95-451a-9058-c5d1a653fcdd4706Deep 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)cc9f5022-c3eb-4fdc-ae26-42c368a6c5784377Denervation of the Spinal  Nerves for Chronic Pain (Independence Administrators)11.15.09
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08.00.94pDenosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)08.00.94pPharmacy (08)Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)798cca7f-66bc-4a18-89fe-800f61ffd3214201Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)08.00.94
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11.16.01jDermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplasty11.16.01jSurgery (11)Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplastya67fb1d0-89a2-439a-919a-39d46565e6a94930Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty11.16.01
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00.03.02adDiagnosticRadiologyServicesIncludedinCapitation00.03.02adAdministrative (00)Diagnostic Radiology Services Included in Capitatione3772d4e-89a5-4eaf-b900-f06b47d8f3724935Diagnostic Radiology Services Included in Capitation00.03.02
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