Medicare Advantage
  
  
  
  
  
  
  
  
  
  
MPattachmentdataPub
  
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1956Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028ePharmacy (08)MA08.028eMA08.028e6ab9a34-6c77-4168-b73e-e42a6a23b38fAbatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use
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1649AbortionSurgery (11)MA11.010aMA11.01085257D39006E79458525854300496FA9AbortionAbortion
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2311AcupunctureMA12.004bMiscellaneous (12)MA12.004bMA12.004b803a4c5-4cb5-4da4-8a1c-511113a95a25AcupunctureAcupuncture
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1344Acute Care Facility Inpatient TransfersMA12.003aMA12.00385257D39006E7945852585970047577DAcute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers
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2306Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066dPharmacy (08)MA08.066dMA08.06653c4e67b-3cda-4ec6-8248-67773a3ce433Ado-Trastuzumab Emtansine (Kadcyla®)Ado-Trastuzumab Emtansine (Kadcyla®)
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1645Agalsidase beta (Fabrazyme®)Pharmacy (08)MA08.033bMA08.03385257D39006E7945852585430046609CAgalsidase beta (Fabrazyme®)Agalsidase beta (Fabrazyme®)
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1345Air Ambulance ServicesMiscellaneous (12)MA12.007aMA12.00785257D39006E79458525859700487CB6Air Ambulance ServicesAir Ambulance Services
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1666Alemtuzumab (Lemtrada™)MA08.015dMA08.01585257D39006E7945852584EB0059DBD8Alemtuzumab (Lemtrada™)Alemtuzumab (Lemtrada™)
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1646Alglucosidase alfa (e.g., Lumizyme®)Pharmacy (08)MA08.036cMA08.03685257D39006E794585258543004566E0Alglucosidase alfa (e.g., Lumizyme®)Alglucosidase alfa (e.g., Lumizyme®)
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2274AllergyImmunotherapyMA07.055dMedicine (07)MA07.055dMA07.055ce8a2742-d7b0-439e-b62b-2e1753eacb79Allergy ImmunotherapyAllergy Immunotherapy
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2305Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050bPharmacy (08)MA08.050bMA08.0503f61cbc3-b488-474e-9b87-7af08a0d7a37Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)
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2425AlwaysBundledProcedureCodesMA00.026iAdministrative (00)MA00.026iMA00.026381e0271-7202-40d7-874d-68b69730823bAlways Bundled Procedure CodesAlways Bundled Procedure Codes
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2460AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005cMedicine (07)MA07.005cMA07.005301346f4-5db6-4773-ade7-a8c8bddfe5feAmbulatory 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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2315AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026fMedicine (07)MA07.026fMA07.02629fb4d0d-8653-4ba0-ad75-1478a34f9c92Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
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2404Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010eDME (05)MA05.010eMA05.010865a578e-c02a-4a8e-8b81-811aef3ab1bcAnkle-Foot/Knee-Ankle-Foot OrthosesAnkle-Foot/Knee-Ankle-Foot Orthoses
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2223AnorectalManometry,Electromyography(EMG)ofAnorectalorUrethralSphincters;BiofeedbackTrainingforPerinealMusclesandAnorectalorUrethralSphinctersMA07.018bMedicine (07)MA07.018bMA07.0189f02b1b1-b4ae-4fb9-ba57-7b2967d1d6c2Anorectal 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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2179ApheresisTherapyMA06.001ePathology and Laboratory (06)MA06.001eMA06.001a8e854f7-94e7-4833-a02c-b7fb4214ff25Apheresis TherapyApheresis Therapy
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2098ApplicationandRemovalofTattoosMA11.072Surgery (11)MA11.072MA11.0723639d8b3-9067-4cd7-9c4c-e376655e9ed3Application and Removal of TattoosApplication and Removal of Tattoos
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1647Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)MA08.091cMA08.09185257D39006E79458525854200771F5AAprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
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2136AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105gSurgery (11)MA11.105gMA11.105e5bdb582-1a6c-4cd1-935c-f5310b7873c8Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
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2273ArtificialHeartsandVentricularAssistDevices(VADs)MA11.011dSurgery (11)MA11.011dMA11.011a4ae04b3-2afd-47d8-af6c-350cfb59df7fArtificial Hearts and Ventricular Assist Devices (VADs)Artificial Hearts and Ventricular Assist Devices (VADs)
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2361ArtificialIntervertebralLumbarDiscInsertionMA11.114Surgery (11)MA11.114MA11.114ab7ba4a7-7b7e-477a-9b36-8be46c7597c1Artificial Intervertebral Lumbar Disc InsertionArtificial Intervertebral Lumbar Disc Insertion
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2420AsparaginaseErwiniaChrysanthemi(Erwinaze®)MA08.085cPharmacy (08)MA08.085cMA08.085167f3869-f6da-433d-9ab8-35366eec6588Asparaginase Erwinia Chrysanthemi (Erwinaze®)Asparaginase Erwinia Chrysanthemi (Erwinaze®)
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1935Atezolizumab(Tecentriq®)MA08.127Pharmacy (08)MA08.127MA08.127f4e0210e-b48a-4acf-bac3-8264b197062dAtezolizumab (Tecentriq®)Atezolizumab (Tecentriq®)
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1879Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)DME (05)MA05.005dMA05.00546045ED869F1832F852585AB0056C456Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
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1325Autonomic Nervous System TestingMA07.027cMA07.02785257D39006E79458525853500666D0AAutonomic Nervous System TestingAutonomic Nervous System Testing
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1921Avelumab(Bavencio®)MA08.122Pharmacy (08)MA08.122MA08.122f91a2c3b-4f6b-4c15-b58c-6d05bcd97376Avelumab (Bavencio®)Avelumab (Bavencio®)
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2144BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisMA11.100eSurgery (11)MA11.100eMA11.100da677fd2-4630-47ac-af75-7526e365af35Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic RhinosinusitisBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
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2342belantamabmafodotin-blmf(Blenrep)MA08.119aPharmacy (08)MA08.119aMA08.11959fa37dd-85e0-4a0e-91ee-d7e1e61633d4belantamab mafodotin-blmf (Blenrep) belantamab mafodotin-blmf (Blenrep)
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1301Belimumab (Benlysta®) for Intravenous UsePharmacy (08)MA08.057bMA08.05785257D39006E7945852584EB005E6F24Belimumab (Benlysta®) for Intravenous UseBelimumab (Benlysta®) for Intravenous Use
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2421Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072gPharmacy (08)MA08.072gMA08.072ced91d45-f963-4361-a204-a200fc6782bbBevacizumab (Avastin®) and Related Biosimilars For Oncologic UseBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
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2343BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037jAdministrative (00)MA00.037jMA00.037c3346ad1-b72f-4800-9cb4-abec12bcb1ecBilling 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
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2107BiofeedbackTherapyMA07.010aMedicine (07)MA07.010aMA07.010c8e9390f-47a4-4253-ac7c-d1678698c4faBiofeedback TherapyBiofeedback Therapy
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1625Bioimpedance for the Detection of LymphedemaMedicine (07)MA07.052MA07.05285257D39006E7945852585350057717DBioimpedance for the Detection of LymphedemaBioimpedance for the Detection of Lymphedema
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2417Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/CanthopexyMA11.047dSurgery (11)MA11.047dMA11.04781caf8fe-115d-4de8-b7d6-6eeeb38650adBlepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/CanthopexyBlepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
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2160Blinatumomab(Blincyto®)MA08.058cPharmacy (08)MA08.058cMA08.0583b7dd28d-6a20-406f-becc-281df3cd1732Blinatumomab (Blincyto®)Blinatumomab (Blincyto®)
a82f627b-608e-46e6-8a8d-739c2bcd90f4.aspx
  
2149Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049cSurgery (11)MA11.049cMA11.049a82f627b-608e-46e6-8a8d-739c2bcd90f4Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
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1405Bortezomib (Bortezomib for Injection, Velcade®)Pharmacy (08)MA08.037fMA08.03785257D39006E79458525838400616E51Bortezomib (Bortezomib for Injection, Velcade®)Bortezomib (Bortezomib for Injection, Velcade®)
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1298Botulinum Toxin AgentsPharmacy (08)MA08.017eMA08.01785257D39006E79458525853E00503779Botulinum Toxin AgentsBotulinum Toxin Agents
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2463BrentuximabVedotin(Adcetris®)MA08.068ePharmacy (08)MA08.068eMA08.0682dbb1a6c-5a4d-4740-ab89-669165aa125eBrentuximab Vedotin (Adcetris®)Brentuximab Vedotin (Adcetris®)
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1363Bronchial ThermoplastySurgery (11)MA11.006bMA11.00685257D39006E7945852585A400669A60Bronchial ThermoplastyBronchial Thermoplasty
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1452Burosumab-twza (Crysvita®)MA08.099aMA08.09985257D39006E79458525847E006E809DBurosumab-twza (Crysvita®)Burosumab-twza (Crysvita®)
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2449Canakinumab(Ilaris®)MA08.101aPharmacy (08)MA08.101aMA08.101da9e0793-604f-4c92-8e6c-21d765aac574Canakinumab (Ilaris®)Canakinumab (Ilaris®)
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1594Canes and CrutchesDME (05)MA05.052bMA05.05285257D39006E794585258507004C92F8Canes and CrutchesCanes and Crutches
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2158CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002bRehabilitation Services (10)MA10.002bMA10.00251e3d603-6f82-4751-8ea5-f1f85418b58cCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
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dce37063-3216-4d24-942a-4765161f8650.aspx
  
2314CareManagementandCarePlanningServicesMA00.006hAdministrative (00)MA00.006hMA00.006dce37063-3216-4d24-942a-4765161f8650Care Management and Care Planning ServicesCare Management and Care Planning Services
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2101Carfilzomib(Kyprolis™)MA08.062ePharmacy (08)MA08.062eMA08.062e395dee3-755a-471c-b8f1-ddc066123e9eCarfilzomib (Kyprolis™)Carfilzomib (Kyprolis™)
7a7e50a2-46a1-4673-b9d9-59a2fce39403.aspx
  
2236CastandSplintApplicationsandAssociatedSuppliesMA00.012cAdministrative (00)MA00.012cMA00.0127a7e50a2-46a1-4673-b9d9-59a2fce39403Cast and Splint Applications and Associated SuppliesCast and Splint Applications and Associated Supplies
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1297Cataract SurgerySurgery (11)MA11.054cMA11.05485257D39006E79458525857500659EB8Cataract SurgeryCataract Surgery
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2112CatheterAblationofCardiacArrhythmiasMA11.060cSurgery (11)MA11.060cMA11.0603caf3ad6-1b9a-42aa-97ec-1a5e31058230Catheter Ablation of Cardiac ArrhythmiasCatheter Ablation of Cardiac Arrhythmias
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1880Cemiplimab-rwlc (LIBTAYO®)MA08.124MA08.12485257D39006E79458525857B007B8F60Cemiplimab-rwlc (LIBTAYO®)Cemiplimab-rwlc (LIBTAYO®)
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1628Cerliponase alfa (Brineura®)MA08.089cMA08.08985257D39006E7945852585340054CA80Cerliponase alfa (Brineura®)Cerliponase alfa (Brineura®)
d5768947-b18e-4bd3-a798-3b5a7af86d2c.aspx
  
2096CervicalTractionDevicesforIn-homeUseMA05.009aDME (05)MA05.009aMA05.009d5768947-b18e-4bd3-a798-3b5a7af86d2cCervical Traction Devices for In-home UseCervical Traction Devices for In-home Use
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1507Cetuximab (Erbitux®)Pharmacy (08)MA08.031dMA08.03185257D39006E79458525846C00639663Cetuximab (Erbitux®)Cetuximab (Erbitux®)
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2115ChemicalPeelsMA11.103aSurgery (11)MA11.103aMA11.103f37d8c75-abe0-4d37-b0c0-c18d46ab4c17Chemical PeelsChemical Peels
1cda1544-b934-4c5f-a14b-3a0e6df2170f.aspx
  
2249ChimericAntigenReceptor(CAR)TherapyMA08.093fPharmacy (08)MA08.093fMA08.0931cda1544-b934-4c5f-a14b-3a0e6df2170fChimeric Antigen Receptor (CAR) TherapyChimeric Antigen Receptor (CAR) Therapy
{"2250": {"Id":2250,"MPAttachmentLetter":"A","Title":"ICD 10 codes","MPPolicyAttachmentInternalSourceId":4741,"PolicyAttachmentPageName":"6ab64e2e-380a-4639-a26d-7bc23fd18feb"},}
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2057ChiropracticServicesMA10.004gRehabilitation Services (10)MA10.004gMA10.004f82146f9-0cf1-4da3-9708-df006eda0513Chiropractic ServicesChiropractic Services
{"2058": {"Id":2058,"MPAttachmentLetter":"A","Title":"Medically neessary ICD-10 diagnosis codes","MPPolicyAttachmentInternalSourceId":4853,"PolicyAttachmentPageName":"2eefa6a2-e9e7-4b20-b95e-7913990c9dc0"},}
F371FB2E48AFB33885257DBE00723399.aspx
  
1368Circulating Tumor Cell (CTC) AssayPathology and Laboratory (06)MA06.030MA06.030F371FB2E48AFB33885257DBE00723399Circulating Tumor Cell (CTC) AssayCirculating Tumor Cell (CTC) Assay
f8924323-e7d0-413d-a657-ace27100d002.aspx
  
2176CoagulationFactorsMA08.004rPharmacy (08)MA08.004rMA08.004f8924323-e7d0-413d-a657-ace27100d002Coagulation Factors Coagulation Factors
85257D39006E7945852585A400689511.aspx
  
1361Cobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingMA06.032MA06.03285257D39006E7945852585A400689511Cobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
{"1859":{"Id":1859,"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":0,"PolicyAttachmentPageName":"85257D39006E7945852585A400689538"},}
85257D39006E7945852584C50059456D.aspx
  
1564Cochlear ImplantationSurgery (11)MA11.039dMA11.03985257D39006E7945852584C50059456DCochlear ImplantationCochlear Implantation
85257D39006E794585258507004C1178.aspx
  
1590Cold Therapy DevicesDME (05)MA05.035bMA05.03585257D39006E794585258507004C1178Cold Therapy DevicesCold Therapy Devices
19b9a826-f613-4a37-9ef2-3b874f2f1b5a.aspx
  
2138Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo™)MA08.128Pharmacy (08)MA08.128MA08.12819b9a826-f613-4a37-9ef2-3b874f2f1b5aCollagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)
85257D39006E794585258507004F8C3D.aspx
  
1591Commode ChairsDME (05)MA05.036bMA05.03685257D39006E794585258507004F8C3DCommode ChairsCommode Chairs
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1668Complementary and Integrative Health ServicesMiscellaneous (12)MA12.001dMA12.00185257D39006E7945852585040068A7CDComplementary and Integrative Health ServicesComplementary and Integrative Health Services
85257D39006E7945852584A1004F1618.aspx
  
1511Complete Decongestive Therapy (CDT)Medicine (07)MA07.042MA07.04285257D39006E7945852584A1004F1618Complete Decongestive Therapy (CDT)Complete Decongestive Therapy (CDT)
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1293Composite Tissue Allotransplantation of the Hand(s) and FaceMA11.112MA11.11285257D39006E79458525853800640308Composite Tissue Allotransplantation of the Hand(s) and FaceComposite Tissue Allotransplantation of the Hand(s) and Face
85257D39006E7945852585510077B9C7.aspx
  
1355Compression GarmentsDME (05)MA05.045aMA05.04585257D39006E7945852585510077B9C7Compression GarmentsCompression Garments
85257D39006E7945852584F2004CAC60.aspx
  
1599Computer Aided Detection (CAD) System for Use with Chest RadiographsRadiology (09)MA09.014aMA09.01485257D39006E7945852584F2004CAC60Computer Aided Detection (CAD) System for Use with Chest RadiographsComputer Aided Detection (CAD) System for Use with Chest Radiographs
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2272Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088cSurgery (11)MA11.088cMA11.0885fccb1cb-d1dd-433d-bebc-e409b6c643f4Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic ProcedureComputer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
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2041ConsultationServicesMA00.049Administrative (00)MA00.049MA00.0491a75604c-5542-4601-b256-9e702f9428baConsultation ServicesConsultation Services
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1875Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)Administrative (00)MA00.002gMA00.00285257D39006E7945852585BB0065691EContinuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)
{"1877": {"Id":1877,"MPAttachmentLetter":"A","Title":"ICD-10: Short term CGM","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585BB00657567"},"1878": {"Id":1878,"MPAttachmentLetter":"B","Title":"THERAPEUTIC LONG-TERM INTERSTITIAL CGMS","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585BB00657732"},}
85257D39006E7945852584E9007261C1.aspx
  
1583Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion PumpAnesthesia (01)MA01.004aMA01.00485257D39006E7945852584E9007261C1Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion PumpContinuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump
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1608Contrast Agents Used in Conjunction with EchocardiographyRadiology (09)MA09.004bMA09.00485257D39006E79458525851B005C2382Contrast Agents Used in Conjunction with EchocardiographyContrast Agents Used in Conjunction with Echocardiography
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2104CornealPachymetryUsingUltrasoundMA07.046fMedicine (07)MA07.046fMA07.046e0f65852-e550-4adc-a4f3-d102b58690c0Corneal Pachymetry Using UltrasoundCorneal Pachymetry Using Ultrasound
{"2105": {"Id":2105,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes Eligible to be Reported for Corneal Pachymetry Using Ultrasound","MPPolicyAttachmentInternalSourceId":4970,"PolicyAttachmentPageName":"1444f578-cd43-4d9b-8efc-e7fdbabdfb63"},}
ad0ebd72-6560-40a1-a162-47178bab8fd3.aspx
  
2119CosmeticProceduresMA12.009aMiscellaneous (12)MA12.009aMA12.009ad0ebd72-6560-40a1-a162-47178bab8fd3Cosmetic ProceduresCosmetic Procedures
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1484Coverage of Medical DevicesDME (05)MA05.040bMA05.04085257D39006E7945852583F90064AAD0Coverage of Medical DevicesCoverage of Medical Devices
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2075CranialElectrotherapyStimulationMA05.066aDME (05)MA05.066aMA05.0665d14dd79-3851-4eaf-bd7c-3896710bc679Cranial Electrotherapy StimulationCranial Electrotherapy Stimulation
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1616Criteria for Reimbursement of Emergency Room ServicesAdministrative (00)MA00.044bMA00.04485257D39006E7945852584FD00658A7ACriteria for Reimbursement of Emergency Room ServicesCriteria for Reimbursement of Emergency Room Services
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1997crizanlizumab-tmca(Adakveo®)MA08.109aPharmacy (08)MA08.109aMA08.109a32ec93e-b4fb-4b69-a647-5b3f7d48fdb4crizanlizumab-tmca (Adakveo®)crizanlizumab-tmca (Adakveo®)
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1630Cryosurgical Ablation of the Prostate GlandSurgery (11)MA11.022aMA11.02285257D39006E794585258535004D7D39Cryosurgical Ablation of the Prostate GlandCryosurgical Ablation of the Prostate Gland
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1882Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)Pharmacy (08)MA08.079fMA08.07985257D39006E79458525856F0067C06ADaratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)
47c29ee2-6b89-4781-9b06-f57ef31f898d.aspx
  
1955Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro™)MA08.079gPharmacy (08)MA08.079gMA08.07947c29ee2-6b89-4781-9b06-f57ef31f898dDaratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)
9e8d5417-cb7f-44f5-8b6a-111809f00afe.aspx
  
2327Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro™)MA08.079hPharmacy (08)MA08.079hMA08.0799e8d5417-cb7f-44f5-8b6a-111809f00afeDaratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™)
85257D39006E794585258588004883FD.aspx
  
1322Day RehabilitationRehabilitation Services (10)MA10.005bMA10.00585257D39006E794585258588004883FDDay RehabilitationDay Rehabilitation
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2004DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014fSurgery (11)MA11.014fMA11.014d1e494aa-49f6-4b68-946e-573a56d2f8b1Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
{"2005": {"Id":2005,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":4877,"PolicyAttachmentPageName":"9c741574-2d46-40d4-83db-7ab901e02739"},"2006": {"Id":2006,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":4878,"PolicyAttachmentPageName":"8894a13e-e602-45df-8db9-1944154b1f75"},"2007": {"Id":2007,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":4879,"PolicyAttachmentPageName":"36282eee-3e0d-4bc3-ad97-d1fe6168a949"},"2008": {"Id":2008,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":4880,"PolicyAttachmentPageName":"325ec966-870f-44d9-a94b-2ae1bfd5a16a"},"2009": {"Id":2009,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":4881,"PolicyAttachmentPageName":"da409332-2260-4450-bcd1-f2f0eff1c6c7"},}
16ffa733-0972-4703-be0f-1baa1a71f1f5.aspx
  
2079DeepBrainStimulation(DBS)MA11.005dSurgery (11)MA11.005dMA11.00516ffa733-0972-4703-be0f-1baa1a71f1f5Deep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)
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2055Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity™)MA08.052hPharmacy (08)MA08.052hMA08.052fe8b47e9-2455-4cec-88f0-e85cff136c80Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™)Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™)
{"2056": {"Id":2056,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":4831,"PolicyAttachmentPageName":"bd7428f9-6a6a-4666-b4e1-a294a453c3bf"},}
855c3dd7-e21c-4c80-966f-b8c6a15a3472.aspx
  
2334DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032cAdministrative (00)MA00.032cMA00.032855c3dd7-e21c-4c80-966f-b8c6a15a3472Direct Access to Obstetrics/Gynecology (OB/GYN) ServicesDirect Access to Obstetrics/Gynecology (OB/GYN) Services
{"2335": {"Id":2335,"MPAttachmentLetter":"A","Title":"Procedure Code for Direct Access OB/GYN for Family Planning","MPPolicyAttachmentInternalSourceId":5194,"PolicyAttachmentPageName":"5f3e1a47-9b97-475d-a095-45b97f6c7876"},}
85257D39006E7945852585A4006756E7.aspx
  
1362Dofetilide (Tikosyn®) Use in the Inpatient SettingPharmacy (08)MA08.021bMA08.02185257D39006E7945852585A4006756E7Dofetilide (Tikosyn®) Use in the Inpatient SettingDofetilide (Tikosyn®) Use in the Inpatient Setting
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2093Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041bMedicine (07)MA07.041bMA07.041d23692bf-87f2-46e4-9ee8-4c39765b6b8dDrug-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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2287DurableMedicalEquipment(DME)MA05.044iDME (05)MA05.044iMA05.0447b68599f-5e6b-47b7-af78-9b467ba97bf3Durable Medical Equipment (DME)Durable Medical Equipment (DME)
{"2288": {"Id":2288,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":5089,"PolicyAttachmentPageName":"b27e4a35-45a5-4757-9658-3a37cc54f117"},"2289": {"Id":2289,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":5090,"PolicyAttachmentPageName":"2adc4e10-7c78-4645-ac3d-4952a08df516"},"2290": {"Id":2290,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":5091,"PolicyAttachmentPageName":"f5d4d3f5-e14e-4cc0-a084-577352829e56"},}
81644841-0f55-4dc1-9476-5ab8d631fd3a.aspx
  
2423DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028eDME (05)MA05.028eMA05.02881644841-0f55-4dc1-9476-5ab8d631fd3aDurable 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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1923Durvalumab(Imfinzi™)MA08.123Pharmacy (08)MA08.123MA08.1232cc301d3-5baf-4ab6-a6a5-21ce1991f10dDurvalumab (Imfinzi™)Durvalumab (Imfinzi™)
{"1924": {"Id":1924,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":4686,"PolicyAttachmentPageName":"2c353d16-201e-4684-9657-003c3bef9330"},}
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1657Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)Pharmacy (08)MA08.044fMA08.04485257D39006E7945852584C800670CC3Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)
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1908Edaravone(Radicava™)MA08.092aPharmacy (08)MA08.092aMA08.09243933fd6-a89a-46a8-89a2-430e9625b5f6Edaravone (Radicava™)Edaravone (Radicava™)
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2454ElectricalContinenceAidMA05.059DME (05)MA05.059MA05.059d0ed73a0-1d77-4f22-9d58-a33008362521Electrical Continence AidElectrical Continence Aid
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2024ElectricalStimulationandElectromagneticStimulationfortheTreatmentofWoundsMA07.013dMedicine (07)MA07.013dMA07.0131c69392b-48d0-4d1f-8932-d5360da9dd64Electrical Stimulation and Electromagnetic Stimulation for the Treatment of WoundsElectrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
{"2025": {"Id":2025,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":4740,"PolicyAttachmentPageName":"deaa6ae5-bf82-4891-b265-fd8a22603956"},}
2b34f47b-170d-4497-a27b-e2473db10dfd.aspx
  
2180Electromyography(EMG)Studies:NeedleEMG,SurfaceEMG(SEMG)MA07.050gMedicine (07)MA07.050gMA07.0502b34f47b-170d-4497-a27b-e2473db10dfdElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
{"2181": {"Id":2181,"MPAttachmentLetter":"G","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5053,"PolicyAttachmentPageName":"726854b6-9990-4be5-b5ba-67cc672d6de3"},"2182": {"Id":2182,"MPAttachmentLetter":"F","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5054,"PolicyAttachmentPageName":"bfc3b8ab-79b3-4253-91d8-ec5865d2e9b7"},"2183": {"Id":2183,"MPAttachmentLetter":"D","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5055,"PolicyAttachmentPageName":"c8e3f9f7-61db-44eb-9f24-76677912c805"},"2184": {"Id":2184,"MPAttachmentLetter":"C","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5056,"PolicyAttachmentPageName":"b5e97c0f-1d18-4a2e-9019-2d7fffa0d991"},"2185": {"Id":2185,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic Studies","MPPolicyAttachmentInternalSourceId":5057,"PolicyAttachmentPageName":"5fdaac7d-0d77-4f9d-aab5-24285ca077aa"},"2186": {"Id":2186,"MPAttachmentLetter":"B","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5058,"PolicyAttachmentPageName":"3b049e48-b578-4525-82a7-62726c63c5ff"},"2187": {"Id":2187,"MPAttachmentLetter":"I","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5059,"PolicyAttachmentPageName":"31c08e58-bc44-4176-8d94-73a9bb4f606e"},"2188": {"Id":2188,"MPAttachmentLetter":"H","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5060,"PolicyAttachmentPageName":"b435fccd-0aaa-493b-8981-d238f7516ae2"},"2189": {"Id":2189,"MPAttachmentLetter":"K","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5061,"PolicyAttachmentPageName":"2ca859a1-a341-4354-bf28-a9db789272e3"},"2190": {"Id":2190,"MPAttachmentLetter":"E","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5062,"PolicyAttachmentPageName":"95377478-0472-4075-8201-a63c067ccf58"},"2191": {"Id":2191,"MPAttachmentLetter":"J","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5063,"PolicyAttachmentPageName":"6e14e80f-8e3b-46dd-a081-21d429929585"},}
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1931ElectronBeamComputedTomography(EBCT)forScreeningEvaluationsMA09.011aRadiology (09)MA09.011aMA09.0117db73249-b6ca-4bca-bc82-51af7fac9622Electron Beam Computed Tomography (EBCT) for Screening EvaluationsElectron Beam Computed Tomography (EBCT) for Screening Evaluations
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