|  | | 6813 | Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028k | Pharmacy (08) | MA08.028k | MA08.028 | 3abbe522-bbdf-44f8-a6af-16e3bea0c50b | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"6814": {"Id":6814,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":9996,"PolicyAttachmentPageName":"ca1db139-cc3c-4181-a8a7-03fcc9888754"},} | |
| | | 7054 | AblationofLungTumorsMA11.052f | Surgery (11) | MA11.052f | MA11.052 | 11fbb850-b636-4319-af7a-9821069b4223 | Ablation of Lung Tumors | Ablation of Lung Tumors | | |
| | | 7299 | AbortionMA11.010d | Surgery (11) | MA11.010d | MA11.010 | 0a2e7306-c89b-4dcf-a5c7-ffd1771d49f3 | Abortion | Abortion | | |
| | | 7122 | AcupunctureMA12.004e | Miscellaneous (12) | MA12.004e | MA12.004 | 9366e796-ed38-4d5d-8599-8869c292b604 | Acupuncture | Acupuncture | {"7123": {"Id":7123,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":10301,"PolicyAttachmentPageName":"e290996c-8fbe-4840-ae9d-fba89f496e33"},} | |
| | | 6720 | AcuteCareFacilityInpatientTransfersMA12.003b | Miscellaneous (12) | MA12.003b | MA12.003 | 13941132-a68a-4591-9d9b-ff9816f367d7 | Acute Care Facility Inpatient Transfers | Acute Care Facility Inpatient Transfers | | |
| | | 6443 | ADAMTS13,recombinant-krhn(Adzynma)MA08.171 | Pharmacy (08) | MA08.171 | MA08.171 | 39840cd3-b8b0-48fd-9761-e89905a97e1a | ADAMTS13, recombinant-krhn (Adzynma) | ADAMTS13, recombinant-krhn (Adzynma) | | |
| | | 6880 | Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066h | Pharmacy (08) | MA08.066h | MA08.066 | f5ae004d-0a34-4fd9-ad40-311b7879a4c2 | Ado-Trastuzumab Emtansine (Kadcyla®) | Ado-Trastuzumab Emtansine (Kadcyla®) | | |
| | | 7217 | Agalsidasebeta(Fabrazyme)andpegunigalsidasealfa-iwxj(Elfabrio)MA08.033d | Pharmacy (08) | MA08.033d | MA08.033 | a15b90a4-136e-4ae5-a39d-f96e973ec0b9 | Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | | |
| | | 6640 | AirAmbulanceServicesMA12.007b | Miscellaneous (12) | MA12.007b | MA12.007 | abf5788e-6c94-494a-a29e-e5881e5bf59f | Air Ambulance Services | Air Ambulance Services | | |
| | | 6758 | Alemtuzumab(Lemtrada®)MA08.015e | Pharmacy (08) | MA08.015e | MA08.015 | e6f1c735-ef06-4a16-b1eb-c3efbf315ed6 | Alemtuzumab (Lemtrada®) | Alemtuzumab (Lemtrada®) | | |
| | | 7348 | Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)MA08.036g | Pharmacy (08) | MA08.036g | MA08.036 | c03de5fe-1748-4099-8c09-18c8fb53bb04 | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ ) | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ ) | | |
| | | 7310 | AllergyImmunotherapyMA07.055e | Medicine (07) | MA07.055e | MA07.055 | 70a1011d-4147-4b1b-9683-1ab29a7ac2dc | Allergy Immunotherapy | Allergy Immunotherapy | | |
| | | 7420 | Alpha-1AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050c | Pharmacy (08) | MA08.050c | MA08.050 | ccf2701d-74df-47be-96bc-167b947a0326 | Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | | |
| | | 7329 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005d | Medicine (07) | MA07.005d | MA07.005 | f7036693-a2f7-480a-9518-268e54487279 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | | |
| | | 6416 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026r | Medicine (07) | MA07.026r | MA07.026 | 95cb8f28-c4c3-4660-83e6-b05917363cd6 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | | |
| | | 7397 | Amivantamab-vmjw(Rybrevant®)andAmivantamabandhyaluronidase-lpuj(RybrevantFaspro™)MA08.148c | Pharmacy (08) | MA08.148c | MA08.148 | 2f72d941-0892-4153-b42f-2bb1a90b91c1 | Amivantamab-vmjw (Rybrevant®) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro™) | Amivantamab-vmjw (Rybrevant®) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro™) | | |
| | | 7192 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008d | Anesthesia (01) | MA01.008d | MA01.008 | 7d52c3de-a856-4398-adfd-795439dff22f | Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management | Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management | {"7193": {"Id":7193,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":10364,"PolicyAttachmentPageName":"a597add0-5771-402d-a03b-2ef6ab7f26ee"},} | |
| | | 7433 | Anifrolumab-fnia(Saphnelo®)MA08.140c | Pharmacy (08) | MA08.140c | MA08.140 | 89403fb2-d745-4122-bd2b-4c25c72c1fff | Anifrolumab-fnia (Saphnelo®) | Anifrolumab-fnia (Saphnelo®) | | |
| | | 6388 | Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010k | DME (05) | MA05.010k | MA05.010 | 7bcc1289-a396-46bf-b3ec-f555ffdef096 | Ankle-Foot/Knee-Ankle-Foot Orthoses | Ankle-Foot/Knee-Ankle-Foot Orthoses | {"6389": {"Id":6389,"MPAttachmentLetter":"A","Title":"HCPCS CODES FOR ANKLE-FOOT/ KNEE-ANKLE FOOT ORTHOSIS","MPPolicyAttachmentInternalSourceId":9618,"PolicyAttachmentPageName":"5080ec15-c5c7-4521-82b4-1aa45be65b2c"},} | |
| | | 6845 | ApheresisTherapyMA06.001f | Pathology and Laboratory (06) | MA06.001f | MA06.001 | f37ea326-e0a7-4c01-a253-ccb5546b3657 | Apheresis Therapy | Apheresis Therapy | | |
| | | 6949 | Apos®biomechanicalshoesystemMA05.070 | DME (05) | MA05.070 | MA05.070 | ab26736d-68c5-4718-b292-84feda3f5967 | Apos® biomechanical shoe system | Apos® biomechanical shoe system | | |
| | | 7197 | ApplicationandRemovalofTattoosMA11.072 | Surgery (11) | MA11.072 | MA11.072 | 9fca0d03-159c-4241-8592-6af0ee69aa9c | Application and Removal of Tattoos | Application and Removal of Tattoos | | |
| | | 6724 | AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105k | Surgery (11) | MA11.105k | MA11.105 | 8df766f8-52b2-4a05-b56f-9fb0ddf7ed0c | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | {"6725": {"Id":6725,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":9965,"PolicyAttachmentPageName":"4040bbbf-c9ef-4547-84e7-d87a5578d565"},} | |
| | | 7435 | AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)MA08.085k | Pharmacy (08) | MA08.085k | MA08.085 | ed544b45-1f85-413f-b1c9-13af9919bfce | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | | |
| | | 6634 | Atezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybreza™)MA08.127f | Pharmacy (08) | MA08.127f | MA08.127 | c812c38c-4f81-4e38-8fb4-f26f9bc35a93 | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) | | |
| | | 6639 | AuricularProsthesesMA05.068 | DME (05) | MA05.068 | MA05.068 | 76898860-853a-4314-8343-8ff94ea268f0 | Auricular Prostheses | Auricular Prostheses | | |
| | | 6289 | AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)MA05.005g | DME (05) | MA05.005g | MA05.005 | cffb659e-3516-4ed5-9fd5-8c32ce9b3cf8 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"6290": {"Id":6290,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9498,"PolicyAttachmentPageName":"62b77d29-4e7a-4d8f-b57d-423887310236"},"6291": {"Id":6291,"MPAttachmentLetter":"A","Title":"ICD-10 codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9499,"PolicyAttachmentPageName":"f664c93f-fe72-4409-b658-dd0db8848e62"},} | |
| | | 7203 | AutonomicNervousSystemTestingMA07.027h | Medicine (07) | MA07.027h | MA07.027 | 2e3774e4-63d7-4e00-a06a-d9fffaec0c43 | Autonomic Nervous System Testing | Autonomic Nervous System Testing | | |
| | | 6979 | Avelumab(Bavencio®)MA08.122e | Pharmacy (08) | MA08.122e | MA08.122 | 0d1a3bb1-c45a-40c0-9ba3-464725d48826 | Avelumab (Bavencio®) | Avelumab (Bavencio®) | | |
| | | 7313 | Axatilimab-csfr(Niktimvo™)forIntravenousUseMA08.180 | Pharmacy (08) | MA08.180 | MA08.180 | 00939922-b74a-4f0b-9408-4c653d7b3ad6 | Axatilimab-csfr (Niktimvo™) for Intravenous Use | Axatilimab-csfr (Niktimvo™) for Intravenous Use | | |
| | | 6295 | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisorRecurrentAcuteRhinosinusitisMA11.100f | Surgery (11) | MA11.100f | MA11.100 | df59f2ba-1771-49f9-804f-1df634450e92 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | | |
| | | 7408 | Belantamabmafodotin-blmf(Blenrep)MA08.192 | Pharmacy (08) | MA08.192 | MA08.192 | 5a95a1dd-c7b1-4f9a-9851-974539880d9a | Belantamab mafodotin-blmf (Blenrep) | Belantamab mafodotin-blmf (Blenrep) | | |
| | | 6464 | Belimumab(Benlysta®)forIntravenousUseMA08.057d | Pharmacy (08) | MA08.057d | MA08.057 | cc6c6e2e-6c7c-4229-90fc-a6b0c6ffe6c1 | Belimumab (Benlysta®) for Intravenous Use | Belimumab (Benlysta®) for Intravenous Use | | |
| | | 7383 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072p | Pharmacy (08) | MA08.072p | MA08.072 | be047316-8f8a-4767-8879-b46ae89dc0ab | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"7384": {"Id":7384,"MPAttachmentLetter":"A","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":10204,"PolicyAttachmentPageName":"6c90f036-cacd-44ee-afd4-5256b469f3c4"},} | |
| | | 7100 | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037n | Administrative (00) | MA00.037n | MA00.037 | db8d1dfa-4283-4f83-adb1-ff4c82359859 | Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus | Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus | {"7101": {"Id":7101,"MPAttachmentLetter":"A","Title":"Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus - CPT/HCPCS Codes","MPPolicyAttachmentInternalSourceId":10319,"PolicyAttachmentPageName":"c21151af-5458-4ba0-9fc2-1c1125834b47"},} | |
| | | 7300 | BiofeedbackTherapyMA07.010c | Medicine (07) | MA07.010c | MA07.010 | af947cab-4f5d-4199-a72b-5f05b7704d74 | Biofeedback Therapy | Biofeedback Therapy | | |
| | | 6895 | BioimpedancefortheDetectionofLymphedemaMA07.052a | Medicine (07) | MA07.052a | MA07.052 | 27f18383-2c02-463b-a5b5-c8f589dc87e9 | Bioimpedance for the Detection of Lymphedema | Bioimpedance for the Detection of Lymphedema | | |
| | | 6839 | Blinatumomab(Blincyto®)MA08.058h | Pharmacy (08) | MA08.058h | MA08.058 | 4a869572-c438-499d-aa84-4e3f8b1ae601 | Blinatumomab (Blincyto®) | Blinatumomab (Blincyto®) | | |
| | | 6506 | Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049h | Surgery (11) | MA11.049h | MA11.049 | 6f5a5386-f33c-4fac-8e2b-a41e116a9f96 | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | | |
| | | 6726 | BotulinumToxinAgentsMA08.017m | Pharmacy (08) | MA08.017m | MA08.017 | 8cb03fcf-035f-4974-809d-2d2523729b4a | Botulinum Toxin Agents | Botulinum Toxin Agents | {"6727": {"Id":6727,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":9955,"PolicyAttachmentPageName":"76a22480-2f48-4705-9904-d2fd4ab21ef9"},} | |
| | | 6844 | BrentuximabVedotin(Adcetris®)MA08.068l | Pharmacy (08) | MA08.068l | MA08.068 | f1166ac8-5ed4-4079-b12f-8d635e22deb0 | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | | |
| | | 6191 | BronchialValvesMA11.020 | Surgery (11) | MA11.020 | MA11.020 | 3fcc7ddf-57aa-46dc-ad3a-862150ec9635 | Bronchial Valves | Bronchial Valves | | |
| | | 7108 | BundledProcedureCodesMA00.026y | Administrative (00) | MA00.026y | MA00.026 | b7d451ea-be7c-4ff4-8f8c-f235ca626071 | Bundled Procedure Codes | Bundled Procedure Codes | {"7109": {"Id":7109,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":10324,"PolicyAttachmentPageName":"3cf8f3f0-9b41-4d8c-9eff-811f16ecb48d"},"7110": {"Id":7110,"MPAttachmentLetter":"A","Title":"Always Bundled and Bundled Procedures (MPFSDB Indicator B and T)","MPPolicyAttachmentInternalSourceId":10325,"PolicyAttachmentPageName":"fc8e911f-667a-43ee-b4a1-ff5976a9c8a8"},"7111": {"Id":7111,"MPAttachmentLetter":"D","Title":"Procedures/Services Not Eligible for Separate Reimbursement when reported with another specific Procedure/Service","MPPolicyAttachmentInternalSourceId":10326,"PolicyAttachmentPageName":"84e9b81e-82d3-4954-a9d2-dbb1f95c8c8b"},"7112": {"Id":7112,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":10327,"PolicyAttachmentPageName":"063d3aaf-86a3-4ef4-9c34-17ab79b80256"},} | |
| | | 6455 | Burosumab-twza(Crysvita®)MA08.099b | Pharmacy (08) | MA08.099b | MA08.099 | 3d6da7ba-a920-4005-a36a-09a6461405db | Burosumab-twza (Crysvita®) | Burosumab-twza (Crysvita®) | | |
| | | 6448 | Canakinumab(Ilaris®)MA08.101c | Pharmacy (08) | MA08.101c | MA08.101 | c6044efb-14c8-4522-9254-fc7db8224cd8 | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | {"6449": {"Id":6449,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9690,"PolicyAttachmentPageName":"f824febb-e725-4765-9299-819ac2b1fb93"},} | |
| | | 7199 | CanesandCrutchesMA05.052c | DME (05) | MA05.052c | MA05.052 | 9f6208e2-4108-4998-ab94-49ff7f9f73d1 | Canes and Crutches | Canes and Crutches | | |
| | | 7311 | CapsuleEndoscopyMA07.022f | Medicine (07) | MA07.022f | MA07.022 | e845a61d-1d8e-4e76-a213-930bb25853f2 | Capsule Endoscopy | Capsule Endoscopy | | |
| | | 7279 | CardiacContractilityModulationMA05.038 | DME (05) | MA05.038 | MA05.038 | a13a6242-036a-4bb3-8ae8-465e608eb6cf | Cardiac Contractility Modulation | Cardiac Contractility Modulation | | |
| | | 7440 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002g | Rehabilitation Services (10) | MA10.002g | MA10.002 | cc89a8de-7dbb-42dc-b555-c93df2c63e39 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"7441": {"Id":7441,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":10309,"PolicyAttachmentPageName":"d53a448f-95ae-40bf-987e-8f484c546473"},} | |
| | | 7106 | CareManagementandCarePlanningServicesMA00.006p | Administrative (00) | MA00.006p | MA00.006 | e7ee4b6b-f1de-4fdd-bd2c-fe0b5961aebd | Care Management and Care Planning Services | Care Management and Care Planning Services | | |
| | | 6891 | Carfilzomib(Kyprolis®)MA08.062k | Pharmacy (08) | MA08.062k | MA08.062 | f6dee1fa-4df1-4097-9024-bd42bbbfaa8f | Carfilzomib (Kyprolis®) | Carfilzomib (Kyprolis®) | | |
| | | 5739 | CastandSplintApplicationsandAssociatedSuppliesMA00.012c | Administrative (00) | MA00.012c | MA00.012 | 38b84f55-c5c3-47ea-94a7-daf68ce3bd93 | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"5740": {"Id":5740,"MPAttachmentLetter":"A","Title":"Procedures Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":8998,"PolicyAttachmentPageName":"a49d93ab-d66a-4ada-ac9c-5ff32d7a768f"},} | |
| | | 6943 | CataractSurgeryMA11.054e | Surgery (11) | MA11.054e | MA11.054 | 75be5abb-d207-4ec3-a255-96291ca705e0 | Cataract Surgery | Cataract Surgery | {"6944": {"Id":6944,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":10189,"PolicyAttachmentPageName":"1f887835-0c6c-406c-b97a-89a6eaf75bd1"},} | |
| | | 6650 | CatheterAblationofCardiacArrhythmiasMA11.060h | Surgery (11) | MA11.060h | MA11.060 | 5683d2ad-e42e-4a37-9847-6086570a43e0 | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | | |
| | | 6997 | Cemiplimab-rwlc(Libtayo®)MA08.124e | Pharmacy (08) | MA08.124e | MA08.124 | 6644e290-be87-4710-84ec-5f621628059a | Cemiplimab-rwlc (Libtayo®) | Cemiplimab-rwlc (Libtayo®) | | |
| | | 6951 | Cerliponasealfa(Brineura®)MA08.089d | Pharmacy (08) | MA08.089d | MA08.089 | 3e5bb7d1-2403-483b-b3a5-20754f01e010 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | {"6952": {"Id":6952,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Cerliponase alfa (Brineura®)","MPPolicyAttachmentInternalSourceId":10164,"PolicyAttachmentPageName":"db182bf3-f484-4557-b00b-992bed268bf5"},} | |
| | | 6950 | CervicalTractionDevicesforIn-homeUseMA05.009b | DME (05) | MA05.009b | MA05.009 | c8d8a733-57a1-484a-aeb5-afe6038a7d21 | Cervical Traction Devices for In-home Use | Cervical Traction Devices for In-home Use | | |
| | | 6849 | Cetuximab(Erbitux®)MA08.031g | Pharmacy (08) | MA08.031g | MA08.031 | 4a61f469-e5a8-445e-9996-a9ac943b27cf | Cetuximab (Erbitux®) | Cetuximab (Erbitux®) | {"6850": {"Id":6850,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":9911,"PolicyAttachmentPageName":"2f9ba033-8299-4c11-82e8-c0b848f25147"},"6851": {"Id":6851,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":9912,"PolicyAttachmentPageName":"3e5ea163-50bd-46d2-9da8-66e4f43d36a1"},} | |
| | | 7204 | ChemicalPeelsMA11.103c | Surgery (11) | MA11.103c | MA11.103 | dbf89dd3-ad50-4612-82f6-c24bd9f2428b | Chemical Peels | Chemical Peels | | |
| | | 7170 | ChimericAntigenReceptor(CART)Therapy:YescartaTecartus,Breyanzi,KymriahandAucatzylMA08.093q | Pharmacy (08) | MA08.093q | MA08.093 | fe028e42-9dee-473f-bbe2-af32b38214ad | Chimeric Antigen Receptor (CART) Therapy: Yescarta Tecartus, Breyanzi, Kymriah and Aucatzyl | Chimeric Antigen Receptor (CART) Therapy: Yescarta Tecartus, Breyanzi, Kymriah and Aucatzyl | | |
| | | 7171 | ChimericAntigenReceptorT-cell(CAR-T)Therapy:Carvykti®andAbecma®MA08.190 | Pharmacy (08) | MA08.190 | MA08.190 | cdeb3519-0a12-4bea-8549-bcfd8dfd1551 | Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Carvykti® and Abecma® | Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Carvykti® and Abecma® | | |
| | | 6271 | ChiropracticServicesMA10.004i | Rehabilitation Services (10) | MA10.004i | MA10.004 | d8e2b395-3c2b-4f7c-b2eb-5ea5ba4adc87 | Chiropractic Services | Chiropractic Services | | |
| | | 7062 | CoagulationFactorsMA08.004z | Pharmacy (08) | MA08.004z | MA08.004 | 5c7f8332-b92a-4444-8ba1-a87630002314 | Coagulation Factors | Coagulation Factors | | |
| | | 6907 | Cobalamin(VitaminB12),FolicAcid,andHomocysteineTestingMA06.032a | Pathology and Laboratory (06) | MA06.032a | MA06.032 | f7cd681a-15a7-4d95-9f31-3e91ebce5d53 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | {"6908": {"Id":6908,"MPAttachmentLetter":"A","Title":"ICD 10 CODES FOR MEDICALLY NECESSARY COBALAMIN (VITAMIN B12), FOLIC ACID, AND/OR HOMOCYSTEINE TESTING (CPT CODES 82607, 82746, AND 83090)","MPPolicyAttachmentInternalSourceId":10194,"PolicyAttachmentPageName":"433316de-5bcd-4729-8b15-a1baa0961360"},} | |
| | | 6281 | CochlearImplantationMA11.039e | Surgery (11) | MA11.039e | MA11.039 | 2242f0e2-f338-4f50-837e-1a9ae63f3bd9 | Cochlear Implantation | Cochlear Implantation | | |
| | | 6463 | Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)MA08.128 | Pharmacy (08) | MA08.128 | MA08.128 | 7af63e23-4968-42dd-9609-5108bed6f492 | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | | |
| | | 7207 | CommodeChairsMA05.036c | DME (05) | MA05.036c | MA05.036 | 354b0222-3888-4ca0-8de2-915494bd124d | Commode Chairs | Commode Chairs | | |
| | | 5483 | ComplementaryandIntegrativeHealthServicesMA12.001e | Miscellaneous (12) | MA12.001e | MA12.001 | 0ebbc2e0-fe75-4e98-bc5c-e967fbbc79bc | Complementary and Integrative Health Services | Complementary and Integrative Health Services | | |
| | | 7387 | CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112 | Surgery (11) | MA11.112 | MA11.112 | 58bd7abf-d885-4a58-9ef0-0fc0f3f0bf89 | Composite Tissue Allotransplantation of the Hand(s) and Face | Composite Tissue Allotransplantation of the Hand(s) and Face | | |
| | | 7276 | CompressionGarmentsMA05.045g | DME (05) | MA05.045g | MA05.045 | f247cf54-99cb-4da1-ac73-396b90b2ca43 | Compression Garments | Compression Garments | | |
| | | 6852 | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014b | Radiology (09) | MA09.014b | MA09.014 | 05ae0cda-63a1-43e3-86db-f18b219ee8cf | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | | |
| | | 7189 | Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088c | Surgery (11) | MA11.088c | MA11.088 | d4eb2e41-f216-455d-8295-9d6435dde85d | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | | |
| | | 6953 | ContinuousGlucoseMonitorsandHomeBloodGlucoseMonitorsandSuppliesMA00.002r | Administrative (00) | MA00.002r | MA00.002 | 0f7ebd97-13b2-4e08-8d7d-0c52db33e9e4 | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | {"6954": {"Id":6954,"MPAttachmentLetter":"B","Title":"Implantable Continuous Glucose Monitors (I-CGM)","MPPolicyAttachmentInternalSourceId":10161,"PolicyAttachmentPageName":"b832a3f1-18a7-4a2f-a874-ede563db231c"},"6955": {"Id":6955,"MPAttachmentLetter":"A","Title":"ICD10: Long-Term Interstitial CGMS (Non-Implantable)","MPPolicyAttachmentInternalSourceId":10162,"PolicyAttachmentPageName":"ee088ce2-0d0d-4066-8086-85c561a74f90"},} | |
| | | 6199 | ContrastAgentsUsedinConjunctionwithEchocardiographyMA09.004c | Radiology (09) | MA09.004c | MA09.004 | af6f9598-ef4d-4b6d-9a46-e279494ba233 | Contrast Agents Used in Conjunction with Echocardiography | Contrast Agents Used in Conjunction with Echocardiography | | |
| | | 6776 | CornealPachymetryUsingUltrasoundMA07.046h | Medicine (07) | MA07.046h | MA07.046 | 1ea9368b-a3da-4355-a4a3-ef737bce7d62 | Corneal Pachymetry Using Ultrasound | Corneal Pachymetry Using Ultrasound | {"6777": {"Id":6777,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes Eligible to be Reported for Corneal Pachymetry Using Ultrasound","MPPolicyAttachmentInternalSourceId":9946,"PolicyAttachmentPageName":"06561ab0-d92b-4c93-9fc7-0a928b5a748f"},} | |
| | | 6606 | Cosibelimab-ipdl(Unloxcyt™)MA08.184 | Pharmacy (08) | MA08.184 | MA08.184 | 982f590a-dcc0-45e2-bf1f-dd6cfcb6e485 | Cosibelimab-ipdl (Unloxcyt™) | Cosibelimab-ipdl (Unloxcyt™) | | |
| | | 7445 | CosmeticProceduresMA12.009a | Miscellaneous (12) | MA12.009a | MA12.009 | a9f1fc70-8292-4a25-85b2-504645dd22d3 | Cosmetic Procedures | Cosmetic Procedures | | |
| | | 5925 | CoverageofMedicalDevicesMA05.040b | DME (05) | MA05.040b | MA05.040 | 0e3e858b-54b3-41e4-812b-9a87aec99862 | Coverage of Medical Devices | Coverage of Medical Devices | | |
| | | 6963 | CranialElectrotherapyStimulationMA05.066d | DME (05) | MA05.066d | MA05.066 | 3e8cb3e8-cb38-4175-93f6-28bd966da17a | Cranial Electrotherapy Stimulation | Cranial Electrotherapy Stimulation | | |
| | | 6599 | crizanlizumab-tmca(Adakveo®) MA08.109c | Pharmacy (08) | MA08.109c | MA08.109 | c36317dd-b097-4425-b146-2f4e174615cd | crizanlizumab-tmca (Adakveo®) | crizanlizumab-tmca (Adakveo®) | | |
| | | 6429 | Crovalimab-akkz(PiaSky)MA08.178 | Pharmacy (08) | MA08.178 | MA08.178 | 557114c7-a50a-4e59-8dde-ff7a76bb8d7e | Crovalimab-akkz (PiaSky) | Crovalimab-akkz (PiaSky) | | |
| | | 7126 | CryosurgicalAblationoftheProstateGlandMA11.022a | Surgery (11) | MA11.022a | MA11.022 | 44f4be67-b467-4fda-b9ab-6a58eff7cba9 | Cryosurgical Ablation of the Prostate Gland | Cryosurgical Ablation of the Prostate Gland | | |
| | | 6669 | Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)MA08.079m | Pharmacy (08) | MA08.079m | MA08.079 | c9cccd33-7128-4acf-8ad1-47c94e443c5c | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | | |
| | | 6863 | Datopotamabderuxtecan(Datroway®)MA08.185 | Pharmacy (08) | MA08.185 | MA08.185 | caf1600f-54bf-4fa4-8d97-a65d56f1d118 | Datopotamab deruxtecan (Datroway®) | Datopotamab deruxtecan (Datroway®) | | |
| | | 6983 | DayRehabilitationMA10.005c | Rehabilitation Services (10) | MA10.005c | MA10.005 | cf9f5613-e285-43f3-9ed1-945e99155cc1 | Day Rehabilitation | Day Rehabilitation | | |
| | | 7304 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014h | Surgery (11) | MA11.014h | MA11.014 | 030e5c23-0056-4424-ab90-f8a59f0bd5f6 | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"7305": {"Id":7305,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":10475,"PolicyAttachmentPageName":"93d5ebb2-c14a-48e1-aa8d-5f3a5dba561b"},"7306": {"Id":7306,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":10476,"PolicyAttachmentPageName":"46517c29-4163-4789-9474-72e7ae6fef1f"},"7307": {"Id":7307,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":10477,"PolicyAttachmentPageName":"ac9860e6-562a-4977-a85b-6979a44bae09"},"7308": {"Id":7308,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":10478,"PolicyAttachmentPageName":"83723525-2800-4213-9752-b226e56ad656"},"7309": {"Id":7309,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":10479,"PolicyAttachmentPageName":"d77d8984-9be0-45e1-8767-71bf6b61a78b"},} | |
| | | 6933 | DeepBrainStimulation(DBS)MA11.005h | Surgery (11) | MA11.005h | MA11.005 | 778dbe91-6682-4915-9325-2bf4842348c5 | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | | |
| | | 7314 | Denosumab(Prolia®,Xgeva®)andrelatedbiosimilars,andRomosozumab-aqqg(Evenity®)MA08.052p | Pharmacy (08) | MA08.052p | MA08.052 | aef2dadc-4825-441d-b459-af2bb3a068f3 | Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®) | Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®) | {"7315": {"Id":7315,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":10558,"PolicyAttachmentPageName":"ebb7f96d-07b5-440a-8c65-90a6da28ae7c"},} | |
| | | 7235 | DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099f | Surgery (11) | MA11.099f | MA11.099 | c7b9be3a-6016-4ce5-b555-3ed47d28451a | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | | |
| | | 7113 | DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032h | Administrative (00) | MA00.032h | MA00.032 | 84af9f8c-7758-4261-bd54-104c781da60d | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | {} | |
| | | 6649 | DirectEndoscopicNecrosectomy(DEN)fortheTreatmentofPancreaticNecrosisMA11.115 | Surgery (11) | MA11.115 | MA11.115 | c3ef48d9-9845-4877-ae29-6c0e73f238e3 | Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis | Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis | | |
| | | 7330 | Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021c | Pharmacy (08) | MA08.021c | MA08.021 | 8b1f436c-1b91-4728-b237-d14cedece949 | Dofetilide (Tikosyn®) Use in the Inpatient Setting | Dofetilide (Tikosyn®) Use in the Inpatient Setting | | |
| | | 6419 | Dostarlimab-gxly(Jemperli)MA08.136f | Pharmacy (08) | MA08.136f | MA08.136 | f7fe82b4-f8a5-4949-9bfb-37fa110bb8ea | Dostarlimab-gxly (Jemperli) | Dostarlimab-gxly (Jemperli) | | |
| | | 7252 | Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041c | Medicine (07) | MA07.041c | MA07.041 | c965d653-9238-4ea0-a9a9-e667551450bc | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | | |
| | | 6827 | DurableMedicalEquipment(DME)MA05.044v | DME (05) | MA05.044v | MA05.044 | 883fe741-32fc-4930-882b-c738b5986dbd | Durable Medical Equipment (DME) | Durable Medical Equipment (DME) | {"6828": {"Id":6828,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":9536,"PolicyAttachmentPageName":"1ac464ee-798e-44c3-95bd-fcf0de5d8b05"},"6829": {"Id":6829,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":9537,"PolicyAttachmentPageName":"1fa42601-265b-426a-8190-215f331f8cd8"},"6830": {"Id":6830,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":9538,"PolicyAttachmentPageName":"de6fd878-65f3-4394-89f5-99980524bff3"},} | |
| | | 5926 | DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028e | DME (05) | MA05.028e | MA05.028 | 948db512-ee28-439f-85e5-fbbdbcdbebdd | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | | |
| | | 6604 | Durvalumab(Imfinzi®)andTremelimumab-actl(Imjudo®)MA08.123e | Pharmacy (08) | MA08.123e | MA08.123 | c5f92ffa-8818-428a-a78a-8bc3b92ac271 | Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) | Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) | | |
| | | 7039 | Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)forintravenousadministrationMA08.044l | Pharmacy (08) | MA08.044l | MA08.044 | 585fdb3a-46e3-479d-a04b-e6d712f5e6ce | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration | {"7040": {"Id":7040,"MPAttachmentLetter":"A","Title":"Dosing and Frequency","MPPolicyAttachmentInternalSourceId":10174,"PolicyAttachmentPageName":"819514f4-16e9-44a2-8d8c-5878b524b82e"},} | |
| | | 7395 | Efbemalenograstimalfa-vuxw(Ryzneuta®),Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082p | Pharmacy (08) | MA08.082p | MA08.082 | f18a5712-d251-47df-b9aa-c851755eb7a2 | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | {"7396": {"Id":7396,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":10508,"PolicyAttachmentPageName":"65d1a654-b519-4edb-8399-cc3e525d14cd"},} | |
| | | 7051 | Efgartigimodalfa-fcab(Vyvgart)andefgartigimod-alfaandhyaluronidase-qvfc(VyvgartHytrulo)MA08.142e | Pharmacy (08) | MA08.142e | MA08.142 | fb4e3c94-5cae-48f4-9962-da25e8151151 | Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo) | Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo) | | |
