|  | | 08.01.40h | Lanreotide(Somatuline®Depot)08.01.40h | Pharmacy (08) | Lanreotide (Somatuline® Depot) | 49ab2f8b-b69e-401e-9fe1-8a9c9bb85fa6 | 7864 | Lanreotide (Somatuline® Depot) | 08.01.40 | |
| | | 11.06.10a | Laparoscopic,Percutaneous,andTranscervicalTechniquesforUterineFibroidMyolysis11.06.10a | Surgery (11) | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 7cb6147b-0351-40af-bc3b-627ced21e384 | 7144 | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 11.06.10 | |
| | | 07.03.28 | LaserInterstitialThermalTherapy(LITT)07.03.28 | Medicine (07) | Laser Interstitial Thermal Therapy (LITT) | 61138da3-c82e-499e-bd9e-f4c4dc35ade8 | 7998 | Laser Interstitial Thermal Therapy (LITT) | 07.03.28 | |
| | | 05.00.85 | LeadlessPacemakers05.00.85 | DME (05) | Leadless Pacemakers | 4c87ee4b-3879-41b0-a8e4-38d7a90e83a4 | 8082 | Leadless Pacemakers | 05.00.85 | |
| | | 08.01.33l | Leuprolide(Camcevi™,Eligard®,Fensolvi®,LupronDepot®)08.01.33l | Pharmacy (08) | Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®) | f550ec90-d982-463f-85d2-5c1f40986e13 | 7971 | Leuprolide (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®) | 08.01.33 | {"7972": {"Id":7972,"MPAttachmentLetter":"A","Title":"LEUPROLIDE ACETATE (LUPRON DEPOT - J1950)","MPPolicyAttachmentInternalSourceId":10143,"PolicyAttachmentPageName":"65486b89-ae43-46e1-b7ad-fc5119f8d95c"},"7973": {"Id":7973,"MPAttachmentLetter":"D","Title":"LEUPROLIDE ACETATE (ELIGARD and LUPRON DEPOT- J9217)","MPPolicyAttachmentInternalSourceId":10144,"PolicyAttachmentPageName":"1c865b2c-1da0-4161-8a92-ea35ae22fe32"},"7974": {"Id":7974,"MPAttachmentLetter":"B","Title":"LEUPROLIDE ACETATE (FENSOLVI- J1951)","MPPolicyAttachmentInternalSourceId":10145,"PolicyAttachmentPageName":"a86e9b5a-29cf-49d7-8220-02dcfcefa167"},"7975": {"Id":7975,"MPAttachmentLetter":"C","Title":"LEUPROLIDE MESYLATE (CAMCEVI- J1952)","MPPolicyAttachmentInternalSourceId":10146,"PolicyAttachmentPageName":"02cd5dd9-b9a5-4724-8cad-5e2a983e56d3"},} |
| | | 08.02.22 | Lifileucel(Amtagvi™)08.02.22 | Pharmacy (08) | Lifileucel (Amtagvi™) | 5e951dd7-701e-4426-8ad9-34d344d268ad | 7583 | Lifileucel (Amtagvi™) | 08.02.22 | |
| | | 08.02.47a | linvoseltamab-gcpt(Lynozyfic™)08.02.47a | Pharmacy (08) | linvoseltamab-gcpt (Lynozyfic™) | e06caf51-5dd6-4271-afb4-80cb39f9f7b7 | 8072 | linvoseltamab-gcpt (Lynozyfic™) | 08.02.47 | |
| | | 11.08.03n | LipectomyandLiposuction11.08.03n | Surgery (11) | Lipectomy and Liposuction | c0c84e9a-8f7c-447a-987e-8f06e1427168 | 7612 | Lipectomy and Liposuction | 11.08.03 | |
| | | 08.00.59d | Loncastuximabtesirine-lpyl(Zynlonta®)08.00.59d | Pharmacy (08) | Loncastuximab tesirine-lpyl (Zynlonta®) | 33096ed0-c39d-40a3-84fd-fc952ef3353a | 7867 | Loncastuximab tesirine-lpyl (Zynlonta®) | 08.00.59 | |
| | | 08.02.15 | Lovotibeglogeneautotemcel(Lyfgenia®)08.02.15 | Pharmacy (08) | Lovotibeglogene autotemcel (Lyfgenia®) | 7669b33a-17a0-4fcf-9d22-10e1b3cac3bf | 7960 | Lovotibeglogene autotemcel (Lyfgenia®) | 08.02.15 | |
| | | 05.00.59q | LowerLimbProstheses05.00.59q | DME (05) | Lower Limb Prostheses | 2c7175ba-ee11-493b-9aaa-e8994d79f5e7 | 7630 | Lower Limb Prostheses | 05.00.59 | {"7631": {"Id":7631,"MPAttachmentLetter":"A","Title":"HCPCS Level II Code Number(s) and Narrative(s)","MPPolicyAttachmentInternalSourceId":9927,"PolicyAttachmentPageName":"ee485e29-f96c-47ac-94e9-3caf9379b29e"},} |
| | | 09.00.31d | LowOsmolarContrastAgents09.00.31d | Radiology (09) | Low Osmolar Contrast Agents | 7b338562-e52b-482b-9227-1f0dd2d7863d | 7117 | Low Osmolar Contrast Agents | 09.00.31 | |
| | | 08.01.74c | Lumasiran(Oxlumo®)08.01.74c | Pharmacy (08) | Lumasiran (Oxlumo®) | 5578a622-d6ed-43e7-9719-0cffa125128e | 7987 | Lumasiran (Oxlumo®) | 08.01.74 | |
| | | 08.01.67c | Lurbinectedin(Zepzelca®)08.01.67c | Pharmacy (08) | Lurbinectedin (Zepzelca®) | 0d45e6ba-edb0-4f36-ab1e-70ab4aeea4d5 | 7378 | Lurbinectedin (Zepzelca®) | 08.01.67 | |
| | | 08.00.10d | Luspatercept–aamt(Reblozyl®)08.00.10d | Pharmacy (08) | Luspatercept–aamt (Reblozyl®) | ea7d0d72-9202-485d-af9f-4433b3b40266 | 7926 | Luspatercept–aamt (Reblozyl®) | 08.00.10 | |
| | | 08.01.57a | Lutathera®(LutetiumLu177Dotatate)(IndependenceAdministrators)08.01.57a | Pharmacy (08) | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 1badf96b-891e-4a73-85aa-80b5741a373d | 7067 | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 08.01.57 | |
| | | 06.02.01l | LymeDisease:DiagnosisandIntravenous(IV)AntibioticTherapy06.02.01l | Pathology and Laboratory (06) | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | 76c6898f-3c5c-441f-b7f2-d5d8043fea03 | 7985 | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | 06.02.01 | |
| | | 09.00.45l | MagneticResonanceImaging(MRI)ContrastAgents09.00.45l | Radiology (09) | Magnetic Resonance Imaging (MRI) Contrast Agents | 842f387c-3050-40e0-b4d3-ef625f1df0e6 | 7123 | Magnetic Resonance Imaging (MRI) Contrast Agents | 09.00.45 | |
| | | 11.06.06h | MagneticResonanceImaging(MRI)-GuidedFocusedUltrasoundAblation11.06.06h | Surgery (11) | Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation | afa5e60b-5ca2-4ab8-9ee2-a62ae7813452 | 7648 | Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation | 11.06.06 | |
| | | 08.01.37f | MaintenanceTreatmentofOpioidorAlcoholUseDisorder08.01.37f | Pharmacy (08) | Maintenance Treatment of Opioid or Alcohol Use Disorder | 60af25db-29b5-44f8-b1e8-b0eb1ba1376e | 7522 | Maintenance Treatment of Opioid or Alcohol Use Disorder | 08.01.37 | {"7523": {"Id":7523,"MPAttachmentLetter":"A","Title":"ICD10 Codes","MPPolicyAttachmentInternalSourceId":9529,"PolicyAttachmentPageName":"181536e5-bc82-4ebe-a756-3ac8e8923748"},} |
| | | 11.14.24b | ManipulationUnderAnesthesia11.14.24b | Surgery (11) | Manipulation Under Anesthesia | 1f859342-533d-4b66-bbd6-54f0bac445cb | 7369 | Manipulation Under Anesthesia | 11.14.24 | |
| | | 05.00.12j | ManualWheelchairs05.00.12j | DME (05) | Manual Wheelchairs | 3a597001-f41b-4206-bf7c-4bcde9bb1f49 | 7213 | Manual Wheelchairs | 05.00.12 | {"7214": {"Id":7214,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Manual Wheelchairs","MPPolicyAttachmentInternalSourceId":9532,"PolicyAttachmentPageName":"1bb9f7e3-ae5c-4eb0-b44d-97a7cc1a98c9"},} |
| | | 08.01.75e | Margetuximab-cmkb(Margenza)08.01.75e | Pharmacy (08) | Margetuximab-cmkb (Margenza) | bbb28fb9-a7a7-4f61-98c6-c7e019be2768 | 7639 | Margetuximab-cmkb (Margenza) | 08.01.75 | {"7640": {"Id":7640,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":9960,"PolicyAttachmentPageName":"3f1a2ce6-af05-4059-b1ad-6fa6e80071d9"},} |
| | | 00.01.48d | MarijuanaforMedicalUse00.01.48d | Administrative (00) | Marijuana for Medical Use | 41ce0a90-0284-4aad-8ba0-e001ddce9ac4 | 7114 | 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 | 50143300-6135-4ffb-a79c-f7b4833b48a5 | 7701 | 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 | 3ce5af25-de65-47cd-81e0-d10fe8ffa5bd | 7709 | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | 06.02.39 | |
| | | 05.00.70e | MechanicalStretchingDevicesfortheTreatmentofJointStiffnessorContractures05.00.70e | DME (05) | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | c30a107a-1268-4569-b6d0-27e8055ae164 | 7487 | 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 | 1693c098-7ceb-48b4-91ee-8fe20c1e5180 | 7549 | Medical and Surgical Treatment of Temporomandibular Joint Disorder | 07.08.03 | |
| | | 12.01.02c | MedicalNecessity12.01.02c | Miscellaneous (12) | Medical Necessity | 8e68d012-75c2-4f03-8120-09304faa0885 | 7945 | Medical Necessity | 12.01.02 | |
| | | 10.00.04 | MedicalNutritionTherapy(MNT)/NutritionCounseling10.00.04 | Rehabilitation Services (10) | Medical Nutrition Therapy (MNT)/Nutrition Counseling | 19864647-f186-48ce-98f8-413a4c31b07d | 7238 | Medical Nutrition Therapy (MNT)/Nutrition Counseling | 10.00.04 | |
| | | 11.14.03h | MeniscalAllograftTransplantationandMeniscalImplants(IndependenceAdministrators)11.14.03h | Surgery (11) | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | 25211264-967d-4b51-937b-9ecec7da40e3 | 7281 | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | 11.14.03 | {"7282": {"Id":7282,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":9615,"PolicyAttachmentPageName":"44c5ae09-d27d-4b1d-ad53-ba9552acb470"},} |
| | | 11.14.01i | MentoplastyorGenioplasty11.14.01i | Surgery (11) | Mentoplasty or Genioplasty | 6e26f5c1-e1c5-41f4-b4c0-bfb1590510b5 | 7613 | Mentoplasty or Genioplasty | 11.14.01 | |
| | | 11.14.21l | Microprocessor-ControlledProsthesesforLower-ExtremityAmputees11.14.21l | Surgery (11) | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | 88f1c4ce-5632-416b-8ad3-3f936809daca | 7643 | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | 11.14.21 | |
| | | 11.15.24a | MigraineDeactivationSurgery11.15.24a | Surgery (11) | Migraine Deactivation Surgery | ddc01368-8e57-4a6b-8681-95369d0e81fa | 7370 | Migraine Deactivation Surgery | 11.15.24 | |
| | | 08.02.19a | Mirikizumab-mrkz(Omvoh®)forIntravenousUse08.02.19a | Pharmacy (08) | Mirikizumab-mrkz (Omvoh®) for Intravenous Use | ab7e1984-9028-44df-9c5c-54c043afddd4 | 7994 | Mirikizumab-mrkz (Omvoh®) for Intravenous Use | 08.02.19 | |
| | | 08.02.01c | Mirvetuximabsoravtansine-gynx(Elahere®)08.02.01c | Pharmacy (08) | Mirvetuximab soravtansine-gynx (Elahere®) | e4e8a2f9-d080-4d1e-96e9-f96e2903fda2 | 7421 | 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 | c8f3f51c-0c96-475b-8136-12c074cfa3f8 | 7115 | Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | 03.00.15 | |
| | | 03.00.06ad | Modifier25:Significant,SeparatelyIdentifiableEvaluationandManagementServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalontheSameDayoftheProcedureorOtherService03.00.06ad | 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 | 6ee4715f-8eb3-4d48-81ed-ab4fceb6de72 | 8103 | 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 | {"8104": {"Id":8104,"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":10374,"PolicyAttachmentPageName":"9c5d7029-ec99-4b8f-8cf4-b234251c29fe"},"8105": {"Id":8105,"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":10375,"PolicyAttachmentPageName":"b78fa268-a8de-4404-927a-6514024cf1f5"},} |
| | | 03.00.05z | Modifier50:BilateralProcedure03.00.05z | Clinical Logic (03) | Modifier 50: Bilateral Procedure | fa6af219-5eba-4d42-863b-a2ff5d9ad211 | 6915 | Modifier 50: Bilateral Procedure | 03.00.05 | |
| | | 03.00.32b | Modifier52:ReducedServices03.00.32b | Clinical Logic (03) | Modifier 52: Reduced Services | 0a42637d-deea-46d6-be21-a7750ef4d7d8 | 7149 | Modifier 52: Reduced Services | 03.00.32 | |
| | | 03.00.33b | Modifier53:DiscontinuedProcedure03.00.33b | Clinical Logic (03) | Modifier 53: Discontinued Procedure | 4e1abf3f-5293-42d0-b483-25ca7cf81be2 | 7124 | Modifier 53: Discontinued Procedure | 03.00.33 | |
| | | 03.00.16p | Modifier57:DecisionforSurgery03.00.16p | Clinical Logic (03) | Modifier 57: Decision for Surgery | 98d32768-32b9-4553-a1ac-9c571bc6aa0c | 7125 | Modifier 57: Decision for Surgery | 03.00.16 | |
| | | 00.10.11ab | Modifier62:TwoSurgeons00.10.11ab | Administrative (00) | Modifier 62: Two Surgeons | 122b6437-68a7-47a3-ad58-b8d7b6959500 | 6916 | 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 | 36c667e5-e1a4-4010-8816-8d623ee12ef5 | 7277 | 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 | ea69561c-4d49-450e-be14-e49a18b0cd07 | 7280 | 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 | 8d4cf872-776e-4387-9873-d5b44d412d63 | 7118 | 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 | d0d46862-b3f1-4581-85c8-f7dba61383a7 | 7116 | Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | 03.00.28 | |
| | | 03.00.20t | Modifiers26(ProfessionalComponent)andTC(TechnicalComponent)03.00.20t | Clinical Logic (03) | Modifiers 26 (Professional Component) and TC (Technical Component) | 42f028a1-e4b4-4c50-82cb-05fc6c8314d0 | 7089 | Modifiers 26 (Professional Component) and TC (Technical Component) | 03.00.20 | |
| | | 00.10.18y | ModifiersforAssistant-at-SurgeryServices:80,81,82,andAS00.10.18y | Administrative (00) | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 6f51046e-5480-4081-8e50-e246466d3c73 | 6746 | 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) | 00ce3785-e1f6-469b-8740-49745aed74c6 | 7278 | 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 | |
| | | 08.01.52g | Mogamulizumab-kpkc(Poteligeo®)08.01.52g | Pharmacy (08) | Mogamulizumab-kpkc (Poteligeo®) | afddda48-b166-4ec0-9c66-f9932eea7dab | 7450 | Mogamulizumab-kpkc (Poteligeo®) | 08.01.52 | |
| | | 11.08.23k | MohsMicrographicSurgery11.08.23k | Surgery (11) | Mohs Micrographic Surgery | d3d64e64-0eb6-4470-bcbd-d244e85018f7 | 7469 | Mohs Micrographic Surgery | 11.08.23 | {"7470": {"Id":7470,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":9770,"PolicyAttachmentPageName":"2bec2535-0b31-4cd2-b625-6c0c3a17a026"},} |
| | | 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) | 318518bd-cac0-412c-9db5-5ffdf849a5e7 | 7139 | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | 06.02.36 | |
| | | 08.01.93f | MonoclonalAntibodiesDirectedAgainstAmyloidfortheTreatmentofAlzheimer'sDisease08.01.93f | Pharmacy (08) | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | c168512d-283f-4bdd-aafa-35892dc0a774 | 7999 | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease | 08.01.93 | |
| | | 08.02.00c | Mosunetuzumab-axgb(Lunsumio™)08.02.00c | Pharmacy (08) | Mosunetuzumab-axgb (Lunsumio™) | 47cedcf2-1cae-4f41-abea-e341b165ec2f | 7423 | 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) | c4ee5de7-ee3f-4527-8a30-6f7eaa1f6193 | 7129 | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators) | 06.02.32 | |
| | | 00.01.60j | MultipleProcedurePaymentReduction(MPPR)onCertainDiagnosticServices00.01.60j | Administrative (00) | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | c972b201-a6ab-4a67-818e-e255f476ba5b | 7606 | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 00.01.60 | |
| | | 00.01.68c | MultipleProcedurePaymentReductionGuidelinesforPhysical,Occupational,andSpeechTherapyServices00.01.68c | Administrative (00) | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 564864a0-8ea3-43f5-8dfb-528b36fb1ab0 | 7571 | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 00.01.68 | |
| | | 11.00.10y | MultipleSurgeryPaymentReduction11.00.10y | Surgery (11) | Multiple Surgery Payment Reduction | 10b463d3-2bb6-459b-8b1d-f17a56eb5f88 | 6954 | Multiple Surgery Payment Reduction | 11.00.10 | {} |
| | | 00.01.66r | MusculoskeletalServices(Independence)00.01.66r | Administrative (00) | Musculoskeletal Services (Independence) | 0c837d5e-9027-4cca-a3bd-71d0c8e4f676 | 8090 | Musculoskeletal Services (Independence) | 00.01.66 | {"8091": {"Id":8091,"MPAttachmentLetter":"B","Title":"Procedure Codes for Joint Surgery","MPPolicyAttachmentInternalSourceId":10352,"PolicyAttachmentPageName":"191f327c-d7b6-4200-acbc-c9b0deb7ffba"},"8092": {"Id":8092,"MPAttachmentLetter":"C","Title":"Procedures Codes for Interventional Pain Management","MPPolicyAttachmentInternalSourceId":10353,"PolicyAttachmentPageName":"5ff86257-64c8-498d-a40f-ac5ac1b6e753"},"8093": {"Id":8093,"MPAttachmentLetter":"A","Title":"Procedure Codes for Spinal Surgery","MPPolicyAttachmentInternalSourceId":10354,"PolicyAttachmentPageName":"e8b285bc-999e-4c56-b697-6f56bca8a0e4"},} |
| | | 08.02.11b | NadofarageneFiradenovec-vncg(Adstiladrin®)08.02.11b | Pharmacy (08) | Nadofaragene Firadenovec-vncg (Adstiladrin®) | 915d8a05-6b81-4695-8e7b-86235d475ebb | 7587 | Nadofaragene Firadenovec-vncg (Adstiladrin®) | 08.02.11 | |
| | | 08.00.64i | Natalizumab(Tysabri®)andRelatedBiosimilars08.00.64i | Pharmacy (08) | Natalizumab (Tysabri®) and Related Biosimilars | 60499be5-e781-4cd8-8c44-753f5865b9e6 | 7705 | Natalizumab (Tysabri®) and Related Biosimilars | 08.00.64 | |
| | | 05.00.15t | NebulizersandInhalationSolutions05.00.15t | DME (05) | Nebulizers and Inhalation Solutions | ee6835d3-6921-4c1b-9f1e-8152f32a9b86 | 7553 | Nebulizers and Inhalation Solutions | 05.00.15 | |
| | | 05.00.38m | NegativePressureWoundTherapySystems05.00.38m | DME (05) | Negative Pressure Wound Therapy Systems | f479b721-14a0-4c2b-9858-9074d0837048 | 7263 | Negative Pressure Wound Therapy Systems | 05.00.38 | |
| | | 06.02.38d | NerveFiberDensityTesting06.02.38d | Pathology and Laboratory (06) | Nerve Fiber Density Testing | ca7091bf-314c-48b5-ae84-d8ea7fff5ed7 | 7700 | 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) | 9c674419-fc1b-4b7b-9bd9-524c6c26b153 | 7400 | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | 05.00.73 | |
| | | 07.03.08o | NeuropsychologicalTestingforNeurologicallyBasedConditions07.03.08o | Medicine (07) | Neuropsychological Testing for Neurologically Based Conditions | 55422027-f2a5-4dde-bf7f-2b2acc7f7ad7 | 7480 | Neuropsychological Testing for Neurologically Based Conditions | 07.03.08 | {"7481": {"Id":7481,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":9705,"PolicyAttachmentPageName":"04fb1170-f407-4c32-8e1a-b7cc140927f1"},} |
| | | 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"},} |
| | | 08.02.43 | Nipocalimab-aahu(Imaavy)08.02.43 | Pharmacy (08) | Nipocalimab-aahu (Imaavy) | cfdc4c51-5ea6-44b4-ab80-f0fcd80ce9b6 | 8023 | Nipocalimab-aahu (Imaavy) | 08.02.43 | |
| | | 08.01.62f | Nivolumab(Opdivo®),NivolumabandHyaluronidase-nvhy(OpdivoQvantig™)08.01.62f | Pharmacy (08) | Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™) | f62336b5-247f-4b86-a49a-03e0bd1b74e6 | 7461 | Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™) | 08.01.62 | |
| | | 08.01.94d | NivolumabandRelatlimab-rmbw(Opdualag™)forintravenoususe08.01.94d | Pharmacy (08) | Nivolumab and Relatlimab-rmbw (Opdualag™) for intravenous use | 56fc0579-a473-4c4f-9b5b-3535eefaf742 | 7428 | Nivolumab and Relatlimab-rmbw (Opdualag™) for intravenous use | 08.01.94 | |
| | | 08.02.26 | Nogapendekinalfainbakicept-pmln(Anktiva®)08.02.26 | Pharmacy (08) | Nogapendekin alfa inbakicept-pmln (Anktiva®) | 890ce77d-ed04-426d-ab27-24cbc93ff86d | 7291 | Nogapendekin alfa inbakicept-pmln (Anktiva®) | 08.02.26 | |
| | | 07.10.05n | NoncontraceptiveUseoftheLevonorgestrel-ReleasingIntrauterineSystem07.10.05n | Medicine (07) | Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System | 58ac6a1c-c053-46c1-90e9-1465fda1ef04 | 7148 | 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 | 062fe04d-94fe-43b3-8760-d519fb737a0f | 7819 | Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home | 07.03.25 | |
| | | 06.02.47f | NoninvasivePrenatalScreeningforFetalAneuploidiesUsingCell-FreeFetalDNA(IndependenceAdministrators)06.02.47f | Pathology and Laboratory (06) | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators) | 811619c0-0b97-43bc-8d26-df32275515be | 7957 | 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 | 2ed2df62-74cd-455b-a5c4-09e141ca7f2e | 7824 | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (APAP) and Bi-Level Devices | 05.00.30 | |
| | | 06.02.56i | NoninvasiveTechniquesfortheEvaluationandMonitoringofIndividualswithChronicLiverDisease06.02.56i | Pathology and Laboratory (06) | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | cf2a56d4-1dec-4a68-8d2b-98bbbd5a8b9a | 7702 | 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 | a04f40a1-7c03-4700-a798-9ea21528318e | 7478 | Non-Surgical Spinal Decompression Therapy | 07.08.01 | |
| | | 00.01.24n | NotMedicallyNecessaryServicesandObsoleteorUnreliableDiagnosticTests00.01.24n | Administrative (00) | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | c4fb6cb1-0d20-412f-b26d-eb25508b191d | 8102 | Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests | 00.01.24 | |
| | | 11.15.19e | Nucleoplasty11.15.19e | Surgery (11) | Nucleoplasty | e67c4535-7abc-41e3-9007-dd2d096f79a7 | 8113 | 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 | bc0ab493-0aa0-4b75-9cb4-07bcd62a6662 | 7796 | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18 | {"7797": {"Id":7797,"MPAttachmentLetter":"A","Title":"PA Mandates","MPPolicyAttachmentInternalSourceId":10117,"PolicyAttachmentPageName":"4aaeffc3-31b1-4d3f-875b-cfe13b970e3a"},"7798": {"Id":7798,"MPAttachmentLetter":"B","Title":"NJ Mandates","MPPolicyAttachmentInternalSourceId":10118,"PolicyAttachmentPageName":"37b0fe20-d91d-45c9-8dbe-c7cd5866a174"},"7799": {"Id":7799,"MPAttachmentLetter":"C","Title":"Caloric Requirements","MPPolicyAttachmentInternalSourceId":10119,"PolicyAttachmentPageName":"6d82e10f-aa7c-450e-a695-c42eeeb7f2c9"},} |
| | | 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 | 835c6e68-323d-47d9-a5fa-d00ad1d1d138 | 7892 | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | 00.03.10 | {"7893": {"Id":7893,"MPAttachmentLetter":"B","Title":"Rule out Ectopic Pregnancy","MPPolicyAttachmentInternalSourceId":10179,"PolicyAttachmentPageName":"7e330d98-915a-4f15-a4a3-5d0f622c3063"},"7894": {"Id":7894,"MPAttachmentLetter":"A","Title":"High Risk Pregnancy","MPPolicyAttachmentInternalSourceId":10180,"PolicyAttachmentPageName":"4e44edae-3120-4c35-a052-ef92cf583650"},"7895": {"Id":7895,"MPAttachmentLetter":"D","Title":"First-trimester screening and Ovarian Dysfunction","MPPolicyAttachmentInternalSourceId":10181,"PolicyAttachmentPageName":"12750719-48fe-4955-a068-0c31fe6cdefe"},"7896": {"Id":7896,"MPAttachmentLetter":"C","Title":"Rule out intrauterine pathology and Screening for Fetal abnormalities","MPPolicyAttachmentInternalSourceId":10182,"PolicyAttachmentPageName":"12b0fd06-ce41-484e-9220-c5acd87fa405"},} |
| | | 08.01.38e | Ocrelizumab(Ocrevus®)andOcrelizumabandHyaluronidase-ocsq(OcrevusZunovo™)08.01.38e | Pharmacy (08) | Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™) | 76cc3a44-f541-498c-bcff-1710dca05a88 | 7706 | Ocrelizumab (Ocrevus®) and Ocrelizumab and Hyaluronidase-ocsq (Ocrevus Zunovo™) | 08.01.38 | |
| | | 08.01.10k | OctreotideAcetate(Sandostatin®LARDepot)08.01.10k | Pharmacy (08) | Octreotide Acetate (Sandostatin® LAR Depot) | ce96548b-3284-47c9-bfff-857033521515 | 7559 | Octreotide Acetate (Sandostatin® LAR Depot) | 08.01.10 | |
| | | 08.00.15g | Off-labelCoverageforPrescriptionDrugsand/orBiologics08.00.15g | Pharmacy (08) | Off-label Coverage for Prescription Drugs and/or Biologics | c8ae5c2b-f1c8-4af0-b7fc-32435048ee11 | 7455 | 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®) | c9bfe61b-4404-42fa-985b-523467cb92fb | 7119 | olipudase alfa-rpcp (Xenpozyme®) | 08.01.96 | {"7120": {"Id":7120,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for olipudase alfa-rpcp (Xenpozyme)","MPPolicyAttachmentInternalSourceId":9383,"PolicyAttachmentPageName":"301fcbf8-d553-4290-b19f-b19d5709f8d0"},} |
| | | 08.00.55m | Omalizumab(Xolair®)08.00.55m | Pharmacy (08) | Omalizumab (Xolair®) | 7c2b5d53-38a2-4922-9d65-e6950a32045f | 7933 | Omalizumab (Xolair®) | 08.00.55 | {"7934": {"Id":7934,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Omalizumab (Xolair®)","MPPolicyAttachmentInternalSourceId":10095,"PolicyAttachmentPageName":"832a359c-8d6d-4711-bef8-4d4ce3d04ffb"},} |
| | | 11.14.08d | OrthognathicSurgery11.14.08d | Surgery (11) | Orthognathic Surgery | 9e930706-7ab2-4d76-987c-4ba8d0906839 | 7552 | Orthognathic Surgery | 11.14.08 | |
| | | 07.13.01k | Orthoptic/PleopticTraining07.13.01k | Medicine (07) | Orthoptic/Pleoptic Training | a62072e0-ec9c-40ee-ab1f-9f620fb62cc2 | 7409 | Orthoptic/Pleoptic Training | 07.13.01 | |
| | | 11.14.12f | OsteochondralAllograftTransplantation(IndependenceAdministrators)11.14.12f | Surgery (11) | Osteochondral Allograft Transplantation (Independence Administrators) | e3a72b6f-9848-4020-91f2-2a4bbb719656 | 7211 | Osteochondral Allograft Transplantation (Independence Administrators) | 11.14.12 | |
| | | 11.14.09h | OsteochondralAutograftTransplantation(IndependenceAdministrators)11.14.09h | Surgery (11) | Osteochondral Autograft Transplantation (Independence Administrators) | 08c59b35-a7e1-44ee-ad88-b5952bf11f2e | 7212 | Osteochondral Autograft Transplantation (Independence Administrators) | 11.14.09 | |
| | | 05.00.81a | OsteogenicStimulators(non-invasive,invasive/semi-invasive,electricalandultrasound)05.00.81a | DME (05) | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | db8b38d9-afb4-44dc-88d3-6f3ef1359e36 | 7250 | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | 05.00.81 | |
| | | 05.00.50o | OstomySupplies05.00.50o | DME (05) | Ostomy Supplies | 2d20a6c6-b436-4c6f-a66e-02f7baf5e3c6 | 7393 | Ostomy Supplies | 05.00.50 | {"7394": {"Id":7394,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Ostomy Supplies","MPPolicyAttachmentInternalSourceId":9673,"PolicyAttachmentPageName":"ab08f967-0657-4856-a897-3410dad31492"},} |
| | | 11.01.01j | OtoplastyorNon-SurgicalExternalEarMolding11.01.01j | Surgery (11) | Otoplasty or Non-Surgical External Ear Molding | 0891cd84-991c-4f5f-9bd3-ec876955b29e | 7578 | 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 | b6e3a3fc-871c-4f55-9f9c-ec034c60c9c4 | 7906 | Outpatient Diabetes Education and Self-Management Training | 12.05.01 | {"7907": {"Id":7907,"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":10190,"PolicyAttachmentPageName":"c6eb518f-d9d8-4765-b8cc-6815e05ec75c"},"7908": {"Id":7908,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E08.00- E10.3491)","MPPolicyAttachmentInternalSourceId":10191,"PolicyAttachmentPageName":"d9ca1aca-bd97-4dbc-99a7-1061081b779f"},"7909": {"Id":7909,"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":10192,"PolicyAttachmentPageName":"9e63aaae-a5fa-45cf-a2a4-cc581e434a78"},} |
| | | 10.03.01o | OutpatientPhysicalMedicine,Rehabilitation,andHabilitationServices10.03.01o | Rehabilitation Services (10) | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | a271ecc0-e4fb-48eb-bd90-35e6487774e6 | 7497 | 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 | 206c8ced-a37f-4d71-b838-93e7a56ea015 | 7881 | Outpatient Short-Term Rehabilitation Services Included in Capitation | 00.03.03 | {"7882": {"Id":7882,"MPAttachmentLetter":"A","Title":"No Title","MPPolicyAttachmentInternalSourceId":10183,"PolicyAttachmentPageName":"38b1d8cf-ffcf-4463-9b1f-534d05faa688"},} |
| | | 08.00.90u | PaclitaxelProtein-BoundParticlesforInjectableSuspension(Albumin-Bound)/(Abraxane®forInjectableSuspension)08.00.90u | Pharmacy (08) | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 95e3d27e-8107-4070-9871-fb189bba7cd7 | 7641 | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 08.00.90 | {"7642": {"Id":7642,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":9962,"PolicyAttachmentPageName":"dc5b12b8-46d8-4537-a324-0b080c105ebc"},} |
