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4712Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028iPharmacy (08)MA08.028iMA08.02881aa888e-296c-422d-8ba8-e81243f8f744Abatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use
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5258AbortionMA11.010bSurgery (11)MA11.010bMA11.01097edeed7-c66a-4637-8052-16aaf9a6fc9eAbortionAbortion
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5210AcupunctureMA12.004cMiscellaneous (12)MA12.004cMA12.00417d506eb-c5fb-4488-b959-a4e75880d2e0AcupunctureAcupuncture
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4632AcuteCareFacilityInpatientTransfersMA12.003bMiscellaneous (12)MA12.003bMA12.003cd466655-0ef1-4249-9599-28e5a0e0a86eAcute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers
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5272Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066gPharmacy (08)MA08.066gMA08.066db6e085d-3e46-4bde-b37c-672c6dcdba72Ado-Trastuzumab Emtansine (Kadcyla®)Ado-Trastuzumab Emtansine (Kadcyla®)
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4316Agalsidasebeta(Fabrazyme®)MA08.033cPharmacy (08)MA08.033cMA08.033899c9577-2cf3-4cf9-80dd-865bc7bd577dAgalsidase beta (Fabrazyme®)Agalsidase beta (Fabrazyme®)
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4546AirAmbulanceServicesMA12.007bMiscellaneous (12)MA12.007bMA12.00721b96147-07c3-431a-b6e2-54dcc732d539Air Ambulance ServicesAir Ambulance Services
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4438Alemtuzumab(Lemtrada®)MA08.015dPharmacy (08)MA08.015dMA08.0158067664a-80c3-4d44-a11e-3ced21699339Alemtuzumab (Lemtrada®)Alemtuzumab (Lemtrada®)
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4476Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®)MA08.036fPharmacy (08)MA08.036fMA08.0361ae76050-dc9f-4acc-8570-eedd1dd4bb9bAlglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )
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4854AllergyImmunotherapyMA07.055dMedicine (07)MA07.055dMA07.0553e070cb9-2526-4b23-bf99-c8aba195b1b2Allergy ImmunotherapyAllergy Immunotherapy
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4383Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050bPharmacy (08)MA08.050bMA08.05018476a80-146f-492a-bf5d-642fda50dc24Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)
b3cf9f4b-fb97-4491-8229-7e8def8e51ec.aspx
  
5169AlwaysBundledProcedureCodesMA00.026tAdministrative (00)MA00.026tMA00.026b3cf9f4b-fb97-4491-8229-7e8def8e51ecAlways Bundled Procedure CodesAlways Bundled Procedure Codes
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5245AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005cMedicine (07)MA07.005cMA07.005f1e90256-36b5-4258-a55d-665e0ef0f39bAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) DevicesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
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5058AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026oMedicine (07)MA07.026oMA07.0264bdd0149-1059-400b-918d-be4fb6fd04ddAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
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5048Amivantamab-vmjw(Rybrevant™)MA08.148Pharmacy (08)MA08.148MA08.1487d71ab86-9ee6-4beb-b10a-1cf9a5c0ef99Amivantamab-vmjw (Rybrevant™)Amivantamab-vmjw (Rybrevant™)
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4756AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008bAnesthesia (01)MA01.008bMA01.00823e3aa80-5874-405c-a103-7e45fece45bdAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint ManagementAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
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4539Anifrolumab-fnia(Saphnelo®)MA08.140bPharmacy (08)MA08.140bMA08.140b4d3f597-41f0-492e-b517-a8331717cee3Anifrolumab-fnia (Saphnelo®)Anifrolumab-fnia (Saphnelo®)
e150be66-daf8-4df2-aa35-f88e1318411e.aspx
  
5056Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010iDME (05)MA05.010iMA05.010e150be66-daf8-4df2-aa35-f88e1318411eAnkle-Foot/Knee-Ankle-Foot OrthosesAnkle-Foot/Knee-Ankle-Foot Orthoses
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4398AnorectalManometry,Electromyography(EMG)ofAnorectalorUrethralSphincters;BiofeedbackTrainingforPerinealMusclesandAnorectalorUrethralSphinctersMA07.018cMedicine (07)MA07.018cMA07.018de604fb8-ee97-41c4-b98a-5bb8b7fb8a4cAnorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral SphinctersAnorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
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4981ApheresisTherapyMA06.001ePathology and Laboratory (06)MA06.001eMA06.00139dcf591-f9fc-44f7-bfc4-2d1736f2fd49Apheresis TherapyApheresis Therapy
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5036Apos®biomechanicalshoesystemMA05.070DME (05)MA05.070MA05.07003291464-9bff-4c1f-84d2-71221d6cc6bdApos® biomechanical shoe systemApos® biomechanical shoe system
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5214ApplicationandRemovalofTattoosMA11.072Surgery (11)MA11.072MA11.0722a27f7af-3e2a-4413-932d-11598d28a540Application and Removal of TattoosApplication and Removal of Tattoos
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4137AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105jSurgery (11)MA11.105jMA11.105df24c7d1-3b2b-41a3-ba0a-d25c9c5e7d70Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
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4884ArtificialIntervertebralLumbarDiscInsertionMA11.114bSurgery (11)MA11.114bMA11.1149772efeb-a7bd-4217-ac52-ea05bc5a3d31Artificial Intervertebral Lumbar Disc InsertionArtificial Intervertebral Lumbar Disc Insertion
7d0a7b7f-0ed5-4a94-ab38-982449843b7e.aspx
  
4558Asparaginaseerwiniachrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze®)MA08.085gPharmacy (08)MA08.085gMA08.0857d0a7b7f-0ed5-4a94-ab38-982449843b7eAsparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)Asparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)
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4272Atezolizumab(Tecentriq®)MA08.127cPharmacy (08)MA08.127cMA08.12738d9e3e1-1b0d-4386-b60a-9b0787ca330fAtezolizumab (Tecentriq®)Atezolizumab (Tecentriq®)
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4759AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)MA05.005gDME (05)MA05.005gMA05.00550cf8ab2-c1d7-4114-bf48-301031b97b42Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
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4469AutonomicNervousSystemTestingMA07.027fMedicine (07)MA07.027fMA07.027ff1221f9-30d9-4ac7-bbab-964e32913b1cAutonomic Nervous System TestingAutonomic Nervous System Testing
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5156Avelumab(Bavencio®)MA08.122cPharmacy (08)MA08.122cMA08.122214619b7-9453-46b2-8e3d-0e7843183edeAvelumab (Bavencio®)Avelumab (Bavencio®)
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4250BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisMA11.100eSurgery (11)MA11.100eMA11.1006a0c5929-9fd0-40f2-8aee-a03e3c5d7160Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic RhinosinusitisBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
bccd1651-281b-4398-bd5c-64d796fe33fb.aspx
  
4436Belimumab(Benlysta®)forIntravenousUseMA08.057dPharmacy (08)MA08.057dMA08.057bccd1651-281b-4398-bd5c-64d796fe33fbBelimumab (Benlysta®) for Intravenous UseBelimumab (Benlysta®) for Intravenous Use
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4502Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072mPharmacy (08)MA08.072mMA08.07246cea12e-7050-4ace-8a7f-113e18bd0426Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
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4964BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037lAdministrative (00)MA00.037lMA00.037df2725e5-51fc-4d42-95c9-22377801776dBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility CampusBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
{"4965": {"Id":4965,"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":7909,"PolicyAttachmentPageName":"3471875c-7222-4749-bf82-8cc0c2280af2"},}
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4276BiofeedbackTherapyMA07.010aMedicine (07)MA07.010aMA07.010186e43b9-48ee-4ef3-842d-adf5eef12376Biofeedback TherapyBiofeedback Therapy
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4719BioimpedancefortheDetectionofLymphedemaMA07.052Medicine (07)MA07.052MA07.0521511575d-8683-46df-9aae-8fd9d97cc10dBioimpedance for the Detection of LymphedemaBioimpedance for the Detection of Lymphedema
471e433d-f780-4d16-882b-1406395273b3.aspx
  
4004Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/CanthopexyMA11.047dSurgery (11)MA11.047dMA11.047471e433d-f780-4d16-882b-1406395273b3Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/CanthopexyBlepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
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4269Blinatumomab(Blincyto®)MA08.058fPharmacy (08)MA08.058fMA08.05803966d42-a58c-417b-ad2a-bd444959368aBlinatumomab (Blincyto®)Blinatumomab (Blincyto®)
1bc70177-61e1-4ece-96c4-22262d4cb381.aspx
  
5071Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049fSurgery (11)MA11.049fMA11.0491bc70177-61e1-4ece-96c4-22262d4cb381Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
e196fa27-34f5-4e62-98af-922a3647dd39.aspx
  
4820BotulinumToxinAgentsMA08.017jPharmacy (08)MA08.017jMA08.017e196fa27-34f5-4e62-98af-922a3647dd39Botulinum Toxin AgentsBotulinum Toxin Agents
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dd70b2ce-1cc7-48f3-ad08-4bc652df61dc.aspx
  
5145BrentuximabVedotin(Adcetris®)MA08.068iPharmacy (08)MA08.068iMA08.068dd70b2ce-1cc7-48f3-ad08-4bc652df61dcBrentuximab Vedotin (Adcetris®)Brentuximab Vedotin (Adcetris®)
{"5146": {"Id":5146,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7785,"PolicyAttachmentPageName":"0182b661-bf45-4c5d-a186-2e64765891a2"},}
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4633BronchialValvesMA11.020Surgery (11)MA11.020MA11.020a709d47e-0945-492c-b064-7ffe02701b0cBronchial ValvesBronchial Valves
139fe438-ff72-40f7-98d1-4bfe79daf96e.aspx
  
4477Burosumab-twza(Crysvita®)MA08.099bPharmacy (08)MA08.099bMA08.099139fe438-ff72-40f7-98d1-4bfe79daf96eBurosumab-twza (Crysvita®)Burosumab-twza (Crysvita®)
e823b28a-58d2-4201-8b11-a1e4fd9480f8.aspx
  
4484Canakinumab(Ilaris®)MA08.101bPharmacy (08)MA08.101bMA08.101e823b28a-58d2-4201-8b11-a1e4fd9480f8Canakinumab (Ilaris®)Canakinumab (Ilaris®)
ce3cfd1e-4c67-4ca8-817e-690ac71d2f34.aspx
  
5185CanesandCrutchesMA05.052bDME (05)MA05.052bMA05.052ce3cfd1e-4c67-4ca8-817e-690ac71d2f34Canes and CrutchesCanes and Crutches
5fb9f4ac-c527-472a-b667-a78635412888.aspx
  
5204CapsuleEndoscopyMA07.022eMedicine (07)MA07.022eMA07.0225fb9f4ac-c527-472a-b667-a78635412888Capsule EndoscopyCapsule Endoscopy
0c9b7de9-21a0-4ad0-849c-9b58ef072e42.aspx
  
5267CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002fRehabilitation Services (10)MA10.002fMA10.0020c9b7de9-21a0-4ad0-849c-9b58ef072e42Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
{"5268": {"Id":5268,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":8306,"PolicyAttachmentPageName":"77cc58cd-1a6f-4268-aee2-7d959cc428ab"},}
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5173CareManagementandCarePlanningServicesMA00.006nAdministrative (00)MA00.006nMA00.006ef7eca15-41e7-4d18-bb82-5e9138505093Care Management and Care Planning ServicesCare Management and Care Planning Services
9ae20d79-ba8d-4ced-abc5-527f69c7c997.aspx
  
5054Carfilzomib(Kyprolis)MA08.062hPharmacy (08)MA08.062hMA08.0629ae20d79-ba8d-4ced-abc5-527f69c7c997Carfilzomib (Kyprolis)Carfilzomib (Kyprolis)
b86099e5-ed74-4f52-9ab4-c534c779cb23.aspx
  
3612CastandSplintApplicationsandAssociatedSuppliesMA00.012cAdministrative (00)MA00.012cMA00.012b86099e5-ed74-4f52-9ab4-c534c779cb23Cast and Splint Applications and Associated SuppliesCast and Splint Applications and Associated Supplies
{"3613": {"Id":3613,"MPAttachmentLetter":"A","Title":"Procedures Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":6422,"PolicyAttachmentPageName":"eec4f404-030d-42ce-855c-d06522638dd4"},}
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4010CataractSurgeryMA11.054dSurgery (11)MA11.054dMA11.05435d53c26-0c5b-4b14-b8b8-a5597e77fe0cCataract SurgeryCataract Surgery
{"4011": {"Id":4011,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6669,"PolicyAttachmentPageName":"00eafbe0-27dc-4b22-bec7-d83dddcb66d7"},}
e18335ca-0588-4f80-a184-297223e33223.aspx
  
4768CatheterAblationofCardiacArrhythmiasMA11.060gSurgery (11)MA11.060gMA11.060e18335ca-0588-4f80-a184-297223e33223Catheter Ablation of Cardiac ArrhythmiasCatheter Ablation of Cardiac Arrhythmias
74f40bc4-a8ec-402a-a1f7-a1329d8a66c8.aspx
  
4653Cemiplimab-rwlc(Libtayo®)MA08.124cPharmacy (08)MA08.124cMA08.12474f40bc4-a8ec-402a-a1f7-a1329d8a66c8Cemiplimab-rwlc (Libtayo®)Cemiplimab-rwlc (Libtayo®)
cbcee004-59ba-4f3d-ace3-5dd2bb9e1992.aspx
  
4473Cerliponasealfa(Brineura®)MA08.089cPharmacy (08)MA08.089cMA08.089cbcee004-59ba-4f3d-ace3-5dd2bb9e1992Cerliponase alfa (Brineura®)Cerliponase alfa (Brineura®)
758792dc-b695-4e8f-8010-624a774b081b.aspx
  
4333CervicalTractionDevicesforIn-homeUseMA05.009aDME (05)MA05.009aMA05.009758792dc-b695-4e8f-8010-624a774b081bCervical Traction Devices for In-home UseCervical Traction Devices for In-home Use
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5235Cetuximab(Erbitux®)MA08.031gPharmacy (08)MA08.031gMA08.03138e8f5e0-eab4-421d-a5b3-807ff85010d8Cetuximab (Erbitux®)Cetuximab (Erbitux®)
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4980ChemicalPeelsMA11.103bSurgery (11)MA11.103bMA11.10368af371b-fdac-4133-a97a-bf73d8c4b158Chemical PeelsChemical Peels
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4939ChimericAntigenReceptor(CAR)TherapyMA08.093lPharmacy (08)MA08.093lMA08.093d8d1be84-2787-48b6-bb3e-5777c6a2c939Chimeric Antigen Receptor (CAR) TherapyChimeric Antigen Receptor (CAR) Therapy
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4934ChiropracticServicesMA10.004iRehabilitation Services (10)MA10.004iMA10.0041d244cbe-e372-44f9-ad14-62a9ee25d888Chiropractic ServicesChiropractic Services
{}
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1368Circulating Tumor Cell (CTC) AssayPathology and Laboratory (06)MA06.030MA06.030F371FB2E48AFB33885257DBE00723399Circulating Tumor Cell (CTC) AssayCirculating Tumor Cell (CTC) Assay
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5149CoagulationFactorsMA08.004vPharmacy (08)MA08.004vMA08.004f447005e-abcc-475f-aa45-41bbaa0db95bCoagulation FactorsCoagulation Factors
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4206Cobalamin(VitaminB12),FolicAcid,andHomocysteineTestingMA06.032aPathology and Laboratory (06)MA06.032aMA06.03208299b3d-e691-4b8a-b760-476b6013cdcfCobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
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4631CochlearImplantationMA11.039eSurgery (11)MA11.039eMA11.0394bfe53c3-a7a4-4796-9218-525f38f768eeCochlear ImplantationCochlear Implantation
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5216Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)MA08.128Pharmacy (08)MA08.128MA08.128a7b81ecf-cefa-42a8-aa7c-f728507035baCollagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
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5199CommodeChairsMA05.036bDME (05)MA05.036bMA05.0366536528d-3a29-42cc-a5ba-3bdca5c484ebCommode ChairsCommode Chairs
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3614ComplementaryandIntegrativeHealthServicesMA12.001dMiscellaneous (12)MA12.001dMA12.001a62fd0fa-8e7b-4ed1-bb67-fd235c1159f0Complementary and Integrative Health ServicesComplementary and Integrative Health Services
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4584CompleteDecongestiveTherapy(CDT)MA07.042Medicine (07)MA07.042MA07.042b4e4e763-9995-4651-935b-e382cd5fb5beComplete Decongestive Therapy (CDT)Complete Decongestive Therapy (CDT)
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4251CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112Surgery (11)MA11.112MA11.112df7d7068-6c32-45da-b37f-2e979978b0d5Composite Tissue Allotransplantation of the Hand(s) and FaceComposite Tissue Allotransplantation of the Hand(s) and Face
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5196CompressionGarmentsMA05.045dDME (05)MA05.045dMA05.045cc20f86e-ed64-4e9d-9dfa-9a300af2b384Compression GarmentsCompression Garments
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4261Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014aRadiology (09)MA09.014aMA09.0145280f42d-aefd-4364-b335-f20bb8471cffComputer-Aided Detection (CAD) System for Use with Chest RadiographsComputer-Aided Detection (CAD) System for Use with Chest Radiographs
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5244Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088cSurgery (11)MA11.088cMA11.088bba5081d-4c80-4f43-bdfa-e81babdc9b90Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic ProcedureComputer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
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4229ConsultationServicesMA00.049bAdministrative (00)MA00.049bMA00.04950f137b2-f09b-4bba-bf10-c689ad659402Consultation ServicesConsultation Services
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5292ContinuousGlucoseMonitorsandHomeBloodGlucoseMonitorsandSuppliesMA00.002mAdministrative (00)MA00.002mMA00.002a4539a91-e46c-4779-886b-04db0fc02defContinuous Glucose Monitors and Home Blood Glucose Monitors and SuppliesContinuous Glucose Monitors and Home Blood Glucose Monitors and Supplies
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4293ContrastAgentsUsedinConjunctionwithEchocardiographyMA09.004cRadiology (09)MA09.004cMA09.004d647b737-a9b2-45c6-8d24-5a6b333db1e7Contrast Agents Used in Conjunction with EchocardiographyContrast Agents Used in Conjunction with Echocardiography
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4669CornealPachymetryUsingUltrasoundMA07.046gMedicine (07)MA07.046gMA07.0468a3160e2-2cd8-48bb-8348-56066ba7c299Corneal Pachymetry Using UltrasoundCorneal Pachymetry Using Ultrasound
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5218CosmeticProceduresMA12.009aMiscellaneous (12)MA12.009aMA12.0093d6b55b7-1271-45c2-a667-be77db0458a9Cosmetic ProceduresCosmetic Procedures
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3048CoverageofMedicalDevicesMA05.040bDME (05)MA05.040bMA05.04069c3f8a1-1044-489c-869e-7e78dbb55b06Coverage of Medical DevicesCoverage of Medical Devices
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5072CranialElectrotherapyStimulationMA05.066dDME (05)MA05.066dMA05.0669f9f128c-59e6-472a-b922-feb5034bfe68Cranial Electrotherapy StimulationCranial Electrotherapy Stimulation
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4169CriteriaforReimbursementofEmergencyRoomServicesMA00.044cAdministrative (00)MA00.044cMA00.044bd8724e2-053c-46e0-ad5a-4e5dbf9cf587Criteria for Reimbursement of Emergency Room ServicesCriteria for Reimbursement of Emergency Room Services
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4810crizanlizumab-tmca(Adakveo®)MA08.109bPharmacy (08)MA08.109bMA08.10915a1b743-0c2d-4f22-bb7d-c37c2d029e27crizanlizumab-tmca (Adakveo®)crizanlizumab-tmca (Adakveo®)
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4974CryosurgicalAblationoftheProstateGlandMA11.022aSurgery (11)MA11.022aMA11.022f26ae49b-8ec6-4683-aaf4-48a783faf22fCryosurgical Ablation of the Prostate GlandCryosurgical Ablation of the Prostate Gland
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4683Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro®)MA08.079kPharmacy (08)MA08.079kMA08.079143087a4-01b2-4afb-a001-eb8ba9423773Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)
ee92c759-ee9f-4de2-8688-6082eef33136.aspx
  
4493DayRehabilitationMA10.005bRehabilitation Services (10)MA10.005bMA10.005ee92c759-ee9f-4de2-8688-6082eef33136Day RehabilitationDay Rehabilitation
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4278DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014gSurgery (11)MA11.014gMA11.0148aa69314-d990-40ec-a294-8971cc5c5e5bDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
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5122DeepBrainStimulation(DBS)MA11.005hSurgery (11)MA11.005hMA11.005dd818e85-f344-4c53-a2d4-1a4aebb6fd88Deep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)
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5154Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)MA08.052lPharmacy (08)MA08.052lMA08.052f02a318c-a818-47ab-a614-46aa61d61896Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)
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4751DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099dSurgery (11)MA11.099dMA11.099af858c6b-1475-4646-9116-3543770cabccDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
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5004DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032fAdministrative (00)MA00.032fMA00.0327393357c-6383-4146-9971-34e92357c526Direct Access to Obstetrics/Gynecology (OB/GYN) ServicesDirect Access to Obstetrics/Gynecology (OB/GYN) Services
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5263Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021cPharmacy (08)MA08.021cMA08.02101e34de8-b7d9-453b-970c-f5e26b7b36d9Dofetilide (Tikosyn®) Use in the Inpatient SettingDofetilide (Tikosyn®) Use in the Inpatient Setting
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5274Dostarlimab-gxly(Jemperli)MA08.136ePharmacy (08)MA08.136eMA08.13633c3e42b-4fa6-444d-ad2f-399988971cc5Dostarlimab-gxly (Jemperli)Dostarlimab-gxly (Jemperli)
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4971Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041bMedicine (07)MA07.041bMA07.04108ccc71e-d011-4b15-9c05-434fc1442308Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic MalignanciesDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
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5165DurableMedicalEquipment(DME)MA05.044pDME (05)MA05.044pMA05.044a8bed8df-5615-4d27-ac24-74f702417bffDurable Medical Equipment (DME)Durable Medical Equipment (DME)
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4015DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028eDME (05)MA05.028eMA05.0281b12ffb5-60aa-4123-895e-6165136f7204Durable Medical Equipment (DME) Not Subject to a Rental to Purchase MaximumDurable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
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4684Durvalumab(Imfinzi®)andtremelimumab-act(Imjudo®)MA08.123cPharmacy (08)MA08.123cMA08.1234b3152da-96b0-4cf1-8b23-032f3ac547dcDurvalumab (Imfinzi®) and tremelimumab-act (Imjudo®)Durvalumab (Imfinzi®) and tremelimumab-act (Imjudo®)
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4321Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)MA08.044hPharmacy (08)MA08.044hMA08.04475362d2f-b4f7-4f18-90c0-e39dc57aaea7Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)
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5119Efgartigimodalfa-fcab(Vyvgart)andefgartigimodalfaandhyaluronidase-qvfc(VyvgartHytrulo)MA08.142cPharmacy (08)MA08.142cMA08.14232a0494d-89f3-48ca-af9a-b4f7254ff682Efgartigimod alfa - fcab (Vyvgart) and efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)Efgartigimod alfa - fcab (Vyvgart) and efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
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5106Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082kPharmacy (08)MA08.082kMA08.08260e97141-190f-4cc0-a5a5-3e480d5c22e0Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related BiosimilarsEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars
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5212ElectricalStimulationandElectromagneticStimulationfortheTreatmentofWoundsMA07.013dMedicine (07)MA07.013dMA07.013c835851d-a3e1-4abb-b0c3-e8388227a0acElectrical Stimulation and Electromagnetic Stimulation for the Treatment of WoundsElectrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
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4898ElectroconvulsiveTherapy(ECT)MA14.001aBehavioral Health (14)MA14.001aMA14.001b3df3c46-8422-4101-a5a0-0346f4da00f0Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)
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4886Electromyography(EMG)Studies:NeedleEMG,SurfaceEMG(SEMG)MA07.050kMedicine (07)MA07.050kMA07.050f7f69693-100a-49a3-8994-a5924c2ac9e6Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
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4526Emapalumab-lzsg(Gamifant®)MA08.104bPharmacy (08)MA08.104bMA08.104d93e61a3-8972-41ac-8749-41a709b851c0Emapalumab-lzsg (Gamifant®)Emapalumab-lzsg (Gamifant®)
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