|  | | 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 | 3874acde-f35a-4773-9128-b57b077f50b5 | 5395 | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 11.06.10 | |
| | | 11.08.03m | LipectomyandLiposuction11.08.03m | Surgery (11) | Lipectomy and Liposuction | a9305dbb-78ab-4c4a-888e-280db458b862 | 5702 | 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 | |
| | | 05.00.59l | LowerLimbProstheses05.00.59l | DME (05) | Lower Limb Prostheses | e75ec488-464c-4ff3-8b86-c84539ab60bd | 5040 | Lower Limb Prostheses | 05.00.59 | {"5041": {"Id":5041,"MPAttachmentLetter":"A","Title":"HCPCS Level II Code Number(s) and Narrative(s)","MPPolicyAttachmentInternalSourceId":6864,"PolicyAttachmentPageName":"5d4c7876-b09e-418c-b636-43a2ed867559"},} |
| | | 07.00.14g | Low-LevellaserTherapy07.00.14g | Medicine (07) | Low-Level laser Therapy | 6e817540-e45a-4589-a854-928064730d5a | 5003 | Low-Level laser Therapy | 07.00.14 | |
| | | 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 | |
| | | 08.01.67c | 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 | 4ad1cfa7-090d-4e50-901e-fefce9cc8ebe | 5479 | 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 | df76937c-c78f-4b13-afb1-eedc0c58be4d | 5183 | Maintenance Treatment of Opioid or Alcohol Use Disorder | 08.01.37 | {"5184": {"Id":5184,"MPAttachmentLetter":"A","Title":"ICD10 Codes","MPPolicyAttachmentInternalSourceId":7188,"PolicyAttachmentPageName":"6e6e1abb-fabe-43d6-b5ec-b082eab6e073"},} |
| | | 11.14.24b | ManipulationUnderAnesthesia11.14.24b | Surgery (11) | Manipulation Under Anesthesia | 1512f401-509b-4e8d-8e8c-66dd81580dfb | 5033 | Manipulation Under Anesthesia | 11.14.24 | |
| | | 05.00.12j | ManualWheelchairs05.00.12j | DME (05) | Manual Wheelchairs | aad25590-3c6e-4393-abd4-fdc897f4e357 | 5200 | Manual Wheelchairs | 05.00.12 | {"5201": {"Id":5201,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Manual Wheelchairs","MPPolicyAttachmentInternalSourceId":7194,"PolicyAttachmentPageName":"cd002ff1-aa24-44ca-b7b7-f87e169ebb66"},} |
| | | 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 | 7f27ada8-d669-4ec3-b68f-290aef45b5c6 | 5331 | 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 | b7fe7e35-7711-4fdd-82eb-f752fad6f821 | 5296 | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 05.00.70 | |
| | | 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 | |
| | | 12.01.02a | MedicalNecessity12.01.02a | Miscellaneous (12) | Medical Necessity | 90c53478-e5ad-4b94-9834-d76a9defa73c | 5056 | Medical Necessity | 12.01.02 | |
| | | 11.14.03h | MeniscalAllograftTransplantationandMeniscalImplants(IndependenceAdministrators)11.14.03h | Surgery (11) | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | ab9b0f50-63ad-4931-9745-9c521bfc4b02 | 5164 | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | 11.14.03 | {"5165": {"Id":5165,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":7283,"PolicyAttachmentPageName":"782f8d54-d2fa-430c-81d5-d6a595b24631"},} |
| | | 11.14.01h | MentoplastyorGenioplasty11.14.01h | Surgery (11) | Mentoplasty or Genioplasty | 86e5fd7e-aad4-4118-b434-e2a0fb9fc603 | 5634 | 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 | 29e06d23-ef41-43a6-9ff1-03d2c121acb2 | 5259 | Migraine Deactivation Surgery | 11.15.24 | |
| | | 08.02.01a | Mirvetuximabsoravtansine-gynx(ElahereTM)08.02.01a | Pharmacy (08) | Mirvetuximab soravtansine-gynx (Elahere TM) | 5a679ac6-c091-4f81-8384-68b9b275f8a1 | 5426 | Mirvetuximab soravtansine-gynx (Elahere TM) | 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 | |
| | | 03.00.06y | Modifier25:Significant,SeparatelyIdentifiableEvaluationandManagementServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalontheSameDayoftheProcedureorOtherService03.00.06y | 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 | 9a3e3a84-c187-4744-9def-256382432439 | 5694 | 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 | {"5695": {"Id":5695,"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":7842,"PolicyAttachmentPageName":"28fe0898-b6de-4364-aaab-321fe4c3dd09"},"5696": {"Id":5696,"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":7843,"PolicyAttachmentPageName":"3ea7875d-3260-44dc-ab92-a88919596897"},} |
| | | 03.00.05v | Modifier50:BilateralProcedure03.00.05v | Clinical Logic (03) | Modifier 50: Bilateral Procedure | 2598d97c-808c-4631-8edc-570f83982026 | 5692 | 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 | |
| | | 00.10.11w | Modifier62:TwoSurgeons00.10.11w | Administrative (00) | Modifier 62: Two Surgeons | e47573dd-7731-4e9a-bade-cb8ffb2981b4 | 5686 | Modifier 62: Two Surgeons | 00.10.11 | |
| | | 00.10.17n | Modifier66:SurgicalTeam00.10.17n | Administrative (00) | Modifier 66: Surgical Team | 8397a464-dfe4-4fe6-bef5-ba2486d9b27c | 5448 | Modifier 66: Surgical Team | 00.10.17 | {"5449": {"Id":5449,"MPAttachmentLetter":"A","Title":"Team Surgery Review Form","MPPolicyAttachmentInternalSourceId":7496,"PolicyAttachmentPageName":"5e0c4b67-0d3b-4ae1-bbbb-6f6a6146dab4"},} |
| | | 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 | |
| | | 03.00.20q | Modifiers26(ProfessionalComponent)andTC(TechnicalComponent)03.00.20q | Clinical Logic (03) | Modifiers 26 (Professional Component) and TC (Technical Component) | 06addacf-aba2-4801-8002-4a02e8d31b72 | 5445 | Modifiers 26 (Professional Component) and TC (Technical Component) | 03.00.20 | |
| | | 00.10.18u | ModifiersforAssistant-at-SurgeryServices:80,81,82,andAS00.10.18u | Administrative (00) | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 22975769-6113-410d-a49f-948a4743c483 | 5790 | 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 | d0e4489b-c807-4e43-9abb-a90f6f1cebdd | 4018 | Modifiers XE, XS, XP, XU, and 59 | 03.00.08 | |
| | | 08.01.52e | Mogamulizumab-kpkc(Poteligeo®)08.01.52e | Pharmacy (08) | Mogamulizumab-kpkc (Poteligeo®) | 7c095e43-8c2f-4cc6-bde8-ff7ce5d0d066 | 5764 | Mogamulizumab-kpkc (Poteligeo®) | 08.01.52 | |
| | | 11.08.23k | MohsMicrographicSurgery11.08.23k | Surgery (11) | Mohs Micrographic Surgery | 425d19c0-3f9f-4c60-81b3-44fa9ab11ba6 | 5703 | Mohs Micrographic Surgery | 11.08.23 | {"5704": {"Id":5704,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":7742,"PolicyAttachmentPageName":"0db64d66-edab-4b48-9377-ad8d251eb842"},} |
| | | 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 | |
| | | 08.01.93b | MonoclonalAntibodiesDirectedAgainstAmyloidfortheTreatmentofAlzheimer'sDisease08.01.93b | Pharmacy (08) | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | 9100f336-6896-4fc2-bb95-b5f56f97a2bf | 5826 | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | 08.01.93 | |
| | | 08.02.00a | Mosunetuzumab-axgb(Lunsumio™)08.02.00a | Pharmacy (08) | Mosunetuzumab-axgb (Lunsumio™) | 1c90381d-5c4e-41a7-b8a3-405061c1eadb | 5424 | Mosunetuzumab-axgb (Lunsumio™) | 08.02.00 | |
| | | 08.01.53b | MoxetumomabPasudotox-tdfk(Lumoxiti™)08.01.53b | Pharmacy (08) | Moxetumomab Pasudotox-tdfk (Lumoxiti™) | 5db42656-7643-4771-b865-b073924d040a | 5344 | 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) | 721d132a-c067-4496-9719-659f7dcda8ae | 5821 | 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"},} |
| | | 00.01.60i | MultipleProcedurePaymentReduction(MPPR)onCertainDiagnosticServices00.01.60i | Administrative (00) | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 29f4d728-6d59-4a42-9d5a-5024c351e0cf | 5701 | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 00.01.60 | {} |
| | | 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"},} |
| | | 00.01.66j | MusculoskeletalServices(Independence)00.01.66j | Administrative (00) | Musculoskeletal Services (Independence) | d550e9ec-ec5d-409c-b804-4c8ca7f5654e | 5827 | Musculoskeletal Services (Independence) | 00.01.66 | {"5828": {"Id":5828,"MPAttachmentLetter":"C","Title":"Procedures Codes for Interventional Pain Management","MPPolicyAttachmentInternalSourceId":7525,"PolicyAttachmentPageName":"22c02a08-8146-416d-85ef-10589aa5fdb4"},"5829": {"Id":5829,"MPAttachmentLetter":"B","Title":"Procedure Codes for Joint Surgery","MPPolicyAttachmentInternalSourceId":7527,"PolicyAttachmentPageName":"1d0060ae-1dd8-4c60-9f9e-5afff0db2954"},"5830": {"Id":5830,"MPAttachmentLetter":"A","Title":"Procedure Codes for Spinal Surgery","MPPolicyAttachmentInternalSourceId":7529,"PolicyAttachmentPageName":"87f9f3cd-126d-4008-9952-a47aeedf9ea9"},} |
| | | 08.02.11 | NadofarageneFiradenovec-vncg(Adstiladrin®)08.02.11 | Pharmacy (08) | Nadofaragene Firadenovec-vncg (Adstiladrin®) | 4dffeac0-500f-4393-82a0-acab6a2a68b6 | 5712 | Nadofaragene Firadenovec-vncg (Adstiladrin®) | 08.02.11 | |
| | | 08.00.64g | Natalizumab(Tysabri®)08.00.64g | Pharmacy (08) | Natalizumab (Tysabri®) | 38c9d73e-1854-43a4-a84e-996a8548f43d | 5029 | Natalizumab (Tysabri®) | 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 | |
| | | 05.00.15s | 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 | |
| | | 07.03.18t | 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 | 04c283f0-0d21-49f7-b081-f6509c7cf356 | 5028 | 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) | 9e05fb40-63e9-45e2-91c3-74caff5be60b | 5459 | 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 | 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"},} |
| | | 08.01.94b | nivolumabandrelatlimab-rmbw(Opdualag™)08.01.94b | Pharmacy (08) | nivolumab and relatlimab-rmbw (Opdualag™) | 4b656b5a-1933-4c05-a6e1-3c0d2797d402 | 5079 | 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 | 33583433-bcce-4f0e-9195-bc63df104ee3 | 5110 | 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) | 3d222c19-6bda-4fa0-af3c-0a8e4340e2d9 | 5284 | 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 | 66dfdaab-e8c1-46c1-b52f-5e6dcdc2d5b6 | 5590 | 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 | fd101826-54fe-400c-890f-b730a793bf36 | 5342 | 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 | f6faecec-f27c-495d-92b5-c51aa359eacd | 5034 | Non-Surgical Spinal Decompression Therapy | 07.08.01 | |
| | | 00.01.24j | NotMedicallyNecessaryServicesandObsoleteorUnreliableDiagnosticTests00.01.24j | Administrative (00) | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | ea1066ee-6337-40a1-8848-516c44b36058 | 5435 | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | 00.01.24 | |
| | | 11.15.19e | Nucleoplasty11.15.19e | Surgery (11) | Nucleoplasty | 791c320a-6657-46fd-9c81-6b7a599c6b6e | 5258 | Nucleoplasty | 11.15.19 | |
| | | 08.00.18p | NutritionalFormulas,EnteralNutrition,MedicalFoods,Low-ProteinModifiedFoodProducts,andDonatedBreastMilk08.00.18p | Pharmacy (08) | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 12e551b1-d2a2-4509-8a41-d9084930dbb2 | 5646 | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18 | {"5647": {"Id":5647,"MPAttachmentLetter":"A","Title":"PA Mandates","MPPolicyAttachmentInternalSourceId":7680,"PolicyAttachmentPageName":"4f8411b5-b08a-44b2-8cce-4ccb8367463b"},"5648": {"Id":5648,"MPAttachmentLetter":"C","Title":"Caloric Requirements","MPPolicyAttachmentInternalSourceId":7681,"PolicyAttachmentPageName":"4aa4984d-5169-445e-a413-b6de00a28703"},"5649": {"Id":5649,"MPAttachmentLetter":"B","Title":"NJ Mandates","MPPolicyAttachmentInternalSourceId":7682,"PolicyAttachmentPageName":"58eecbb8-38a3-4002-a197-cc14f27bebe1"},} |
| | | 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®) | ae1aeee4-6171-4fdd-8df9-4446b77289ad | 5226 | Ocrelizumab (Ocrevus®) | 08.01.38 | |
| | | 08.01.10h | OctreotideAcetate(Sandostatin®LARDepot)08.01.10h | Pharmacy (08) | Octreotide Acetate (Sandostatin® LAR Depot) | 4c196624-4864-4bb7-8aef-306caa06aa05 | 5508 | Octreotide Acetate (Sandostatin® LAR Depot) | 08.01.10 | {"5509": {"Id":5509,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7469,"PolicyAttachmentPageName":"27cb9574-e31d-4db2-b515-bdb36eabd04e"},} |
| | | 08.00.15f | Off-labelCoverageforPrescriptionDrugsand/orBiologics08.00.15f | Pharmacy (08) | Off-label Coverage for Prescription Drugs and/or Biologics | bb8577e0-65a6-4cae-b2ba-f2fd1e235004 | 5109 | 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™) | 2c6e3a0a-fcb3-4058-9e4e-484aa1d1f61a | 5130 | olipudase alfa-rpcp (Xenpozyme™) | 08.01.96 | {"5131": {"Id":5131,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for olipudase alfa-rpcp (Xenpozyme)","MPPolicyAttachmentInternalSourceId":7286,"PolicyAttachmentPageName":"df90b024-8c8b-4988-927e-671a59325f8b"},} |
| | | 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 | 3c7dd31a-3064-43f5-868b-c4c424d263a6 | 5257 | Orthognathic Surgery | 11.14.08 | |
| | | 07.13.01j | Orthoptic/PleopticTraining07.13.01j | Medicine (07) | Orthoptic/Pleoptic Training | 628dcdf2-33a8-45ba-a02e-0e112f82b75c | 5383 | Orthoptic/Pleoptic Training | 07.13.01 | |
| | | 11.14.12f | OsteochondralAllograftTransplantation(IndependenceAdministrators)11.14.12f | Surgery (11) | Osteochondral Allograft Transplantation (Independence Administrators) | a15b2285-73dc-4a44-b463-26b1270bf485 | 5166 | Osteochondral Allograft Transplantation (Independence Administrators) | 11.14.12 | |
| | | 11.14.09h | OsteochondralAutograftTransplantation(IndependenceAdministrators)11.14.09h | Surgery (11) | Osteochondral Autograft Transplantation (Independence Administrators) | 16c02493-eb9f-49fb-a1a7-7f82484d7036 | 5168 | 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 | ad7874c1-5b87-422a-8e18-dfd6233a4f02 | 5403 | Ostomy Supplies | 05.00.50 | {"5404": {"Id":5404,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Ostomy Supplies","MPPolicyAttachmentInternalSourceId":7436,"PolicyAttachmentPageName":"8f03d7bc-9d10-46d4-8b5a-48999e039382"},} |
| | | 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"},} |
| | | 10.03.01n | OutpatientPhysicalMedicine,Rehabilitation,andHabilitationServices10.03.01n | Rehabilitation Services (10) | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | 762b165d-283c-4311-9702-b234d9e22ef6 | 5386 | 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 | |
| | | 08.00.90o | PaclitaxelProtein-BoundParticlesforInjectableSuspension(Albumin-Bound)/(Abraxane®forInjectableSuspension)08.00.90o | Pharmacy (08) | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | c0f37485-6e6d-4890-87ac-958a671dc3cf | 5706 | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 08.00.90 | {"5707": {"Id":5707,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":7456,"PolicyAttachmentPageName":"8eb8395b-7918-418f-964b-21c25369f908"},} |
| | | 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) | 39568f1b-da2d-4cf7-be38-eece3020bcd5 | 5575 | 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 | 6cab2bf4-56db-4b38-a0ea-b28bcd932878 | 5254 | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06 | {"5255": {"Id":5255,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":7380,"PolicyAttachmentPageName":"3e6d76c6-7600-4f34-a86c-6dc44d3b4847"},} |
| | | 07.10.04c | ParenterallyAdministeredTerbutalineSulfateforthePreventionorTreatmentofPre-TermLabor07.10.04c | Medicine (07) | Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor | da49e163-42c4-457c-81c5-0d8db51da00d | 5393 | 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 | 7e6b1434-60a9-428f-9f5d-72af4318a332 | 5067 | Partial Coherence Interferometry | 07.13.08 | {"5068": {"Id":5068,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7218,"PolicyAttachmentPageName":"3246dbfc-62a2-4a7e-9892-e3a705b06be2"},} |
