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9218d81f-664c-4325-86e2-b7cdfee1f8d5.aspx
  
07.00.14h​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-LevelLaserTherapy07.00.14hMedicine (07)​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy9218d81f-664c-4325-86e2-b7cdfee1f8d56600​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy07.00.14
488dec00-d5ea-416c-86b2-e1e16d582e79.aspx
  
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
{"6642": {"Id":6642,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8937,"PolicyAttachmentPageName":"615490c4-cfdc-4742-85d2-cd9e840106ed"},}
06ffc3eb-f745-408c-ae63-cf0ba3ecbbdc.aspx
  
12.00.01hAcupuncture12.00.01hMiscellaneous (12)Acupuncture06ffc3eb-f745-408c-ae63-cf0ba3ecbbdc6059Acupuncture12.00.01
{"6060": {"Id":6060,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":8416,"PolicyAttachmentPageName":"95367bbb-8f90-4ffd-8085-a5bac9b24308"},}
ad65734f-8c9d-4c0a-b362-9b3677e62f35.aspx
  
12.04.04bAcuteCareFacilityInpatientTransfers12.04.04bMiscellaneous (12)Acute Care Facility Inpatient Transfersad65734f-8c9d-4c0a-b362-9b3677e62f356190Acute Care Facility Inpatient Transfers12.04.04
d5e67f8a-f5e2-4997-8424-41e3b326d8b7.aspx
  
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
b2f741cb-d1fd-49a3-91e0-bf9f2d147f8d.aspx
  
08.01.11iAdo-TrastuzumabEmtansine(Kadcyla®)08.01.11iPharmacy (08)Ado-Trastuzumab Emtansine (Kadcyla®)b2f741cb-d1fd-49a3-91e0-bf9f2d147f8d6105Ado-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"},}
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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
245ffd2b-6443-450c-854f-d6716f6c1f0c.aspx
  
12.04.03cAirAmbulanceServices12.04.03cMiscellaneous (12)Air Ambulance Services245ffd2b-6443-450c-854f-d6716f6c1f0c6418Air 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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08.00.72lAlglucosidasealfa(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
f9143396-59dc-41c7-b0bd-3276abbd228c.aspx
  
07.00.21jAllergyImmunotherapy07.00.21jMedicine (07)Allergy Immunotherapyf9143396-59dc-41c7-b0bd-3276abbd228c6262Allergy Immunotherapy07.00.21
aacfb39b-5245-40ea-9144-83238a559ae3.aspx
  
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
5e8e88d4-c3f6-49aa-a4b4-8048806aaad2.aspx
  
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
d32eec72-479b-43a6-bdf3-cfe24dfa12b2.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®)d32eec72-479b-43a6-bdf3-cfe24dfa12b26266Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)08.00.91
a87e8fab-e387-4910-a92c-f1b7616b55e5.aspx
  
00.01.52vAlwaysBundledProcedureCodes00.01.52vAdministrative (00)Always Bundled Procedure Codesa87e8fab-e387-4910-a92c-f1b7616b55e56479Always Bundled Procedure Codes00.01.52
{"6480": {"Id":6480,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":8882,"PolicyAttachmentPageName":"3c3a22b1-8c12-4247-814d-3d7b6ff8647e"},"6481": {"Id":6481,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (Indicator B)","MPPolicyAttachmentInternalSourceId":8883,"PolicyAttachmentPageName":"ff9475a6-1486-414d-853f-59a8703d7675"},"6482": {"Id":6482,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":8884,"PolicyAttachmentPageName":"10b87d63-3926-45c0-9841-c9891de2bffd"},}
eeb386be-be45-43cb-b8dd-5eaca1df97ee.aspx
  
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
de404cf7-22c0-4e3a-8f36-1c2c91d65745.aspx
  
07.02.21pAmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21pMedicine (07)Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoringde404cf7-22c0-4e3a-8f36-1c2c91d657456115Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21
22e3725e-1aab-4c4e-a86b-bd4cb90f60b2.aspx
  
08.01.90aAmivantamab-vmjw(Rybrevant®)08.01.90aPharmacy (08)Amivantamab-vmjw (Rybrevant®)22e3725e-1aab-4c4e-a86b-bd4cb90f60b26324Amivantamab-vmjw (Rybrevant®)08.01.90
142c8236-6430-4f8e-99d8-3cc44fc27dca.aspx
  
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
{"6676": {"Id":6676,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9043,"PolicyAttachmentPageName":"9198205f-cc8f-4dc8-8637-891b21ef044c"},}
d76f0864-8820-4305-aef9-042ca7cef74f.aspx
  
08.01.82cAnifrolumab-fnia(Saphnelo®)08.01.82cPharmacy (08)Anifrolumab-fnia (Saphnelo®)d76f0864-8820-4305-aef9-042ca7cef74f6388Anifrolumab-fnia (Saphnelo®)08.01.82
fe722ca4-78d7-45f4-b87b-93327b0f1be1.aspx
  
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
{"6162": {"Id":6162,"MPAttachmentLetter":"A","Title":"HCPCS Codes","MPPolicyAttachmentInternalSourceId":8450,"PolicyAttachmentPageName":"49a552ed-2d8e-4614-98a6-1999bffabbb6"},}
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06.03.04nApheresisTherapy06.03.04nPathology and Laboratory (06)Apheresis Therapyfecd240a-368a-41a9-b5bd-3a444f0cf66d5811Apheresis Therapy06.03.04
fa430b3c-36f7-432f-93c9-91524119145b.aspx
  
05.00.84Apos®biomechanicalshoesystem05.00.84DME (05)Apos® biomechanical shoe systemfa430b3c-36f7-432f-93c9-91524119145b5871Apos® biomechanical shoe system05.00.84
585fcd79-7a3a-47af-8791-80a5d1d21317.aspx
  
11.08.05gApplicationandRemovalofTattoos11.08.05gSurgery (11)Application and Removal of Tattoos585fcd79-7a3a-47af-8791-80a5d1d213176047Application and Removal of Tattoos11.08.05
b635799b-2e23-43e5-adc9-0dfcfe2217b9.aspx
  
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
313650d2-3c00-43a3-ad1b-36d6fd45655e.aspx
  
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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ca8705e7-f5e4-43fe-aba0-460c9e68fa27.aspx
  
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
5e7b1367-fc83-4e3e-b80b-d19ed56c3b37.aspx
  
11.15.31bArtificialIntervertebralLumbarDiscInsertion11.15.31bSurgery (11)Artificial Intervertebral Lumbar Disc Insertion5e7b1367-fc83-4e3e-b80b-d19ed56c3b375719Artificial Intervertebral Lumbar Disc Insertion11.15.31
e42f4b0b-d29c-4163-a6dd-40be8a4f0e37.aspx
  
08.01.35hAsparaginaseErwiniaChrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze®)08.01.35hPharmacy (08)Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)e42f4b0b-d29c-4163-a6dd-40be8a4f0e376716Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)08.01.35
07b6094a-2341-4bed-a1b8-841e3fe33dcc.aspx
  
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
b753c112-cb1c-4a31-a437-b39ee728998e.aspx
  
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
ab4a9746-3c0a-4512-bd38-0b178d74977d.aspx
  
08.01.69cAtezolizumab(Tecentriq®)08.01.69cPharmacy (08)Atezolizumab (Tecentriq®)ab4a9746-3c0a-4512-bd38-0b178d74977d5045Atezolizumab (Tecentriq®)08.01.69
{"5046": {"Id":5046,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7179,"PolicyAttachmentPageName":"0d497a54-8cfd-430b-9dff-dd040a596b3c"},}
854d35ec-1da5-4c9b-96c7-258cc052d5ff.aspx
  
05.00.82AuricularProstheses05.00.82DME (05)Auricular Prostheses854d35ec-1da5-4c9b-96c7-258cc052d5ff6321Auricular Prostheses05.00.82
444a363e-bb66-41ec-b11d-2151aaa5d1da.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)444a363e-bb66-41ec-b11d-2151aaa5d1da6598Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators)11.14.06
de68459f-cd9d-4108-a14e-398f4455f8a8.aspx
  
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
{"5597": {"Id":5597,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":7702,"PolicyAttachmentPageName":"2ac8befd-4776-4224-8cdc-8ea56fd0ab32"},"5598": {"Id":5598,"MPAttachmentLetter":"A","Title":"ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":7703,"PolicyAttachmentPageName":"a848bbd6-6bba-49f9-85aa-b02e7fe5f1f2"},}
2fbad6ab-e991-4724-b940-8fe96c5d52ad.aspx
  
07.03.23gAutonomicNervousSystemTesting07.03.23gMedicine (07)Autonomic Nervous System Testing2fbad6ab-e991-4724-b940-8fe96c5d52ad6696Autonomic Nervous System Testing07.03.23
9499af12-5287-4d71-85ef-b16bcb9e683a.aspx
  
08.01.64cAvelumab(Bavencio®)08.01.64cPharmacy (08)Avelumab (Bavencio®)9499af12-5287-4d71-85ef-b16bcb9e683a5994Avelumab (Bavencio®)08.01.64
{"5995": {"Id":5995,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":8159,"PolicyAttachmentPageName":"d3cfac37-0ba9-436f-a06d-acb8f5fea15e"},}
24f38e25-4fbe-4329-b23f-2b507113624c.aspx
  
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
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"},}
e31a657f-48be-4a73-9792-130bfcdf2d6c.aspx
  
08.00.99eBelimumab(Benlysta®)forIntravenousUse08.00.99ePharmacy (08)Belimumab (Benlysta®) for Intravenous Usee31a657f-48be-4a73-9792-130bfcdf2d6c6312Belimumab (Benlysta®) for Intravenous Use08.00.99
e6dbad62-468b-468f-b299-699bc381c4b9.aspx
  
08.02.10bBeremageneGeperpavec(Vyjuvek™)08.02.10bPharmacy (08)Beremagene Geperpavec (Vyjuvek™)e6dbad62-468b-468f-b299-699bc381c4b96516Beremagene Geperpavec (Vyjuvek™)08.02.10
eaeb3ab5-7cc1-47ad-b9ed-89caee51d73b.aspx
  
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
3ce6559a-1431-405f-b76b-dffbc7349670.aspx
  
08.00.66vBevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66vPharmacy (08)Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use3ce6559a-1431-405f-b76b-dffbc73496706722Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use08.00.66
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0c8d2564-3861-4119-a5ac-33bc514ae8ab.aspx
  
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
{"5795": {"Id":5795,"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":7908,"PolicyAttachmentPageName":"ea57ccb3-fc18-4495-8ca8-249692b39da8"},}
21ae79a9-3406-47c5-bb6d-1fae80367998.aspx
  
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
{"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"},}
1b5502ef-edab-448d-a895-c6cb8b610cc9.aspx
  
07.00.01nBiofeedbackTherapy07.00.01nMedicine (07)Biofeedback Therapy1b5502ef-edab-448d-a895-c6cb8b610cc96514Biofeedback Therapy07.00.01
f9a6a3eb-3e75-4270-bf9f-f6b8aff92631.aspx
  
07.06.03bBioimpedancefortheDetectionofLymphedema07.06.03bMedicine (07)Bioimpedance for the Detection of Lymphedemaf9a6a3eb-3e75-4270-bf9f-f6b8aff926316599Bioimpedance for the Detection of Lymphedema07.06.03
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bed8434e-8b79-418e-b18e-118a5e7dccd8.aspx
  
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00.01.59nCareManagementandCarePlanningServices00.01.59nAdministrative (00)Care Management and Care Planning Servicescd60daa2-173d-4be1-9b25-3bbed6aa295a6013Care Management and Care Planning Services00.01.59
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3f34cb7e-a0e5-43f0-9d38-caed6786f817.aspx
  
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a8bbd22a-8279-42e6-bce7-e23c36601e5f.aspx
  
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7db4611a-daa5-4bb7-9dd6-fbec48738550.aspx
  
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c6349587-f8ed-4988-af17-d7556abd45f7.aspx
  
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1bbe9c18-3706-4e0f-96f6-aab8d62484b6.aspx
  
08.00.92agCoagulationFactors08.00.92agPharmacy (08)Coagulation Factors1bbe9c18-3706-4e0f-96f6-aab8d62484b65984Coagulation Factors08.00.92
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06.02.54cCobalamin(VitaminB12),FolicAcid,andHomocysteineTesting06.02.54cPathology and Laboratory (06)Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing84c1878f-0009-47d5-8883-e6a2090ddade6494Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing06.02.54
{"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"},}
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86537148-8562-4da7-87ef-9ebe5abed28b.aspx
  
11.03.12uColorectalCancerScreening11.03.12uSurgery (11)Colorectal Cancer Screening86537148-8562-4da7-87ef-9ebe5abed28b6541Colorectal Cancer Screening11.03.12
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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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07.06.01bCompleteDecongestiveTherapy(CDT)07.06.01bMedicine (07)Complete Decongestive Therapy (CDT)380691f8-a783-41d2-9c89-5180c9877c3e6538Complete Decongestive Therapy (CDT)07.06.01
2b5ef5e6-615c-4d34-8f9e-8e49c34dcdfb.aspx
  
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93d9046c-91e9-4834-8660-9e60f7bab2be.aspx
  
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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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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
ccbf392a-076f-491f-81a7-7c009973654a.aspx
  
07.13.07lCornealPachymetryUsingUltrasound07.13.07lMedicine (07)Corneal Pachymetry Using Ultrasoundccbf392a-076f-491f-81a7-7c009973654a6421Corneal Pachymetry Using Ultrasound07.13.07
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fb6694bb-0c14-4e23-a1d8-d9709f7ff567.aspx
  
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1d7fb09e-4b4a-486f-a848-b96cc2105d3b.aspx
  
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e09e0da7-d349-4852-8d61-0dbc6ecd6b83.aspx
  
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1e846c90-26ad-42a3-a022-87051c882730.aspx
  
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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
f3947580-94ff-4833-9972-eae6958cb8ca.aspx
  
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7767bb97-a6be-4bcf-9f35-e36fc9a2e87a.aspx
  
11.11.03dCryosurgicalAblationoftheProstateGland11.11.03dSurgery (11)Cryosurgical Ablation of the Prostate Gland7767bb97-a6be-4bcf-9f35-e36fc9a2e87a6526Cryosurgical Ablation of the Prostate Gland11.11.03
370f27b0-7c52-4adb-a6b5-badb05e0aea2.aspx
  
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
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 Nailsf8389c50-7373-416b-8e33-b719d614340c6255Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails11.08.17
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95f895cc-90a8-4770-97e4-8c4cc31b20fd.aspx
  
08.02.13Delandistrogenemoxeparvovec(delandistrogenemoxeparvovec-rokl;Elevidys®)08.02.13Pharmacy (08)Delandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®) 95f895cc-90a8-4770-97e4-8c4cc31b20fd6431Delandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®) 08.02.13
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11.15.09qDenervationoftheSpinalNervesforChronicPain(IndependenceAdministrators)11.15.09qSurgery (11)Denervation of the Spinal Nerves for Chronic Pain (Independence Administrators)9e315134-2c60-4148-9216-f2cc2f8561226674Denervation of the Spinal  Nerves for Chronic Pain (Independence Administrators)11.15.09
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