|  | | 08.01.40e | Lanreotide(Somatuline®Depot)08.01.40e | Pharmacy (08) | Lanreotide (Somatuline® Depot) | b23324af-17c8-465d-89a2-a53aa831de7b | 4618 | Lanreotide (Somatuline® Depot) | 08.01.40 | {"4619": {"Id":4619,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6756,"PolicyAttachmentPageName":"9e32cf66-6058-4728-8c83-44b05eba44e9"},} |
| | | 11.06.10 | Laparoscopic,Percutaneous,andTranscervicalTechniquesforUterineFibroidMyolysis11.06.10 | Surgery (11) | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 3729b42d-5f69-4566-9e55-579670af00fa | 4268 | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 11.06.10 | |
| | | 11.08.03l | LipectomyandLiposuction11.08.03l | Surgery (11) | Lipectomy and Liposuction | 6cc36479-c47c-404c-93f8-1ae85fe79e7d | 4490 | Lipectomy and Liposuction | 11.08.03 | |
| | | 08.00.59b | Loncastuximabtesirine-lpyl(Zynlonta®)08.00.59b | Pharmacy (08) | Loncastuximab tesirine-lpyl (Zynlonta®) | 3c24366e-029e-4d30-8524-c3a394ee81fe | 4884 | Loncastuximab tesirine-lpyl (Zynlonta®) | 08.00.59 | |
| | | 05.00.59k | LowerLimbProstheses05.00.59k | DME (05) | Lower Limb Prostheses | 95e7ec8f-ea9e-439e-8808-f619b3fb846a | 3578 | Lower Limb Prostheses | 05.00.59 | {"3579": {"Id":3579,"MPAttachmentLetter":"A","Title":"HCPCS Level II Code Number(s) and Narrative(s)","MPPolicyAttachmentInternalSourceId":5873,"PolicyAttachmentPageName":"a634be88-036a-412a-848f-ba1b93b3209f"},} |
| | | 07.00.14g | Low-levelLaserTherapy(LLLT)07.00.14g | Medicine (07) | Low-level Laser Therapy (LLLT) | 821c1131-09eb-4314-b14b-8c160a36e449 | 4231 | Low-level Laser Therapy (LLLT) | 07.00.14 | |
| | | 09.00.31d | LowOsmolarContrastAgents09.00.31d | Radiology (09) | Low Osmolar Contrast Agents | 1b345950-8a8c-4c42-9eac-cb89223eed31 | 3043 | Low Osmolar Contrast Agents | 09.00.31 | |
| | | 08.01.67b | Lurbinectedin(Zepzelca)08.01.67b | Pharmacy (08) | Lurbinectedin (Zepzelca) | 28c5f973-427f-4257-9474-e8f8e1b591c2 | 4162 | Lurbinectedin (Zepzelca) | 08.01.67 | |
| | | 08.00.10b | Luspatercept–aamt(Reblozyl®)08.00.10b | Pharmacy (08) | Luspatercept–aamt (Reblozyl®) | effc7383-610d-4467-af57-6f772be87d5f | 4342 | Luspatercept–aamt (Reblozyl®) | 08.00.10 | |
| | | 08.01.57 | Lutathera®(LutetiumLu177Dotatate)(IndependenceAdministrators)08.01.57 | Pharmacy (08) | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 587ca64c-5670-4915-946a-b3a7c38e6ee6 | 4410 | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 08.01.57 | |
| | | 06.02.01j | LymeDisease:DiagnosisandIntravenous(IV)AntibioticTherapy06.02.01j | Pathology and Laboratory (06) | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | dc9cc665-c1f1-4d2d-9657-13778abf42da | 3005 | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | 06.02.01 | |
| | | 11.15.13d | LysisofEpiduralAdhesions11.15.13d | Surgery (11) | Lysis of Epidural Adhesions | d932d50c-7af9-4ea5-9681-0ab5022227f4 | 4225 | Lysis of Epidural Adhesions | 11.15.13 | |
| | | 09.00.45i | MagneticResonanceImaging(MRI)ContrastAgents09.00.45i | Radiology (09) | Magnetic Resonance Imaging (MRI) Contrast Agents | d4d87368-119f-4422-92aa-840a1f826610 | 3131 | 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 | 8287f8b2-8716-445d-b2e8-ca6bc054a51b | 4508 | Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation | 11.06.06 | |
| | | 08.01.37b | MaintenanceTreatmentofOpioidorAlcoholUseDisorder08.01.37b | Pharmacy (08) | Maintenance Treatment of Opioid or Alcohol Use Disorder | ab893aee-7e07-4b54-864f-7afa01da0f2f | 4691 | Maintenance Treatment of Opioid or Alcohol Use Disorder | 08.01.37 | {"4692": {"Id":4692,"MPAttachmentLetter":"A","Title":"ICD10 Codes","MPPolicyAttachmentInternalSourceId":6488,"PolicyAttachmentPageName":"49e0d27a-9331-402f-84e7-71a30930e605"},} |
| | | 11.14.24b | ManipulationUnderAnesthesia11.14.24b | Surgery (11) | Manipulation Under Anesthesia | d6e16a25-c7d5-4c06-8ad3-ea55a2f0b869 | 4115 | Manipulation Under Anesthesia | 11.14.24 | |
| | | 05.00.12i | ManualWheelchairs05.00.12i | DME (05) | Manual Wheelchairs | e6e4ee3d-9748-42c9-9038-ae92bc2b83f5 | 4235 | Manual Wheelchairs | 05.00.12 | {"4236": {"Id":4236,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Manual Wheelchairs","MPPolicyAttachmentInternalSourceId":6253,"PolicyAttachmentPageName":"7142a3f4-111b-4f89-b4e2-4cca4fd16123"},} |
| | | 08.01.75b | Margetuximab-cmkb(Margenza)08.01.75b | Pharmacy (08) | Margetuximab-cmkb (Margenza) | abeb37e5-c94c-4424-a11c-29b39466749c | 4315 | Margetuximab-cmkb (Margenza) | 08.01.75 | {"4316": {"Id":4316,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":6385,"PolicyAttachmentPageName":"9604cd08-4550-46f0-82d3-49663b726d51"},} |
| | | 00.01.48d | MarijuanaforMedicalUse00.01.48d | Administrative (00) | Marijuana for Medical Use | 383e59e4-a92b-4bc7-885a-4106604996fa | 3436 | 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 | 0ec7e3a3-c6da-40b8-9a74-ee725aecdcee | 4995 | 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 | d267e468-bd50-4330-8b1a-4944db9f891d | 4811 | 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 | 29b043b6-208e-4400-a817-f838480cec1e | 4126 | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 05.00.70 | |
| | | 12.01.02a | Medical Necessity | Miscellaneous (12) | Medical Necessity | 85256AA800623D7A85258566004C91B6 | 2400 | Medical Necessity | 12.01.02 | |
| | | 07.08.03h | MedicalandSurgicalTreatmentofTemporomandibularJointDisorder07.08.03h | Medicine (07) | Medical and Surgical Treatment of Temporomandibular Joint Disorder | cbbd8ae6-e131-4fe3-9e84-de1f8f219fbe | 4519 | Medical and Surgical Treatment of Temporomandibular Joint Disorder | 07.08.03 | |
| | | 07.03.03h | MedicalEvaluationandManagementforAttention-DeficitHyperactivityDisorder(ADHD)07.03.03h | Medicine (07) | Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD) | b9237846-fbc8-493b-a3ec-ae86e6347eed | 4694 | Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD) | 07.03.03 | |
| | | 11.14.03h | MeniscalAllograftTransplantationandMeniscalImplants(IndependenceAdministrators)11.14.03h | Surgery (11) | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | c2b6581a-a4d5-4561-9368-f81dc5c7908a | 4380 | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | 11.14.03 | {"4381": {"Id":4381,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":6407,"PolicyAttachmentPageName":"cb4931e0-7a3e-4e16-b2e9-a2fb77b953fd"},} |
| | | 11.14.01g | MentoplastyorGenioplasty11.14.01g | Surgery (11) | Mentoplasty or Genioplasty | 8ff597e5-0dbf-4a5f-a84e-2f6ee37b08ba | 4228 | Mentoplasty or Genioplasty | 11.14.01 | |
| | | 11.14.21i | Microprocessor-ControlledProsthesesforLower-ExtremityAmputees11.14.21i | Surgery (11) | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | bc4c5498-29e7-4bd2-9c0f-299e58e5fede | 3078 | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | 11.14.21 | |
| | | 11.15.24a | MigraineDeactivationSurgery11.15.24a | Surgery (11) | Migraine Deactivation Surgery | c696f70d-0184-4427-8768-959ec7f5863f | 4346 | Migraine Deactivation Surgery | 11.15.24 | |
| | | 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 | f8d7e646-0584-45eb-91dc-27d2c67fb1ab | 3435 | Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | 03.00.15 | |
| | | 03.00.06w | Modifier25:Significant,SeparatelyIdentifiableEvaluationandManagementServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalontheSameDayoftheProcedureorOtherService03.00.06w | 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 | 44f7db9c-5159-4947-ba5c-9c3075c126ca | 4972 | 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 | {"4973": {"Id":4973,"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":7135,"PolicyAttachmentPageName":"a761640f-01ae-42b0-b577-26ee44bcd593"},"4974": {"Id":4974,"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":7136,"PolicyAttachmentPageName":"02b8e229-bb63-43f2-b363-38e4389eaf3c"},} |
| | | 03.00.05t | Modifier50:BilateralProcedure03.00.05t | Clinical Logic (03) | Modifier 50: Bilateral Procedure | 41922b73-cc56-449b-a8a7-90c5abc95307 | 4516 | Modifier 50: Bilateral Procedure | 03.00.05 | |
| | | 03.00.32b | Modifier52:ReducedServices03.00.32b | Clinical Logic (03) | Modifier 52: Reduced Services | 6492c677-6217-4645-aa98-51b1c2e00d7c | 3835 | Modifier 52: Reduced Services | 03.00.32 | |
| | | 03.00.33b | Modifier53:DiscontinuedProcedure03.00.33b | Clinical Logic (03) | Modifier 53: Discontinued Procedure | 4a23f8b3-7157-4c86-a465-0aa818011060 | 3828 | Modifier 53: Discontinued Procedure | 03.00.33 | |
| | | 03.00.16p | Modifier57:DecisionforSurgery03.00.16p | Clinical Logic (03) | Modifier 57: Decision for Surgery | e7ced3e4-15a1-420e-8929-f0d159ec1670 | 3325 | Modifier 57: Decision for Surgery | 03.00.16 | |
| | | 00.10.11u | Modifier62:TwoSurgeons00.10.11u | Administrative (00) | Modifier 62: Two Surgeons | 4bd84c94-064d-43be-9a7f-1348f1e11f7b | 4989 | Modifier 62: Two Surgeons | 00.10.11 | |
| | | 00.10.17m | Modifier66:SurgicalTeam00.10.17m | Administrative (00) | Modifier 66: Surgical Team | fcd892e5-213b-4cbc-9d79-164181bab86b | 4166 | Modifier 66: Surgical Team | 00.10.17 | {"4167": {"Id":4167,"MPAttachmentLetter":"A","Title":"Team Surgery Review Form","MPPolicyAttachmentInternalSourceId":6341,"PolicyAttachmentPageName":"4f84702c-daf6-45af-a4cc-ffd6a5c6851c"},} |
| | | 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 | 3f390070-f6ea-4ccc-b8e9-dbc89fffb1ab | 3327 | 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 | e47367e6-a014-4f26-b8a3-eded6b029b5b | 3328 | 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 | 24cabd61-2a54-4eda-bcd2-8049fafc5e73 | 3525 | 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 | 99b98586-29b5-497a-b30c-28b14bef62a5 | 3526 | Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | 03.00.28 | |
| | | 03.00.20p | Modifiers26(ProfessionalComponent)andTC(TechnicalComponent)03.00.20p | Clinical Logic (03) | Modifiers 26 (Professional Component) and TC (Technical Component) | 9023d90f-ea9e-4837-bf15-15b4609c61f1 | 4963 | Modifiers 26 (Professional Component) and TC (Technical Component) | 03.00.20 | |
| | | 00.10.18t | ModifiersforAssistant-at-SurgeryServices:80,81,82,andAS00.10.18t | Administrative (00) | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 5a0c009c-df41-46fe-85e9-f75926c59e4e | 4990 | 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) | 7748849d-668f-44a3-b385-64d7e4b3a018 | 3725 | 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 | d0e4489b-c807-4e43-9abb-a90f6f1cebdd | 4018 | Modifiers XE, XS, XP, XU, and 59 | 03.00.08 | |
| | | 08.01.52d | Mogamulizumab-kpkc(Poteligeo®)08.01.52d | Pharmacy (08) | Mogamulizumab-kpkc (Poteligeo®) | 5ad79e01-f20d-4edd-93a6-e9211bfab048 | 4469 | Mogamulizumab-kpkc (Poteligeo®) | 08.01.52 | |
| | | 11.08.23j | Mohs'MicrographicSurgery11.08.23j | Surgery (11) | Mohs' Micrographic Surgery | 2af498eb-f6e4-4e26-9f63-f30ad42b2ff3 | 4191 | Mohs' Micrographic Surgery | 11.08.23 | {"4192": {"Id":4192,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":6293,"PolicyAttachmentPageName":"f9e3b0d9-b4f1-49b3-ad07-a047b0c20c89"},} |
| | | 06.02.36c | MolecularTestingfortheManagementofPancreaticCystsorBarrett'sEsophagus(IndependenceAdministrators)06.02.36c | Pathology and Laboratory (06) | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | d15cd425-f061-4fbc-a119-14d64d51bcb8 | 4420 | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | 06.02.36 | |
| | | 08.01.53b | MoxetumomabPasudotox-tdfk(Lumoxiti™)08.01.53b | Pharmacy (08) | Moxetumomab Pasudotox-tdfk (Lumoxiti™) | f4a173bd-a9ca-4582-9357-b941c3ae36ba | 4493 | Moxetumomab Pasudotox-tdfk (Lumoxiti™) | 08.01.53 | |
| | | 06.02.32d | MultigeneExpressionAssaysforPredictingRecurrenceinColonCancer(IndependenceAdministrators)06.02.32d | Pathology and Laboratory (06) | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators) | 56cef71d-72dd-45ed-ab0c-e989f8be35a9 | 4419 | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators) | 06.02.32 | |
| | | 00.01.68 | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | Administrative (00) | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 5A317727AACA768F8525846600442DF8 | 2131 | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 00.01.68 | {"2217": {"Id":2217,"MPAttachmentLetter":"A","Title":"Multiple Reduction Always Therapy Procedure Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"7B54F250C0C278DE8525846600442E03"},} |
| | | 00.01.60h | MultipleProcedurePaymentReduction(MPPR)onCertainDiagnosticServices00.01.60h | Administrative (00) | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 5a4ae1ad-0ca0-4ecd-bf79-ff4a1156bec3 | 4024 | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 00.01.60 | {"4025": {"Id":4025,"MPAttachmentLetter":"A","Title":"Multiple Reduction Diagnostic Services","MPPolicyAttachmentInternalSourceId":6182,"PolicyAttachmentPageName":"b861da60-72f7-4f31-9db5-ad04a9a7e901"},} |
| | | 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"},} |
| | | 00.01.66g | MusculoskeletalServices(Independence)00.01.66g | Administrative (00) | Musculoskeletal Services (Independence) | 3f770296-d1e6-4aa4-ab6d-bf7b78f1a988 | 4830 | Musculoskeletal Services (Independence) | 00.01.66 | {"4831": {"Id":4831,"MPAttachmentLetter":"C","Title":"Procedures Codes for Interventional Pain Management","MPPolicyAttachmentInternalSourceId":6911,"PolicyAttachmentPageName":"c504e8de-a946-413e-b0c0-03f96af8cf03"},"4832": {"Id":4832,"MPAttachmentLetter":"B","Title":"Procedure Codes for Joint Surgery","MPPolicyAttachmentInternalSourceId":6913,"PolicyAttachmentPageName":"925bbc5f-95a8-4b97-8247-9e965c6df134"},"4833": {"Id":4833,"MPAttachmentLetter":"A","Title":"Procedure Codes for Spinal Surgery","MPPolicyAttachmentInternalSourceId":6914,"PolicyAttachmentPageName":"7f60401e-e44c-4c11-978d-7a389107faed"},} |
| | | 08.00.64g | Natalizumab(Tysabri®)08.00.64g | Pharmacy (08) | Natalizumab (Tysabri®) | 54ab77b9-f40a-4e10-bb27-cba214f22cdf | 4252 | Natalizumab (Tysabri®) | 08.00.64 | |
| | | 00.01.56b | NationalCorrectCodingInitiative(NCCI)CodePairEdits00.01.56b | Administrative (00) | National Correct Coding Initiative (NCCI) Code Pair Edits | d70ca358-985e-4b3e-840b-31c37761debd | 3943 | National Correct Coding Initiative (NCCI) Code Pair Edits | 00.01.56 | |
| | | 05.00.15s | NebulizersandInhalationSolutions05.00.15s | DME (05) | Nebulizers and Inhalation Solutions | be715324-88fe-46a4-b541-f79e6f52f5a7 | 4479 | Nebulizers and Inhalation Solutions | 05.00.15 | |
| | | 05.00.38l | Negative-PressureWoundTherapy(NPWT)Systems05.00.38l | DME (05) | Negative-Pressure Wound Therapy (NPWT) Systems | 36c77c39-2c89-4624-a47d-600445f54e09 | 4638 | Negative-Pressure Wound Therapy (NPWT) Systems | 05.00.38 | |
| | | 07.03.18s | NerveConductionStudies(NCS)andRelatedElectrodiagnosticStudies07.03.18s | Medicine (07) | Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies | 8ad46f60-4e59-4842-a8e6-db2fe7e9dc70 | 4767 | Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies | 07.03.18 | {"4768": {"Id":4768,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic Studies","MPPolicyAttachmentInternalSourceId":6974,"PolicyAttachmentPageName":"2286a1f3-43a6-42cb-b0e0-67007e6911e6"},"4769": {"Id":4769,"MPAttachmentLetter":"F","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6975,"PolicyAttachmentPageName":"6749a6bb-0535-4be7-a2d0-938092a0f19c"},"4770": {"Id":4770,"MPAttachmentLetter":"D","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6976,"PolicyAttachmentPageName":"d6c37cbc-713b-44e5-9880-2fc5a7bb8ca6"},"4771": {"Id":4771,"MPAttachmentLetter":"K","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6977,"PolicyAttachmentPageName":"48e97653-b63e-43ab-86ce-cf95014116d0"},"4772": {"Id":4772,"MPAttachmentLetter":"E","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6978,"PolicyAttachmentPageName":"9a155ec4-97e7-47bf-9458-892fc19de607"},"4773": {"Id":4773,"MPAttachmentLetter":"C","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6979,"PolicyAttachmentPageName":"567cab7a-e062-49fc-b889-4c98f271a179"},"4774": {"Id":4774,"MPAttachmentLetter":"J","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6980,"PolicyAttachmentPageName":"63e246bc-025c-4dd4-8653-71f22382766b"},"4775": {"Id":4775,"MPAttachmentLetter":"G","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6981,"PolicyAttachmentPageName":"4613a087-8e20-4ec8-8120-c5ebe2e5ff1e"},"4776": {"Id":4776,"MPAttachmentLetter":"I","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6982,"PolicyAttachmentPageName":"68e85d05-6336-4925-b042-a60409140b9f"},"4777": {"Id":4777,"MPAttachmentLetter":"H","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6983,"PolicyAttachmentPageName":"a8b12155-730e-49e7-a1c9-d7d0f35b8a62"},"4778": {"Id":4778,"MPAttachmentLetter":"B","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6984,"PolicyAttachmentPageName":"79804ca7-77cc-4226-910d-3eb0f6ad8b42"},} |
| | | 06.02.38d | NerveFiberDensityTesting06.02.38d | Pathology and Laboratory (06) | Nerve Fiber Density Testing | 8876de80-e4d6-4a1b-b87f-9287276acb7b | 4138 | Nerve Fiber Density Testing | 06.02.38 | |
| | | 05.00.73f | NeuromuscularElectricalStimulators(NMES)andFunctionalElectricalStimulators(FES)05.00.73f | DME (05) | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | 0eac7e6f-b7c5-4730-8de5-7856c0a6ed36 | 4828 | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | 05.00.73 | |
| | | 07.03.08l | NeuropsychologicalTestingforNeurologicallyBasedConditions07.03.08l | Medicine (07) | Neuropsychological Testing for Neurologically Based Conditions | 2db9fc2b-7ab9-438d-b384-09cde20c592a | 4748 | Neuropsychological Testing for Neurologically Based Conditions | 07.03.08 | {"4749": {"Id":4749,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6787,"PolicyAttachmentPageName":"b8f07b68-bfb9-47e6-9e25-6412ff0dfaa4"},} |
| | | 00.01.44j | NeverEventsandPreventableSeriousAdverseEvents00.01.44j | Administrative (00) | Never Events and Preventable Serious Adverse Events | 9a0b90c8-7404-4c27-9a2c-836963f214ef | 4859 | Never Events and Preventable Serious Adverse Events | 00.01.44 | {"4860": {"Id":4860,"MPAttachmentLetter":"C","Title":"Never Event or Preventable Serious Adverse Event Reporting Form","MPPolicyAttachmentInternalSourceId":6832,"PolicyAttachmentPageName":"400c99ce-1404-4084-af26-46afcc087cd2"},"4861": {"Id":4861,"MPAttachmentLetter":"B","Title":"New Jersey Act No. 2471","MPPolicyAttachmentInternalSourceId":6833,"PolicyAttachmentPageName":"b1ac50ac-b757-4e84-b1d3-db6d4e012156"},"4862": {"Id":4862,"MPAttachmentLetter":"A","Title":"Pennsylvania House Bill No. 84 addressing Never Events and Preventable Serious Adverse Events","MPPolicyAttachmentInternalSourceId":6834,"PolicyAttachmentPageName":"c3b9bfb0-da02-4bfe-a8a1-a34b4e45db8e"},} |
| | | 08.01.62b | Nivolumab(Opdivo®)08.01.62b | Pharmacy (08) | Nivolumab (Opdivo®) | d27add03-5f98-4404-a2d3-45ad8eedaead | 4636 | Nivolumab (Opdivo®) | 08.01.62 | {"4637": {"Id":4637,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":6531,"PolicyAttachmentPageName":"b684628e-1be7-4566-8330-914f798a63af"},} |
| | | 08.01.94a | nivolumabandrelatlimab-rmbw(Opdualag™)08.01.94a | Pharmacy (08) | nivolumab and relatlimab-rmbw (Opdualag™) | e5b2c1be-952b-4cd2-8fc7-d5e6c328d066 | 4616 | nivolumab and relatlimab-rmbw (Opdualag™) | 08.01.94 | |
| | | 07.10.05m | NoncontraceptiveUseoftheLevonorgestrel-ReleasingIntrauterineSystem07.10.05m | Medicine (07) | Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System | fbbbe67b-67e3-4cde-a2f6-dccbf4d43a71 | 4284 | 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 | 369fa8c0-8b27-4feb-9880-530f102e96b4 | 4497 | 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) | 02fb18f0-470c-4241-9581-b40ebcaf233b | 4992 | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators) | 06.02.47 | |
| | | 05.00.30n | NoninvasiveRespiratoryAssistDevices(RADs):ContinuousPositiveAirwayPressure(CPAP)Devices,Auto-AdjustingPositiveAirwayPressure(APAP)andBi-LevelDevices05.00.30n | DME (05) | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (APAP) and Bi-Level Devices | 8ecb8f53-141c-406a-9ff4-8cc786eb2ad9 | 4824 | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (APAP) and Bi-Level Devices | 05.00.30 | |
| | | 06.02.56g | NoninvasiveTechniquesfortheEvaluationandMonitoringofIndividualswithChronicLiverDisease06.02.56g | Pathology and Laboratory (06) | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | 2706fb98-8bd6-4542-b469-f64131478e6e | 4818 | 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 | bb423d59-af89-4dc1-a448-6594d114df6b | 4234 | Non-Surgical Spinal Decompression Therapy | 07.08.01 | |
| | | 11.15.19e | Nucleoplasty11.15.19e | Surgery (11) | Nucleoplasty | 79a17d97-b7a9-468e-8cf8-f8c018ca8546 | 4345 | Nucleoplasty | 11.15.19 | |
| | | 08.00.18o | NutritionalFormulas,EnteralNutrition,MedicalFoods,Low-ProteinModifiedFoodProducts,andDonatedBreastMilk08.00.18o | Pharmacy (08) | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 98d97e74-bf4f-4f7e-bb81-341e24f5beec | 4671 | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18 | {"4672": {"Id":4672,"MPAttachmentLetter":"A","Title":"PA Mandates","MPPolicyAttachmentInternalSourceId":6768,"PolicyAttachmentPageName":"625dde79-a3f9-4284-9e72-a03324f8456d"},"4673": {"Id":4673,"MPAttachmentLetter":"C","Title":"Caloric Requirements","MPPolicyAttachmentInternalSourceId":6769,"PolicyAttachmentPageName":"3f7d7bd7-5ccd-4360-9145-84279bc0e8ba"},"4674": {"Id":4674,"MPAttachmentLetter":"B","Title":"NJ Mandates","MPPolicyAttachmentInternalSourceId":6770,"PolicyAttachmentPageName":"1c1a73e7-bad7-4b3c-bc82-21ba93c05474"},} |
| | | 00.01.24i | ObsoleteorUnreliableDiagnosticTestsandNotMedicallyNecessaryMedicalServices00.01.24i | Administrative (00) | Obsolete or Unreliable Diagnostic Tests and Not Medically Necessary Medical Services | ca403306-56d3-40c5-955d-ef3805f2bebf | 4801 | Obsolete or Unreliable Diagnostic Tests and Not Medically Necessary Medical Services | 00.01.24 | |
| | | 00.03.10e | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | Administrative (00) | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | F44DE201290B17FD852581E90055D650 | 2118 | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | 00.03.10 | {"2180": {"Id":2180,"MPAttachmentLetter":"A","Title":"High Risk Pregnancy","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"B8C1CA1F2EF44F8E852581E90055D662"},"2181": {"Id":2181,"MPAttachmentLetter":"B","Title":"Rule out Ectopic Pregnancy","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"0C9817EDC55BF784852581E90055D670"},"2182": {"Id":2182,"MPAttachmentLetter":"C","Title":"Rule out intrauterine pathology and Screening for Fetal abnormalities","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"2523EE16188C5ABE852581E90055D67D"},"2183": {"Id":2183,"MPAttachmentLetter":"D","Title":"First-trimester screening and Ovarian Dysfunction","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"289DB16C035AE79A852581E90055D688"},} |
| | | 08.01.38c | Ocrelizumab(Ocrevus®)08.01.38c | Pharmacy (08) | Ocrelizumab (Ocrevus®) | 0e8bb45a-3cfb-4fe3-80ee-02539435722f | 4288 | Ocrelizumab (Ocrevus®) | 08.01.38 | |
| | | 08.01.10g | OctreotideAcetate(Sandostatin®LARDepot)08.01.10g | Pharmacy (08) | Octreotide Acetate (Sandostatin® LAR Depot) | b26b48dc-dc2f-4913-a6d1-22d7002d8fdf | 4197 | Octreotide Acetate (Sandostatin® LAR Depot) | 08.01.10 | {"4198": {"Id":4198,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6307,"PolicyAttachmentPageName":"96366a40-de06-4dd0-9105-5efe1fc50ff1"},} |
| | | 08.00.15f | Off-labelCoverageforPrescriptionDrugsand/orBiologics08.00.15f | Pharmacy (08) | Off-label Coverage for Prescription Drugs and/or Biologics | 449f9a31-dfca-4df0-bde5-0116da43c523 | 4040 | Off-label Coverage for Prescription Drugs and/or Biologics | 08.00.15 | |
| | | 08.00.55i | Omalizumab(Xolair®)08.00.55i | Pharmacy (08) | Omalizumab (Xolair®) | 208cd07c-a1d6-437f-b06b-f35616f8ea87 | 4160 | Omalizumab (Xolair®) | 08.00.55 | {"4161": {"Id":4161,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Omalizumab (Xolair®)","MPPolicyAttachmentInternalSourceId":6249,"PolicyAttachmentPageName":"b2612a29-72fd-46f8-b260-4487e063ddae"},} |
| | | 11.14.08d | OrthognathicSurgery11.14.08d | Surgery (11) | Orthognathic Surgery | d113ee7c-e492-4a6e-880c-b5016bf9d26d | 4344 | Orthognathic Surgery | 11.14.08 | |
| | | 07.13.01j | Orthoptic/PleopticTraining07.13.01j | Medicine (07) | Orthoptic/Pleoptic Training | 9b855cec-b05e-4b75-b40c-78e3027f0cd9 | 4932 | Orthoptic/Pleoptic Training | 07.13.01 | |
| | | 11.14.12f | OsteochondralAllograftTransplantation(IndependenceAdministrators)11.14.12f | Surgery (11) | Osteochondral Allograft Transplantation (Independence Administrators) | 664c9ac1-2b22-4997-ad52-fd481397ad95 | 4382 | Osteochondral Allograft Transplantation (Independence Administrators) | 11.14.12 | |
| | | 11.14.09h | OsteochondralAutograftTransplantation(IndependenceAdministrators)11.14.09h | Surgery (11) | Osteochondral Autograft Transplantation (Independence Administrators) | a96371c5-f45b-4fdf-82fa-bbbbbfcef067 | 4383 | 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) | e3966c68-64e6-4065-8391-f03f764ae9de | 4515 | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | 05.00.81 | |
| | | 05.00.50n | OstomySupplies05.00.50n | DME (05) | Ostomy Supplies | 1420ee54-5759-47a4-b49b-1aee172854d6 | 4738 | Ostomy Supplies | 05.00.50 | {"4739": {"Id":4739,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Ostomy Supplies","MPPolicyAttachmentInternalSourceId":6786,"PolicyAttachmentPageName":"b97a011e-52a7-4f27-b6d5-c1f5e33ba555"},} |
| | | 11.01.01j | OtoplastyorNon-SurgicalExternalEarMolding11.01.01j | Surgery (11) | Otoplasty or Non-Surgical External Ear Molding | 13dfa92a-36ee-40ca-accc-5ffa9d72f96c | 4339 | Otoplasty or Non-Surgical External Ear Molding | 11.01.01 | |
| | | 00.03.03h | Outpatient Short-Term Rehabilitation Services Included in Capitation | Administrative (00) | Outpatient Short-Term Rehabilitation Services Included in Capitation | 85256AA800623D7A852584D60053FD92 | 2160 | Outpatient Short-Term Rehabilitation Services Included in Capitation | 00.03.03 | {"2299": {"Id":2299,"MPAttachmentLetter":"A","Title":"No Title","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85256AA800623D7A852584D60053FD9A"},} |
| | | 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"},} |
| | | 10.03.01n | OutpatientPhysicalMedicine,Rehabilitation,andHabilitationServices10.03.01n | Rehabilitation Services (10) | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | 76d186c0-c542-43dd-8e33-3aaea42e5b7e | 4506 | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | 10.03.01 | |
| | | 11.06.07d | OvarianandInternalIliacVeinEmbolizationasTreatmentforPelvicCongestionSyndrome11.06.07d | Surgery (11) | Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome | 061c3d86-e3e2-4606-9fd2-dd7fe3b4fbbf | 4740 | Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome | 11.06.07 | |
| | | 08.00.90n | PaclitaxelProtein-BoundParticlesforInjectableSuspension(Albumin-Bound)/(Abraxane®forInjectableSuspension)08.00.90n | Pharmacy (08) | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 43d77fe7-54b4-4d0a-81da-d5b56212e00a | 4504 | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 08.00.90 | {"4505": {"Id":4505,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6471,"PolicyAttachmentPageName":"bf3d2e46-bd61-4844-965c-616a2676fd03"},} |
| | | 07.03.27 | PainManagementofPeripheralNervesbyInjection07.03.27 | Medicine (07) | Pain Management of Peripheral Nerves by Injection | 50efa1a4-b418-436b-96af-ddb337a3d794 | 4181 | Pain Management of Peripheral Nerves by Injection | 07.03.27 | |
| | | 11.08.06j | Panniculectomy,Abdominoplasty,AbdominalLipectomy,andOtherExcisionsofRedundantSkin11.08.06j | Surgery (11) | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 1018d313-6208-49eb-bacc-c6c8c2bf3ffa | 4281 | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06 | {"4282": {"Id":4282,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6343,"PolicyAttachmentPageName":"910a2b28-f343-4568-b67f-0afb59acd9e4"},} |
| | | 07.10.04c | ParenterallyAdministeredTerbutalineSulfateforthePreventionorTreatmentofPre-TermLabor07.10.04c | Medicine (07) | Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor | a7ac860f-25cd-450e-a665-d346cba3fa5b | 4283 | Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor | 07.10.04 | |
| | | 07.13.08e | PartialCoherenceInterferometry07.13.08e | Medicine (07) | Partial Coherence Interferometry | 5e213089-7669-4f39-ad66-d169e55dd350 | 4226 | Partial Coherence Interferometry | 07.13.08 | {"4227": {"Id":4227,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6287,"PolicyAttachmentPageName":"943756cc-c0d7-446a-9980-936a7aadacfe"},} |
| | | 05.00.42h | PatientLifts05.00.42h | DME (05) | Patient Lifts | e91cf7a6-87c6-45da-937c-e6ad99367011 | 4355 | Patient Lifts | 05.00.42 | |
| | | 08.01.50b | Patisiran(Onpattro™)08.01.50b | Pharmacy (08) | Patisiran (Onpattro™) | 83f6649b-98c0-4c6b-bc44-1c40027e5c7a | 4809 | Patisiran (Onpattro™) | 08.01.50 | |
| | | 10.00.03 | PediatricIntensiveDayFeedingProgram10.00.03 | Rehabilitation Services (10) | Pediatric Intensive Day Feeding Program | cd5bc3c5-c5c7-4cfb-b4b4-596113cc11a0 | 4334 | Pediatric Intensive Day Feeding Program | 10.00.03 | |
| | | 08.01.02g | Pegloticase(Krystexxa®)08.01.02g | Pharmacy (08) | Pegloticase (Krystexxa®) | fc36adfc-16ee-4df5-92af-0447fc45ae6a | 4035 | Pegloticase (Krystexxa®) | 08.01.02 | {"4036": {"Id":4036,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":6066,"PolicyAttachmentPageName":"e467e12d-1404-4be4-b61f-e7c36dafe8f2"},} |
| | | 07.12.01e | Pelvic Floor Stimulation as a Treatment of Incontinence | Medicine (07) | Pelvic Floor Stimulation as a Treatment of Incontinence | 85256AA800623D7A85258596007D8BBB | 1777 | Pelvic Floor Stimulation as a Treatment of Incontinence | 07.12.01 | |
