|  | | 08.01.40f | Lanreotide(Somatuline®Depot)08.01.40f | Pharmacy (08) | Lanreotide (Somatuline® Depot) | 42f58b0d-b1cf-4935-8038-62c796bb7741 | 6099 | Lanreotide (Somatuline® Depot) | 08.01.40 | {"6100": {"Id":6100,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8170,"PolicyAttachmentPageName":"ccc8b641-3305-4c0d-ab2e-0fa2e4145f8f"},} |
| | | 11.06.10a | Laparoscopic,Percutaneous,andTranscervicalTechniquesforUterineFibroidMyolysis11.06.10a | Surgery (11) | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 42302818-e908-4f2f-88f6-0e0831441240 | 6412 | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 11.06.10 | |
| | | 11.08.03m | LipectomyandLiposuction11.08.03m | Surgery (11) | Lipectomy and Liposuction | e44b660b-8f00-4a25-9ba1-4e4d7cca9593 | 6528 | Lipectomy and Liposuction | 11.08.03 | |
| | | 08.00.59c | Loncastuximabtesirine-lpyl(Zynlonta®)08.00.59c | Pharmacy (08) | Loncastuximab tesirine-lpyl (Zynlonta®) | a3a2c530-9cbb-478e-8f5d-eb80dcba042f | 5772 | Loncastuximab tesirine-lpyl (Zynlonta®) | 08.00.59 | |
| | | 05.00.59o | LowerLimbProstheses05.00.59o | DME (05) | Lower Limb Prostheses | b540f1ab-711e-4cda-81c2-0e94106e0f15 | 6512 | Lower Limb Prostheses | 05.00.59 | {"6513": {"Id":6513,"MPAttachmentLetter":"A","Title":"HCPCS Level II Code Number(s) and Narrative(s)","MPPolicyAttachmentInternalSourceId":8837,"PolicyAttachmentPageName":"2e448667-37cf-421d-af28-85c8a9e0067d"},} |
| | | 09.00.31d | LowOsmolarContrastAgents09.00.31d | Radiology (09) | Low Osmolar Contrast Agents | 4e39b453-4a5b-4a91-885a-e7b7ab9d5eb9 | 5061 | Low Osmolar Contrast Agents | 09.00.31 | |
| | | 08.01.74 | Lumasiran(Oxlumo™)08.01.74 | Pharmacy (08) | Lumasiran (Oxlumo™) | 22d86ae7-c1e7-42f8-bcd0-706e6eb293e8 | 5891 | Lumasiran (Oxlumo™) | 08.01.74 | |
| | | 08.01.67c | Lurbinectedin(Zepzelca®)08.01.67c | Pharmacy (08) | Lurbinectedin (Zepzelca®) | e5b6f045-f809-4c00-bb3c-f544d906da84 | 5290 | Lurbinectedin (Zepzelca®) | 08.01.67 | |
| | | 08.00.10c | Luspatercept–aamt(Reblozyl®)08.00.10c | Pharmacy (08) | Luspatercept–aamt (Reblozyl®) | 0f67d2dd-b927-4f7a-bbad-842856794d67 | 5316 | Luspatercept–aamt (Reblozyl®) | 08.00.10 | |
| | | 08.01.57 | Lutathera®(LutetiumLu177Dotatate)(IndependenceAdministrators)08.01.57 | Pharmacy (08) | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 008dc90f-ae42-4690-a94b-59b4e4d44195 | 5825 | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 08.01.57 | |
| | | 06.02.01k | LymeDisease:DiagnosisandIntravenous(IV)AntibioticTherapy06.02.01k | Pathology and Laboratory (06) | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | ea8b568d-9904-4482-bfac-b0b24d4acb00 | 5831 | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | 06.02.01 | |
| | | 09.00.45k | MagneticResonanceImaging(MRI)ContrastAgents09.00.45k | Radiology (09) | Magnetic Resonance Imaging (MRI) Contrast Agents | 7a62ee9d-35b3-428e-9f4a-0878c125066e | 5778 | Magnetic Resonance Imaging (MRI) Contrast Agents | 09.00.45 | |
| | | 11.06.06g | MagneticResonanceImaging(MRI)-GuidedFocusedUltrasoundAblation11.06.06g | Surgery (11) | Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation | 058e4584-3f08-46cd-ad64-7e936b3e787b | 6411 | Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation | 11.06.06 | |
| | | 08.01.37c | MaintenanceTreatmentofOpioidorAlcoholUseDisorder08.01.37c | Pharmacy (08) | Maintenance Treatment of Opioid or Alcohol Use Disorder | 9bdde8f7-cf28-4bcd-8d75-2f9ac4922e3b | 6340 | Maintenance Treatment of Opioid or Alcohol Use Disorder | 08.01.37 | {"6341": {"Id":6341,"MPAttachmentLetter":"A","Title":"ICD10 Codes","MPPolicyAttachmentInternalSourceId":8708,"PolicyAttachmentPageName":"48d96805-e473-4042-9545-e3163633e7a9"},} |
| | | 11.14.24b | ManipulationUnderAnesthesia11.14.24b | Surgery (11) | Manipulation Under Anesthesia | 8976551b-e116-46a1-9813-0c82b43e743d | 6114 | Manipulation Under Anesthesia | 11.14.24 | |
| | | 05.00.12j | ManualWheelchairs05.00.12j | DME (05) | Manual Wheelchairs | 772e2554-8368-4fbb-b043-a80f729505ce | 6207 | Manual Wheelchairs | 05.00.12 | {"6208": {"Id":6208,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Manual Wheelchairs","MPPolicyAttachmentInternalSourceId":8579,"PolicyAttachmentPageName":"b18c2cc3-99d2-44fe-a6c5-4d44e69a37b0"},} |
| | | 08.01.75c | Margetuximab-cmkb(Margenza)08.01.75c | Pharmacy (08) | Margetuximab-cmkb (Margenza) | c6110f54-8aba-43e3-ad1b-8f665b4fb398 | 5375 | Margetuximab-cmkb (Margenza) | 08.01.75 | {"5376": {"Id":5376,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":7399,"PolicyAttachmentPageName":"7d39c0cb-2804-4651-85bb-c3e63b0631bb"},} |
| | | 00.01.48d | MarijuanaforMedicalUse00.01.48d | Administrative (00) | Marijuana for Medical Use | e2f8796c-a9d5-4675-8532-35b82f7ebbd4 | 5488 | Marijuana for Medical Use | 00.01.48 | |
| | | 07.11.02f | MeasurementofExhaledNitricOxideandBreathCondensateintheDiagnosisandManagementofAsthmaandOtherRespiratoryDisorders07.11.02f | Medicine (07) | Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders | 235e6ba3-5d6f-4355-a830-bbb600937b1b | 5332 | Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders | 07.11.02 | |
| | | 06.02.39d | MeasurementofSerumAntibodiestoandMeasurementofSerumLevelsofBiologics06.02.39d | Pathology and Laboratory (06) | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | 65bbc3e9-8e40-432f-82c2-3f804df0b4c1 | 6349 | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | 06.02.39 | |
| | | 05.00.70c | MechanicalStretchingDevicesfortheTreatmentofJointStiffnessorContractures05.00.70c | DME (05) | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | c292e736-8f15-42bf-9258-ad27cf5a8f65 | 6333 | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 05.00.70 | |
| | | 07.08.03i | MedicalandSurgicalTreatmentofTemporomandibularJointDisorder07.08.03i | Medicine (07) | Medical and Surgical Treatment of Temporomandibular Joint Disorder | 1950a315-92b0-495c-b23e-461bb1148962 | 6067 | Medical and Surgical Treatment of Temporomandibular Joint Disorder | 07.08.03 | |
| | | 12.01.02b | MedicalNecessity12.01.02b | Miscellaneous (12) | Medical Necessity | bb08b5cc-c464-4f52-97b2-28a1416a6ba5 | 6503 | Medical Necessity | 12.01.02 | |
| | | 11.14.03h | MeniscalAllograftTransplantationandMeniscalImplants(IndependenceAdministrators)11.14.03h | Surgery (11) | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | c1c3f72e-3e26-48d1-920e-6966db2d369a | 6578 | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | 11.14.03 | {"6579": {"Id":6579,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":8941,"PolicyAttachmentPageName":"45bb9eef-480c-4cb5-8094-6bc614753d72"},} |
| | | 11.14.01h | MentoplastyorGenioplasty11.14.01h | Surgery (11) | Mentoplasty or Genioplasty | 24207755-bd19-4fbf-8625-ff1efc4f6178 | 6506 | Mentoplasty or Genioplasty | 11.14.01 | |
| | | 11.14.21j | Microprocessor-ControlledProsthesesforLower-ExtremityAmputees11.14.21j | Surgery (11) | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | e1f1c44a-1fde-4cec-9885-12ce38305f9d | 6398 | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | 11.14.21 | |
| | | 11.15.24a | MigraineDeactivationSurgery11.15.24a | Surgery (11) | Migraine Deactivation Surgery | 2bbd18b7-831e-4bf7-84c1-8f22c0d30d45 | 6214 | Migraine Deactivation Surgery | 11.15.24 | |
| | | 08.02.19 | Mirikizumab-mrkz(Omvoh™)forIntravenousUse08.02.19 | Pharmacy (08) | Mirikizumab-mrkz (Omvoh™) for Intravenous Use | 9bcbfef7-18de-42ef-87b6-55a80be01439 | 6571 | Mirikizumab-mrkz (Omvoh™) for Intravenous Use | 08.02.19 | |
| | | 08.02.01b | Mirvetuximabsoravtansine-gynx(Elahere™)08.02.01b | Pharmacy (08) | Mirvetuximab soravtansine-gynx (Elahere™) | 72d46cbb-4484-45a9-b692-6a2f50ba4e59 | 6322 | Mirvetuximab soravtansine-gynx (Elahere™) | 08.02.01 | |
| | | 03.00.15p | Modifier24:UnrelatedEvaluationandManagementServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalDuringaPostoperativePeriod03.00.15p | Clinical Logic (03) | Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | de9e9c47-3bb4-480c-af79-6d57825dc617 | 5064 | Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | 03.00.15 | |
| | | 03.00.06z | Modifier25:Significant,SeparatelyIdentifiableEvaluationandManagementServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalontheSameDayoftheProcedureorOtherService03.00.06z | Clinical Logic (03) | Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | 8f72283d-b853-4bdd-b3ad-a5497a267082 | 5997 | Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | 03.00.06 | {"5998": {"Id":5998,"MPAttachmentLetter":"B","Title":"Problem-focused E&M Codes appended with modifier 25 should be reimbursed at 50% of the applicable fee schedule amount when submitted on the same date of service by the same professional provider or other qualified health care provider, as a preventive E&","MPPolicyAttachmentInternalSourceId":8364,"PolicyAttachmentPageName":"e0fc55b8-95ac-4b53-a482-1f486d11bc56"},"5999": {"Id":5999,"MPAttachmentLetter":"A","Title":"E&M codes appended with modifier 25 should be reimbursed at 50% of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure.","MPPolicyAttachmentInternalSourceId":8365,"PolicyAttachmentPageName":"5dbe6be8-f37a-4f76-a5c3-548eb733032a"},} |
| | | 03.00.05y | Modifier50:BilateralProcedure03.00.05y | Clinical Logic (03) | Modifier 50: Bilateral Procedure | 5e1e41b7-1531-4e69-9f88-3bb898bb57fa | 6509 | Modifier 50: Bilateral Procedure | 03.00.05 | |
| | | 03.00.32b | Modifier52:ReducedServices03.00.32b | Clinical Logic (03) | Modifier 52: Reduced Services | c089bb2c-423f-4e85-8d78-7e2522acf4bf | 5522 | Modifier 52: Reduced Services | 03.00.32 | |
| | | 03.00.33b | Modifier53:DiscontinuedProcedure03.00.33b | Clinical Logic (03) | Modifier 53: Discontinued Procedure | b835e172-8f47-42be-a0cf-3f63a7d3133d | 5523 | Modifier 53: Discontinued Procedure | 03.00.33 | |
| | | 03.00.16p | Modifier57:DecisionforSurgery03.00.16p | Clinical Logic (03) | Modifier 57: Decision for Surgery | b5c59444-0f62-4fcb-8717-62bb24a5bbaf | 5489 | Modifier 57: Decision for Surgery | 03.00.16 | |
| | | 00.10.11z | Modifier62:TwoSurgeons00.10.11z | Administrative (00) | Modifier 62: Two Surgeons | 14d45f23-2d57-47ce-a90c-ce59e6acd74c | 6510 | Modifier 62: Two Surgeons | 00.10.11 | |
| | | 00.10.17o | Modifier66:SurgicalTeam00.10.17o | Administrative (00) | Modifier 66: Surgical Team | cee9d4a3-ebc8-4a88-b14f-de037afbcbe6 | 5980 | Modifier 66: Surgical Team | 00.10.17 | {"5981": {"Id":5981,"MPAttachmentLetter":"A","Title":"Team Surgery Review Form","MPPolicyAttachmentInternalSourceId":8358,"PolicyAttachmentPageName":"24fdde6f-63ee-472b-9e9e-00fd65735f42"},} |
| | | 03.00.02c | Modifier76:RepeatProcedureorServicebySamePhysicianorOtherQualifiedHealthCareProfessional03.00.02c | Clinical Logic (03) | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional | 42176633-901e-445a-8b52-c1d8653c85bf | 5104 | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional | 03.00.02 | |
| | | 03.00.11c | Modifier77:RepeatProcedureorServicebyAnotherPhysicianorOtherQualifiedHealthCareProfessional03.00.11c | Clinical Logic (03) | Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional | 37236b28-776f-4b06-9c4f-02834e055984 | 5101 | Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional | 03.00.11 | |
| | | 03.00.12g | Modifier78:UnplannedReturntotheOperating/ProcedureRoombytheSamePhysicianorOtherQualifiedHealthCareProfessionalFollowingtheInitialProcedureforaRelatedProcedureDuringthePostoperativePeriod03.00.12g | Clinical Logic (03) | Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period | e6f338ca-9339-4559-a434-d115fab590e0 | 5105 | Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period | 03.00.12 | |
| | | 03.00.28n | Modifier79:UnrelatedProcedureorServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalDuringthePostoperativePeriod03.00.28n | Clinical Logic (03) | Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | eda29625-d354-43e3-a2cf-888ee03cc897 | 5102 | Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | 03.00.28 | |
| | | 03.00.20s | Modifiers26(ProfessionalComponent)andTC(TechnicalComponent)03.00.20s | Clinical Logic (03) | Modifiers 26 (Professional Component) and TC (Technical Component) | 476291bc-3ac7-4fc8-938e-1d6b7d49acbd | 6632 | Modifiers 26 (Professional Component) and TC (Technical Component) | 03.00.20 | |
| | | 00.10.18x | ModifiersforAssistant-at-SurgeryServices:80,81,82,andAS00.10.18x | Administrative (00) | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 10af137b-1cbb-498a-b1c4-0a446c6c14c3 | 6511 | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 00.10.18 | |
| | | 03.00.31g | ModifiersforSplitorSharedSurgicalServices(Modifiers54,55,and56)03.00.31g | Clinical Logic (03) | Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56) | 0e19258a-b273-40cc-97ad-49f9bf2c9f4c | 5520 | Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56) | 03.00.31 | |
| | | 03.00.08f | ModifiersXE,XS,XP,XU,and5903.00.08f | Clinical Logic (03) | Modifiers XE, XS, XP, XU, and 59 | eba0dc49-63b2-4445-9acc-208c2f6b979e | 6631 | Modifiers XE, XS, XP, XU, and 59 | 03.00.08 | |
| | | 08.01.52f | Mogamulizumab-kpkc(Poteligeo®)08.01.52f | Pharmacy (08) | Mogamulizumab-kpkc (Poteligeo®) | 60ea10d4-db3c-4d7c-a253-20b66ed4e7e2 | 6323 | Mogamulizumab-kpkc (Poteligeo®) | 08.01.52 | |
| | | 11.08.23k | MohsMicrographicSurgery11.08.23k | Surgery (11) | Mohs Micrographic Surgery | d2afa137-cc2f-4a14-8d24-28c4eda18252 | 6090 | Mohs Micrographic Surgery | 11.08.23 | {"6091": {"Id":6091,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":8479,"PolicyAttachmentPageName":"bd0ed2ed-dab4-4dce-bab8-93180a43ff67"},} |
| | | 06.02.36d | MolecularTestingfortheManagementofPancreaticCystsorBarrett'sEsophagus(IndependenceAdministrators)06.02.36d | Pathology and Laboratory (06) | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | e0a90c62-6b50-403d-bdfe-f6b6ea545afd | 5283 | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | 06.02.36 | |
| | | 08.01.93d | MonoclonalAntibodiesDirectedAgainstAmyloidfortheTreatmentofAlzheimer'sDisease08.01.93d | Pharmacy (08) | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | eebded88-c427-4346-bcc5-7ee7984c6d91 | 6527 | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | 08.01.93 | |
| | | 08.02.00b | Mosunetuzumab-axgb(Lunsumio™)08.02.00b | Pharmacy (08) | Mosunetuzumab-axgb (Lunsumio™) | 72ac7bea-3bbc-4a29-9d19-7f8e45327c67 | 6163 | Mosunetuzumab-axgb (Lunsumio™) | 08.02.00 | |
| | | 06.02.32d | MultigeneExpressionAssaysforPredictingRecurrenceinColonCancer(IndependenceAdministrators)06.02.32d | Pathology and Laboratory (06) | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators) | 4fc4b535-f234-481b-96c2-e7e84fcaecd4 | 6211 | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators) | 06.02.32 | |
| | | 00.01.60i | MultipleProcedurePaymentReduction(MPPR)onCertainDiagnosticServices00.01.60i | Administrative (00) | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 1decf4ce-ff05-4578-b4ab-1846c812b195 | 5875 | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 00.01.60 | {} |
| | | 00.01.68b | MultipleProcedurePaymentReductionGuidelinesforPhysical,Occupational,andSpeechTherapyServices00.01.68b | Administrative (00) | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 4d788700-fa17-4cdd-840b-edd1ae23c9de | 6368 | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 00.01.68 | {"6369": {"Id":6369,"MPAttachmentLetter":"A","Title":"Multiple Reduction Always Therapy Procedure Codes","MPPolicyAttachmentInternalSourceId":8720,"PolicyAttachmentPageName":"fe2a6487-915a-4e8f-a3f0-78d28254ed21"},} |
| | | 11.00.10x | MultipleSurgeryPaymentReduction11.00.10x | Surgery (11) | Multiple Surgery Payment Reduction | afb5dab9-c104-4a32-9f0f-0165854ddf75 | 4729 | Multiple Surgery Payment Reduction | 11.00.10 | {"4730": {"Id":4730,"MPAttachmentLetter":"B","Title":"Healthcare Common Procedure Coding System (HCPCS) Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":6895,"PolicyAttachmentPageName":"b6201a62-c6aa-4b34-aaaf-f2d0451c1d96"},"4731": {"Id":4731,"MPAttachmentLetter":"A2","Title":"Current Procedural Terminology (CPT) Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":6896,"PolicyAttachmentPageName":"882d134d-14c7-4bd1-8fee-644c9ae71729"},"4732": {"Id":4732,"MPAttachmentLetter":"A1","Title":"Current Procedural Terminology (CPT) Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":6897,"PolicyAttachmentPageName":"55e70aba-5dd9-4d91-b843-eee058d5cd6f"},} |
| | | 00.01.66l | MusculoskeletalServices(Independence)00.01.66l | Administrative (00) | Musculoskeletal Services (Independence) | e6c2cebb-d949-4cc0-9fa8-4d9733247f11 | 6186 | Musculoskeletal Services (Independence) | 00.01.66 | {"6187": {"Id":6187,"MPAttachmentLetter":"C","Title":"Procedures Codes for Interventional Pain Management","MPPolicyAttachmentInternalSourceId":8402,"PolicyAttachmentPageName":"c3cf5547-e280-4152-845b-b9f88d437fb9"},"6188": {"Id":6188,"MPAttachmentLetter":"B","Title":"Procedure Codes for Joint Surgery","MPPolicyAttachmentInternalSourceId":8403,"PolicyAttachmentPageName":"fb7a21c7-6ff6-4f20-8231-498ba4b3b7ef"},"6189": {"Id":6189,"MPAttachmentLetter":"A","Title":"Procedure Codes for Spinal Surgery","MPPolicyAttachmentInternalSourceId":8405,"PolicyAttachmentPageName":"e9d26e68-ca19-4b11-9636-700188bfbc6d"},} |
| | | 08.02.11a | NadofarageneFiradenovec-vncg(Adstiladrin®)08.02.11a | Pharmacy (08) | Nadofaragene Firadenovec-vncg (Adstiladrin®) | 17f318a9-1108-472c-88a7-2cfa39819850 | 6131 | Nadofaragene Firadenovec-vncg (Adstiladrin®) | 08.02.11 | |
| | | 08.00.64h | Natalizumab(Tysabri®)andRelatedBiosimilars08.00.64h | Pharmacy (08) | Natalizumab (Tysabri®) and Related Biosimilars | 5a9f46b9-076b-432e-911f-6f988f7eb7e0 | 6136 | Natalizumab (Tysabri®) and Related Biosimilars | 08.00.64 | |
| | | 00.01.56b | NationalCorrectCodingInitiative(NCCI)CodePairEdits00.01.56b | Administrative (00) | National Correct Coding Initiative (NCCI) Code Pair Edits | f9a23570-9bcf-4c3d-b80c-800b09727c20 | 5521 | National Correct Coding Initiative (NCCI) Code Pair Edits | 00.01.56 | |
| | | 05.00.15t | NebulizersandInhalationSolutions05.00.15t | DME (05) | Nebulizers and Inhalation Solutions | 4f4f2c65-9768-43af-81cf-7b151317458c | 5588 | Nebulizers and Inhalation Solutions | 05.00.15 | |
| | | 05.00.38m | NegativePressureWoundTherapySystems05.00.38m | DME (05) | Negative Pressure Wound Therapy Systems | 49d423dc-c100-4119-96c9-325d9c3971db | 5779 | Negative Pressure Wound Therapy Systems | 05.00.38 | |
| | | 07.03.18t | NerveConductionStudies(NCS)andRelatedElectrodiagnosticStudies07.03.18t | Medicine (07) | Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies | 4737bfc4-8151-4650-b879-626391add39c | 5735 | Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies | 07.03.18 | {"5736": {"Id":5736,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic Studies","MPPolicyAttachmentInternalSourceId":7813,"PolicyAttachmentPageName":"c208367d-6985-4462-8fc3-ec44e9f51f1a"},"5737": {"Id":5737,"MPAttachmentLetter":"F","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7814,"PolicyAttachmentPageName":"226c503b-cf58-4267-9763-0cbc87efdc57"},"5738": {"Id":5738,"MPAttachmentLetter":"C","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7815,"PolicyAttachmentPageName":"07ff8a68-0f8c-408a-9664-3631f23f9c84"},"5739": {"Id":5739,"MPAttachmentLetter":"D","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7816,"PolicyAttachmentPageName":"6d5832bb-72f0-4b05-b20b-00786afdd307"},"5740": {"Id":5740,"MPAttachmentLetter":"K","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7817,"PolicyAttachmentPageName":"e159685b-a386-4363-967a-1a3cca44f562"},"5741": {"Id":5741,"MPAttachmentLetter":"E","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7818,"PolicyAttachmentPageName":"f2eca517-080a-45b8-adc0-dd4e2c41b5ed"},"5742": {"Id":5742,"MPAttachmentLetter":"G","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7819,"PolicyAttachmentPageName":"d1d18385-d8a9-497b-a5c9-6c35184bda56"},"5743": {"Id":5743,"MPAttachmentLetter":"J","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7820,"PolicyAttachmentPageName":"a22a7017-1c50-44b1-90d9-b6f5b88919b2"},"5744": {"Id":5744,"MPAttachmentLetter":"H","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7821,"PolicyAttachmentPageName":"f255d926-646a-47fe-a587-c7756bc6d023"},"5745": {"Id":5745,"MPAttachmentLetter":"I","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7822,"PolicyAttachmentPageName":"06678359-14ee-4548-a49e-187d2e879eb0"},"5746": {"Id":5746,"MPAttachmentLetter":"B","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7823,"PolicyAttachmentPageName":"d1f85fbc-f249-49c4-9426-a117b4ca95c8"},} |
| | | 06.02.38d | NerveFiberDensityTesting06.02.38d | Pathology and Laboratory (06) | Nerve Fiber Density Testing | b666bcb7-bdc6-4813-9738-a428187bfc09 | 6498 | Nerve Fiber Density Testing | 06.02.38 | |
| | | 05.00.73g | NeuromuscularElectricalStimulators(NMES)andFunctionalElectricalStimulators(FES)05.00.73g | DME (05) | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | 920611f4-d021-4c4f-8b7a-db41eaa19492 | 6329 | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | 05.00.73 | |
| | | 07.03.08n | NeuropsychologicalTestingforNeurologicallyBasedConditions07.03.08n | Medicine (07) | Neuropsychological Testing for Neurologically Based Conditions | d6821fc1-495d-449a-bff1-98b30acc79a0 | 5635 | Neuropsychological Testing for Neurologically Based Conditions | 07.03.08 | {"5636": {"Id":5636,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7751,"PolicyAttachmentPageName":"86db0f59-e480-40e7-bde9-ec918a188744"},} |
| | | 00.01.44j | NeverEventsandPreventableSeriousAdverseEvents00.01.44j | Administrative (00) | Never Events and Preventable Serious Adverse Events | 335dc023-63c8-481b-bd7c-7e95bce642c2 | 6400 | Never Events and Preventable Serious Adverse Events | 00.01.44 | {"6401": {"Id":6401,"MPAttachmentLetter":"C","Title":"Never Event or Preventable Serious Adverse Event Reporting Form","MPPolicyAttachmentInternalSourceId":8813,"PolicyAttachmentPageName":"86c56a21-135b-415f-af11-e8c09fb82599"},"6402": {"Id":6402,"MPAttachmentLetter":"A","Title":"Pennsylvania House Bill No. 84 addressing Never Events and Preventable Serious Adverse Events","MPPolicyAttachmentInternalSourceId":8814,"PolicyAttachmentPageName":"3489e612-c454-4775-8c33-15bbbf69f7f6"},"6403": {"Id":6403,"MPAttachmentLetter":"B","Title":"New Jersey Act No. 2471","MPPolicyAttachmentInternalSourceId":8815,"PolicyAttachmentPageName":"add9372b-2bdd-482b-b1d4-8b92fa7e94d8"},} |
| | | 08.01.62c | Nivolumab(Opdivo®)08.01.62c | Pharmacy (08) | Nivolumab (Opdivo®) | 5c4684df-177c-42b5-8552-8e47388b798f | 5987 | Nivolumab (Opdivo®) | 08.01.62 | {"5988": {"Id":5988,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":8074,"PolicyAttachmentPageName":"5e97c8fc-54cc-4499-9d0a-f34d9ab451e6"},} |
| | | 08.01.94c | NivolumabandRelatlimab-rmbw(Opdualag™)08.01.94c | Pharmacy (08) | Nivolumab and Relatlimab-rmbw (Opdualag™) | a94a1888-1f39-468f-9f06-abf9336d3587 | 6169 | Nivolumab and Relatlimab-rmbw (Opdualag™) | 08.01.94 | |
| | | 07.10.05n | NoncontraceptiveUseoftheLevonorgestrel-ReleasingIntrauterineSystem07.10.05n | Medicine (07) | Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System | 13b9c97f-ff4d-43d9-b34a-c0f632675400 | 6423 | Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System | 07.10.05 | |
| | | 07.03.25a | NonemergentInpatientVideoElectroencephalogram(EEG)MonitoringandAmbulatoryEEGMonitoringintheHome07.03.25a | Medicine (07) | Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home | baa4ece9-98ba-4323-a3b4-ceeff01fedb4 | 6502 | Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home | 07.03.25 | |
| | | 06.02.47e | NoninvasivePrenatalScreeningforFetalAneuploidiesUsingCell-FreeFetalDNA(IndependenceAdministrators)06.02.47e | Pathology and Laboratory (06) | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators) | 0ad70f90-df9d-4ed5-a24a-a1a8029ee4e3 | 6058 | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators) | 06.02.47 | |
| | | 05.00.30p | NoninvasiveRespiratoryAssistDevices(RADs):ContinuousPositiveAirwayPressure(CPAP)Devices,Auto-AdjustingPositiveAirwayPressure(APAP)andBi-LevelDevices05.00.30p | DME (05) | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (APAP) and Bi-Level Devices | 295f32d5-9491-4fc9-adff-c1e4573a8a21 | 6573 | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (APAP) and Bi-Level Devices | 05.00.30 | |
| | | 06.02.56h | NoninvasiveTechniquesfortheEvaluationandMonitoringofIndividualswithChronicLiverDisease06.02.56h | Pathology and Laboratory (06) | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | 328cff1c-bab1-4db6-a65d-208aab0e9a6e | 5923 | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | 06.02.56 | |
| | | 07.08.01f | Non-SurgicalSpinalDecompressionTherapy07.08.01f | Medicine (07) | Non-Surgical Spinal Decompression Therapy | b02f004a-3f5f-49af-aff7-4c1f6299e9f1 | 6076 | Non-Surgical Spinal Decompression Therapy | 07.08.01 | |
| | | 00.01.24k | NotMedicallyNecessaryServicesandObsoleteorUnreliableDiagnosticTests00.01.24k | Administrative (00) | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | 43dd1977-9420-4cbb-a74d-ac0a2d28adee | 6364 | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | 00.01.24 | |
| | | 11.15.19e | Nucleoplasty11.15.19e | Surgery (11) | Nucleoplasty | 58ba51cb-1c54-4697-8bb4-1ecbbd406190 | 6326 | Nucleoplasty | 11.15.19 | |
| | | 08.00.18q | NutritionalFormulas,EnteralNutrition,MedicalFoods,Low-ProteinModifiedFoodProducts,andDonatedBreastMilk08.00.18q | Pharmacy (08) | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 435660d4-7c54-452f-bcc7-4a76f0c9ef7a | 6610 | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18 | {"6611": {"Id":6611,"MPAttachmentLetter":"C","Title":"Caloric Requirements","MPPolicyAttachmentInternalSourceId":8363,"PolicyAttachmentPageName":"42e3e8cf-53a8-4998-b2c0-0a647c5e2eda"},"6612": {"Id":6612,"MPAttachmentLetter":"A","Title":"PA Mandates","MPPolicyAttachmentInternalSourceId":8663,"PolicyAttachmentPageName":"bfb4fd8f-93c5-4d1d-b2dc-434af48c0a30"},"6613": {"Id":6613,"MPAttachmentLetter":"B","Title":"NJ Mandates","MPPolicyAttachmentInternalSourceId":8664,"PolicyAttachmentPageName":"98e001d1-bc6d-4fb7-96cb-e9cef6e17eb8"},} |
| | | 00.03.10F | ObstetricalUltrasoundsforMembersEnrolledinaHealthMaintenanceOrganization(HMO)orHealthMaintenanceOrganizationPoint-of-Service(HMO-POS)Product00.03.10F | Administrative (00) | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | 7f8302c2-19f4-4ddb-8f99-4a0bfa735caf | 5560 | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | 00.03.10 | {"5561": {"Id":5561,"MPAttachmentLetter":"B","Title":"Rule out Ectopic Pregnancy","MPPolicyAttachmentInternalSourceId":7548,"PolicyAttachmentPageName":"93506959-7870-42f1-aab0-85b9aa8f67dd"},"5562": {"Id":5562,"MPAttachmentLetter":"C","Title":"Rule out intrauterine pathology and Screening for Fetal abnormalities","MPPolicyAttachmentInternalSourceId":7549,"PolicyAttachmentPageName":"b1e7dbb7-62be-499f-a75c-1852e92dae11"},"5563": {"Id":5563,"MPAttachmentLetter":"A","Title":"High Risk Pregnancy","MPPolicyAttachmentInternalSourceId":7550,"PolicyAttachmentPageName":"79c5e79c-da07-4d3f-a0c8-3cdef56fd0dd"},"5564": {"Id":5564,"MPAttachmentLetter":"D","Title":"First-trimester screening and Ovarian Dysfunction","MPPolicyAttachmentInternalSourceId":7551,"PolicyAttachmentPageName":"e83b73f7-1ee4-4c48-a27a-5307de6ba5af"},} |
| | | 08.01.38c | Ocrelizumab(Ocrevus®)08.01.38c | Pharmacy (08) | Ocrelizumab (Ocrevus®) | a46722d8-70d8-4f2b-8a3a-3a05bf1e9e47 | 6204 | Ocrelizumab (Ocrevus®) | 08.01.38 | |
| | | 08.01.10i | OctreotideAcetate(Sandostatin®LARDepot)08.01.10i | Pharmacy (08) | Octreotide Acetate (Sandostatin® LAR Depot) | d9c907a4-8885-48ee-ab3a-47301419bb0b | 6546 | Octreotide Acetate (Sandostatin® LAR Depot) | 08.01.10 | {"6547": {"Id":6547,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8826,"PolicyAttachmentPageName":"f67dfd3a-40e9-4dbb-a47a-7145622b2ba9"},} |
| | | 08.00.15f | Off-labelCoverageforPrescriptionDrugsand/orBiologics08.00.15f | Pharmacy (08) | Off-label Coverage for Prescription Drugs and/or Biologics | c71c0b6a-978f-48b5-a9ef-21f4bc410161 | 6626 | Off-label Coverage for Prescription Drugs and/or Biologics | 08.00.15 | |
| | | 08.01.96a | olipudasealfa-rpcp(Xenpozyme™)08.01.96a | Pharmacy (08) | olipudase alfa-rpcp (Xenpozyme™) | 82766385-cc7c-4d38-92a3-60d3a64891cc | 6020 | olipudase alfa-rpcp (Xenpozyme™) | 08.01.96 | {"6021": {"Id":6021,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for olipudase alfa-rpcp (Xenpozyme)","MPPolicyAttachmentInternalSourceId":8307,"PolicyAttachmentPageName":"0625ef2b-5709-4de4-b2c2-29b854d42dfd"},} |
| | | 08.00.55j | Omalizumab(Xolair®)08.00.55j | Pharmacy (08) | Omalizumab (Xolair®) | 4eabb425-1607-418b-9b7e-784459bfb75d | 6101 | Omalizumab (Xolair®) | 08.00.55 | {"6102": {"Id":6102,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Omalizumab (Xolair®)","MPPolicyAttachmentInternalSourceId":8205,"PolicyAttachmentPageName":"a110cfad-c638-4da1-abd1-a3d188ab7d5a"},} |
| | | 11.14.08d | OrthognathicSurgery11.14.08d | Surgery (11) | Orthognathic Surgery | 6805c0ac-0631-4eb5-9b58-51b0b72e4c6a | 6055 | Orthognathic Surgery | 11.14.08 | |
| | | 07.13.01k | Orthoptic/PleopticTraining07.13.01k | Medicine (07) | Orthoptic/Pleoptic Training | 4af2009d-12eb-47ca-8a30-d4feb336ceb5 | 6520 | Orthoptic/Pleoptic Training | 07.13.01 | |
| | | 11.14.12f | OsteochondralAllograftTransplantation(IndependenceAdministrators)11.14.12f | Surgery (11) | Osteochondral Allograft Transplantation (Independence Administrators) | c5bbc564-020e-4118-be30-6a64af0719ea | 6601 | Osteochondral Allograft Transplantation (Independence Administrators) | 11.14.12 | |
| | | 11.14.09h | OsteochondralAutograftTransplantation(IndependenceAdministrators)11.14.09h | Surgery (11) | Osteochondral Autograft Transplantation (Independence Administrators) | dc351354-56b1-420b-a53f-9e139e0b31a9 | 6602 | Osteochondral Autograft Transplantation (Independence Administrators) | 11.14.09 | |
| | | 05.00.81 | OsteogenicStimulators(non-invasive,invasive/semi-invasive,electricalandultrasound)05.00.81 | DME (05) | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | f7b595de-89ea-47a6-af78-e12eadf82ee0 | 5451 | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | 05.00.81 | |
| | | 05.00.50o | OstomySupplies05.00.50o | DME (05) | Ostomy Supplies | 9e31cf31-d670-4f98-91af-d3ec7a9e93ef | 6507 | Ostomy Supplies | 05.00.50 | {"6508": {"Id":6508,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Ostomy Supplies","MPPolicyAttachmentInternalSourceId":8868,"PolicyAttachmentPageName":"a38a85e0-a16b-44dc-a8ed-c49209411833"},} |
| | | 11.01.01j | OtoplastyorNon-SurgicalExternalEarMolding11.01.01j | Surgery (11) | Otoplasty or Non-Surgical External Ear Molding | 31ca67f6-441d-4bc7-b0bd-9b509be52a5f | 5049 | Otoplasty or Non-Surgical External Ear Molding | 11.01.01 | |
| | | 12.05.01j | OutpatientDiabetesEducationandSelf-ManagementTraining12.05.01j | Miscellaneous (12) | Outpatient Diabetes Education and Self-Management Training | 14e4a1df-d766-40d5-b280-eace3f7f69d1 | 2625 | Outpatient Diabetes Education and Self-Management Training | 12.05.01 | {"2626": {"Id":2626,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E08.00- E10.3491)","MPPolicyAttachmentInternalSourceId":2371,"PolicyAttachmentPageName":"ed035dfc-85f7-4a19-b93a-5a68d1226e03"},"2627": {"Id":2627,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E10.3492- E13.37X2), Continued","MPPolicyAttachmentInternalSourceId":2372,"PolicyAttachmentPageName":"bd6c3245-6e36-47c4-b728-9b5efac2262f"},"2628": {"Id":2628,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E13.37X3- P70.2), Continued","MPPolicyAttachmentInternalSourceId":2373,"PolicyAttachmentPageName":"a903e29d-10c8-4b14-a150-f61bffb56003"},} |
| | | 10.03.01o | OutpatientPhysicalMedicine,Rehabilitation,andHabilitationServices10.03.01o | Rehabilitation Services (10) | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | 5cb7351b-c0f6-4bf6-a9a8-3109571bd6fb | 6012 | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | 10.03.01 | |
| | | 00.03.03i | OutpatientShort-TermRehabilitationServicesIncludedinCapitation00.03.03i | Administrative (00) | Outpatient Short-Term Rehabilitation Services Included in Capitation | 723a7d76-536e-4781-b75b-5d23704d4fb7 | 5576 | Outpatient Short-Term Rehabilitation Services Included in Capitation | 00.03.03 | {"5577": {"Id":5577,"MPAttachmentLetter":"A","Title":"No Title","MPPolicyAttachmentInternalSourceId":7603,"PolicyAttachmentPageName":"e3568853-d080-4f2e-ad60-2cc28a1b9be4"},} |
| | | 11.06.07d | OvarianandInternalIliacVeinEmbolizationasTreatmentforPelvicCongestionSyndrome11.06.07d | Surgery (11) | Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome | 68419e99-bc86-4c81-9fc7-c1a8c5c2c367 | 5720 | Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome | 11.06.07 | |
| | | 08.00.90q | PaclitaxelProtein-BoundParticlesforInjectableSuspension(Albumin-Bound)/(Abraxane®forInjectableSuspension)08.00.90q | Pharmacy (08) | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 3e84db63-9efe-4a8b-aa59-1bcd8ca9e69e | 6385 | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 08.00.90 | {"6386": {"Id":6386,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8668,"PolicyAttachmentPageName":"784508af-0415-4f71-bec6-6eb48f181465"},} |
| | | 07.03.27 | PainManagementofPeripheralNervesbyInjection07.03.27 | Medicine (07) | Pain Management of Peripheral Nerves by Injection | 94789e05-448a-4e25-89cc-1743bf6a2010 | 5090 | Pain Management of Peripheral Nerves by Injection | 07.03.27 | |
| | | 08.00.22q | Palivizumab(Synagis)08.00.22q | Pharmacy (08) | Palivizumab (Synagis) | fc96e0df-db10-4272-b4ef-87b0ab7506b5 | 6577 | Palivizumab (Synagis) | 08.00.22 | |
| | | 11.08.06j | Panniculectomy,Abdominoplasty,AbdominalLipectomy,andOtherExcisionsofRedundantSkin11.08.06j | Surgery (11) | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 40749496-6694-4330-adc6-50566d2b6111 | 6605 | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06 | {"6606": {"Id":6606,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8950,"PolicyAttachmentPageName":"5da97fd9-8ca6-4eea-9d6d-916845303242"},} |
| | | 07.10.04c | ParenterallyAdministeredTerbutalineSulfateforthePreventionorTreatmentofPre-TermLabor07.10.04c | Medicine (07) | Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor | 582d2285-78e9-457a-b550-bc60892decec | 6113 | Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor | 07.10.04 | |
| | | 05.00.42i | PatientLifts05.00.42i | DME (05) | Patient Lifts | 1a27c376-e47b-4a7b-acd4-4630ec5962d3 | 6271 | Patient Lifts | 05.00.42 | |
| | | 08.01.50c | patisiran(Onpattro®)andvutrisiran(Amvuttra™)08.01.50c | Pharmacy (08) | patisiran (Onpattro®) and vutrisiran (Amvuttra™) | 3aedbc12-6d64-44cd-af8b-245538c08d35 | 5086 | patisiran (Onpattro®) and vutrisiran (Amvuttra™) | 08.01.50 | |
