|  | | 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 | | |
| | | 6204 | AbortionMA11.010d | Surgery (11) | MA11.010d | MA11.010 | 5247f0d8-bd39-40b9-8d10-0dbf4ddd71c3 | Abortion | Abortion | | |
| | | 6197 | AcupunctureMA12.004e | Miscellaneous (12) | MA12.004e | MA12.004 | 7b7d21d8-995e-4f47-ba27-8a8ab16dd472 | Acupuncture | Acupuncture | {"6198": {"Id":6198,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":9447,"PolicyAttachmentPageName":"211cfe61-db67-4e17-95a7-67cf12e61ea8"},} | |
| | | 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®) | | |
| | | 6459 | Agalsidasebeta(Fabrazyme)andpegunigalsidasealfa-iwxj(Elfabrio)MA08.033d | Pharmacy (08) | MA08.033d | MA08.033 | 0d8bc4f5-1281-4d61-9a84-c407798d39f1 | 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®) | | |
| | | 6906 | Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)MA08.036g | Pharmacy (08) | MA08.036g | MA08.036 | 3bedc708-0d80-47a5-8a8e-f90e2298c199 | 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™ ) | | |
| | | 6838 | AllergyImmunotherapyMA07.055e | Medicine (07) | MA07.055e | MA07.055 | f3f2bed1-86d0-44d2-9a86-19fd086edaab | Allergy Immunotherapy | Allergy Immunotherapy | | |
| | | 6504 | Alpha-1AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050c | Pharmacy (08) | MA08.050c | MA08.050 | 56725375-ddc3-4f11-b4d2-475da75ab3db | Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | | |
| | | 6367 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005d | Medicine (07) | MA07.005d | MA07.005 | 86337f18-777f-4339-b80d-d15e9e3f7a1f | 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 | | |
| | | 6602 | Amivantamab-vmjw(Rybrevant®)MA08.148b | Pharmacy (08) | MA08.148b | MA08.148 | 3c230b9f-006c-453d-aa44-b067c8a65c1c | Amivantamab-vmjw (Rybrevant®) | Amivantamab-vmjw (Rybrevant®) | | |
| | | 6833 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008d | Anesthesia (01) | MA01.008d | MA01.008 | a99cb627-6c40-44d1-9242-5c5691b4dc1d | 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 | {"6834": {"Id":6834,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9983,"PolicyAttachmentPageName":"39eb1bf7-871f-42c2-b136-8e1ebe8a8948"},} | |
| | | 6451 | Anifrolumab-fnia(Saphnelo®)MA08.140c | Pharmacy (08) | MA08.140c | MA08.140 | 4a171812-61e1-442e-972e-06cdf2ee8886 | 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 | | |
| | | 6731 | ApplicationandRemovalofTattoosMA11.072 | Surgery (11) | MA11.072 | MA11.072 | 641bd572-17cc-490d-a1ec-973d2ec30691 | 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"},} | |
| | | 7076 | AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)MA08.085k | Pharmacy (08) | MA08.085k | MA08.085 | d206e05d-436b-4f89-8e34-9b9c7fd436af | 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"},} | |
| | | 6492 | AutonomicNervousSystemTestingMA07.027h | Medicine (07) | MA07.027h | MA07.027 | 86ecd633-147b-41fe-b453-68d649c76914 | 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®) | | |
| | | 6603 | Axatilimab-csfr(Niktimvo™)forIntravenousUseMA08.180 | Pharmacy (08) | MA08.180 | MA08.180 | 4b32d856-a918-4951-aafa-a3082d9410f3 | 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 | | |
| | | 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 | | |
| | | 6911 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072o | Pharmacy (08) | MA08.072o | MA08.072 | 69076b2c-8bf3-4578-9562-5577882b03b3 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"6912": {"Id":6912,"MPAttachmentLetter":"A","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":10176,"PolicyAttachmentPageName":"5c7d6e94-d2c4-4ac0-8ce7-d176c1f0ef67"},} | |
| | | 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"},} | |
| | | 6309 | BiofeedbackTherapyMA07.010c | Medicine (07) | MA07.010c | MA07.010 | 287956eb-e6fa-4e31-b950-8f115705c651 | 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"},} | |
| | | 6360 | CanesandCrutchesMA05.052c | DME (05) | MA05.052c | MA05.052 | 35408c06-42b6-4b40-9975-75452a74aca9 | Canes and Crutches | Canes and Crutches | | |
| | | 6840 | CapsuleEndoscopyMA07.022f | Medicine (07) | MA07.022f | MA07.022 | d5fb8f9a-f3e7-4cf4-9b78-71feae208c9e | Capsule Endoscopy | Capsule Endoscopy | | |
| | | 7009 | CardiacContractilityModulationMA05.038 | DME (05) | MA05.038 | MA05.038 | 66d8032d-fa3d-4a21-9d18-b67616cc7739 | Cardiac Contractility Modulation | Cardiac Contractility Modulation | | |
| | | 6296 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002f | Rehabilitation Services (10) | MA10.002f | MA10.002 | 7e41ed3b-88ee-4c91-a965-9e4bf3f8f53c | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"6297": {"Id":6297,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":9407,"PolicyAttachmentPageName":"ad37198a-7c92-4132-a342-207fad8df7fa"},} | |
| | | 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"},} | |
| | | 6989 | ChemicalPeelsMA11.103c | Surgery (11) | MA11.103c | MA11.103 | 61fe4e7f-9e54-43ec-81ca-1ae44fcff525 | Chemical Peels | Chemical Peels | | |
| | | 6176 | ChimericAntigenReceptor(CAR)TherapyMA08.093p | Pharmacy (08) | MA08.093p | MA08.093 | 04f53427-7c90-4180-a350-b7d6bf21975c | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | | |
| | | 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®) | | |
| | | 6361 | CommodeChairsMA05.036c | DME (05) | MA05.036c | MA05.036 | 92333976-fe2e-49b9-866c-015ab92000bf | 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 | | |
| | | 6332 | CompressionGarmentsMA05.045f | DME (05) | MA05.045f | MA05.045 | 80f2b6fc-20b2-4f12-9fdc-9714482a2e4d | 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 | | |
| | | 5490 | ConsultationServicesMA00.049b | Administrative (00) | MA00.049b | MA00.049 | 69d6946a-3b6c-4b70-aa82-23b993e2e391 | Consultation Services | Consultation Services | | |
| | | 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™) | | |
| | | 6132 | CosmeticProceduresMA12.009a | Miscellaneous (12) | MA12.009a | MA12.009 | 0713198e-fb30-4e6a-8ccd-3eb4697b63d9 | 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) | | |
| | | 6314 | CryosurgicalAblationoftheProstateGlandMA11.022a | Surgery (11) | MA11.022a | MA11.022 | c678248d-0daf-4096-8915-d70396fb9896 | 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 | | |
| | | 6695 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014h | Surgery (11) | MA11.014h | MA11.014 | 92a465bb-fc1f-4566-98cf-c3b4ecb66497 | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"6696": {"Id":6696,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":9922,"PolicyAttachmentPageName":"df47f52e-9064-4e12-87fa-c838a7f4b3d3"},"6697": {"Id":6697,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":9923,"PolicyAttachmentPageName":"2549759c-e4a4-48ee-b6b2-82ab31d3dcad"},"6698": {"Id":6698,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":9924,"PolicyAttachmentPageName":"45039e76-268c-44e8-9bd9-17d258003368"},"6699": {"Id":6699,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":9925,"PolicyAttachmentPageName":"781f5e6b-1f09-4fc5-9fc8-808fa0f37be0"},"6700": {"Id":6700,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":9926,"PolicyAttachmentPageName":"8dafc666-d05e-4382-941e-92c3d1c0974a"},} | |
| | | 6933 | DeepBrainStimulation(DBS)MA11.005h | Surgery (11) | MA11.005h | MA11.005 | 778dbe91-6682-4915-9325-2bf4842348c5 | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | | |
| | | 7006 | Denosumab(Prolia®,Xgeva®)andrelatedbiosimilars,andRomosozumab-aqqg(Evenity®)MA08.052o | Pharmacy (08) | MA08.052o | MA08.052 | 2f9df985-da4f-4caa-b1b0-846b7680e4ec | Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®) | Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®) | {"7007": {"Id":7007,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":10267,"PolicyAttachmentPageName":"2e8526d5-d0b3-4c1f-a9b9-70deff407d5c"},} | |
| | | 5792 | DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099e | Surgery (11) | MA11.099e | MA11.099 | e0f7fea6-e4d6-4818-989d-b4211c299401 | 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 | | |
| | | 6203 | Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021c | Pharmacy (08) | MA08.021c | MA08.021 | f1080c48-9401-4d71-8de9-6f864ed20ca8 | 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) | | |
| | | 6855 | Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041c | Medicine (07) | MA07.041c | MA07.041 | 5b26393f-e94c-46ee-9bd2-2adbff62a19e | 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"},} | |
| | | 7078 | Efbemalenograstimalfa-vuxw(Ryzneuta®),Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082o | Pharmacy (08) | MA08.082o | MA08.082 | a8b60108-7e46-4a9a-8c1f-e79aa49bd0fc | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | {"7079": {"Id":7079,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":9901,"PolicyAttachmentPageName":"992017d9-4f04-4ebb-8248-f06b0ea98283"},} | |
| | | 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) | | |
| | | 6552 | ElectroconvulsiveTherapy(ECT)MA14.001a | Behavioral Health (14) | MA14.001a | MA14.001 | 274c1577-e38b-47a0-b0aa-b6b0b8387d15 | Electroconvulsive Therapy (ECT) | Electroconvulsive Therapy (ECT) | | |
| | | 6778 | Electromyography(EMG)Studies,NerveConductionStudies(NCS),andRelatedElectrodiagnosticStudiesMA07.050n | Medicine (07) | MA07.050n | MA07.050 | bd15ff42-074f-4d9c-97e7-dbcf7976a134 | Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies | Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies | {"6779": {"Id":6779,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic (EDX) Studies","MPPolicyAttachmentInternalSourceId":10029,"PolicyAttachmentPageName":"1f30fec0-be2b-4fc0-8e7d-4c4457438014"},"6780": {"Id":6780,"MPAttachmentLetter":"E","Title":"ICD10 Codes - Neuromuscular Junction Testing (NJT)","MPPolicyAttachmentInternalSourceId":10030,"PolicyAttachmentPageName":"7e616c94-ca74-4078-9838-6060fe6f0451"},"6781": {"Id":6781,"MPAttachmentLetter":"D","Title":"ICD-10 Codes - Needle Electromyography (NEMG) for Guidance in Conjunction with Chemodenervation","MPPolicyAttachmentInternalSourceId":10031,"PolicyAttachmentPageName":"0bd11ba4-d119-47c0-be8e-656206145719"},"6782": {"Id":6782,"MPAttachmentLetter":"C","Title":"ICD10 Codes - Electromyography (EMG) of Anal or Urethral Sphincter","MPPolicyAttachmentInternalSourceId":10032,"PolicyAttachmentPageName":"6dd6e758-198d-4c97-ad1b-c4310d554580"},"6783": {"Id":6783,"MPAttachmentLetter":"B","Title":"ICD10 Codes - Needle Electromyography (NEMG) and Nerve Conduction Studies (NCS)","MPPolicyAttachmentInternalSourceId":10033,"PolicyAttachmentPageName":"652f2c75-756a-483d-9269-00acecb99498"},"6784": {"Id":6784,"MPAttachmentLetter":"H","Title":"ICD10 Codes - Visual Evoked Potentials (VEP)","MPPolicyAttachmentInternalSourceId":10034,"PolicyAttachmentPageName":"a68876af-370d-4c10-bf0a-1fb4c8c4c947"},"6785": {"Id":6785,"MPAttachmentLetter":"F","Title":"ICD10 Codes - Somatosensory Evoked Potentials (SEP) and Central Motor Evoked Potentials (CMEP)","MPPolicyAttachmentInternalSourceId":10035,"PolicyAttachmentPageName":"d15ade48-0842-42eb-b8bf-4facbb74ce1f"},"6786": {"Id":6786,"MPAttachmentLetter":"G","Title":"ICD10 Codes - Brainstem Auditory Evoked Potentials (BAEP)","MPPolicyAttachmentInternalSourceId":10036,"PolicyAttachmentPageName":"bb5cc9d4-c904-4fe8-9767-d678364dffe7"},} | |
| | | 6327 | Elranatamab-bcmm(Elrexfio™)MA08.168 | Pharmacy (08) | MA08.168 | MA08.168 | 6e0ef2cc-2603-4f7a-9bf1-f6e4c867a987 | Elranatamab-bcmm (Elrexfio™) | Elranatamab-bcmm (Elrexfio™) | | |
