|  | | 1299 | Abatacept (Orencia®) for Injection for Intravenous Use | Pharmacy (08) | MA08.028d | MA08.028 | 85257D39006E7945852584EB005E7F40 | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"1823":{"Id":1823,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584EB005E7F48"},} | |
| | | 1649 | Abortion | Surgery (11) | MA11.010a | MA11.010 | 85257D39006E79458525854300496FA9 | Abortion | Abortion | | |
| | | 1349 | Acupuncture | | MA12.004a | MA12.004 | 85257D39006E7945852585660066FB4B | Acupuncture | Acupuncture | {"1855":{"Id":1855,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E794585258568005E04BD"},} | |
| | | 1344 | Acute Care Facility Inpatient Transfers | | MA12.003a | MA12.003 | 85257D39006E7945852585970047577D | Acute Care Facility Inpatient Transfers | Acute Care Facility Inpatient Transfers | | |
| | | 1430 | Ado-Trastuzumab Emtansine (Kadcyla®) | Pharmacy (08) | MA08.066c | MA08.066 | 85257D39006E7945852583C4005C5F03 | Ado-Trastuzumab Emtansine (Kadcyla®) | Ado-Trastuzumab Emtansine (Kadcyla®) | {"1705":{"Id":1705,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852583C4005C5F0E"},} | |
| | | 1645 | Agalsidase beta (Fabrazyme®) | Pharmacy (08) | MA08.033b | MA08.033 | 85257D39006E7945852585430046609C | Agalsidase beta (Fabrazyme®) | Agalsidase beta (Fabrazyme®) | | |
| | | 1345 | Air Ambulance Services | Miscellaneous (12) | MA12.007a | MA12.007 | 85257D39006E79458525859700487CB6 | Air Ambulance Services | Air Ambulance Services | | |
| | | 1666 | Alemtuzumab (Lemtrada™) | | MA08.015d | MA08.015 | 85257D39006E7945852584EB0059DBD8 | Alemtuzumab (Lemtrada™) | Alemtuzumab (Lemtrada™) | | |
| | | 1646 | Alglucosidase alfa (e.g., Lumizyme®) | Pharmacy (08) | MA08.036c | MA08.036 | 85257D39006E794585258543004566E0 | Alglucosidase alfa (e.g., Lumizyme®) | Alglucosidase alfa (e.g., Lumizyme®) | | |
| | | 1587 | Allergy Immunotherapy | Medicine (07) | MA07.055c | MA07.055 | 85257D39006E7945852584E9007261D7 | Allergy Immunotherapy | Allergy Immunotherapy | | |
| | | 1617 | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection | Pathology and Laboratory (06) | MA06.015c | MA06.015 | 85257D39006E7945852585340058AB4F | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection | | |
| | | 1607 | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™) | Pharmacy (08) | MA08.050a | MA08.050 | E5CF8D3FC1845D768525851F0066272E | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™) | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™) | | |
| | | 1559 | Always Bundled Procedure Codes | Administrative (00) | MA00.026g | MA00.026 | 85257D39006E7945852584BE00618356 | Always Bundled Procedure Codes | Always Bundled Procedure Codes | {"1776":{"Id":1776,"MPAttachmentLetter":"A","Title":"CPT Codes and HCPCS Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584BE0061835A"},} | |
| | | 1641 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Medicine (07) | MA07.005c | MA07.005 | 85257D39006E79458525852700659BB3 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | | |
| | | 1558 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | | MA07.026e | MA07.026 | 85257D39006E79458525849B0072F230 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | | |
| | | 1447 | Ankle-Foot/Knee-Ankle-Foot Orthoses | DME (05) | MA05.010d | MA05.010 | 85257D39006E79458525847900571033 | Ankle-Foot/Knee-Ankle-Foot Orthoses | Ankle-Foot/Knee-Ankle-Foot Orthoses | {"1714":{"Id":1714,"MPAttachmentLetter":"A","Title":"HCPCS CODES FOR ANKLE-FOOT/ KNEE-ANKLE FOOT ORTHOSIS","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525847900571039"},} | |
| | | 1548 | Anorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters | Medicine (07) | MA07.018b | MA07.018 | 85257D39006E7945852584C8004B13BC | Anorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters | Anorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters | | |
| | | 1376 | Apheresis Therapy | Pathology and Laboratory (06) | MA06.001e | MA06.001 | 85257D39006E7945852581E800533DBD | Apheresis Therapy | Apheresis Therapy | | |
| | | 1461 | Application and Removal of Tattoos | Surgery (11) | MA11.072 | MA11.072 | 85257D39006E794585258464005D9537 | Application and Removal of Tattoos | Application and Removal of Tattoos | | |
| | | 1647 | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | | MA08.091c | MA08.091 | 85257D39006E79458525854200771F5A | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | {"1800":{"Id":1800,"MPAttachmentLetter":"A","Title":"Risk of Emesis Without Prophylaxis: Intravenous and Oral Antineoplastic Agents","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525854200771F88"},} | |
| | | 1433 | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Surgery (11) | MA11.105f | MA11.105 | 85257D39006E794585258397005A5730 | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | {"1707":{"Id":1707,"MPAttachmentLetter":"A","Title":"No Title","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E794585258397005A5739"},} | |
| | | 1533 | Artificial Hearts and Ventricular Assist Devices (VADs) | Surgery (11) | MA11.011c | MA11.011 | 85257D39006E7945852584CE0057BE40 | Artificial Hearts and Ventricular Assist Devices (VADs) | Artificial Hearts and Ventricular Assist Devices (VADs) | | |
| | | 1311 | Artificial Intervertebral Disc Insertion | Surgery (11) | MA11.044g | MA11.044 | 60E1FC5D8D97065A852585880062C00E | Artificial Intervertebral Disc Insertion | Artificial Intervertebral Disc Insertion | | |
| | | 1519 | Asparaginase Erwinia Chrysanthemi (Erwinaze®) | | MA08.085b | MA08.085 | 85257D39006E79458525848D004D2F20 | Asparaginase Erwinia Chrysanthemi (Erwinaze®) | Asparaginase Erwinia Chrysanthemi (Erwinaze®) | | |
| | | 1316 | Autologous Chondrocyte Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions | Surgery (11) | MA11.082c | MA11.082 | 85257D39006E79458525849B0043944F | Autologous Chondrocyte Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions | Autologous Chondrocyte Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions | | |
| | | 1879 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | DME (05) | MA05.005d | MA05.005 | 46045ED869F1832F852585AB0056C456 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"1867": {"Id":1867,"MPAttachmentLetter":"A","Title":"ICD-10 codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"5801A106F8EA95A1852585AB0056C464"},"1868": {"Id":1868,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"BFE142D6DE3A8525852585AB0056C46C"},} | |
| | | 1325 | Autonomic Nervous System Testing | | MA07.027c | MA07.027 | 85257D39006E79458525853500666D0A | Autonomic Nervous System Testing | Autonomic Nervous System Testing | | |
| | | 1921 | Avelumab(Bavencio®)MA08.122 | Pharmacy (08) | MA08.122 | MA08.122 | f91a2c3b-4f6b-4c15-b58c-6d05bcd97376 | Avelumab (Bavencio®) | Avelumab (Bavencio®) | {"1922": {"Id":1922,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":4675,"PolicyAttachmentPageName":"765f7154-9f56-4ca8-bd28-3b9c1d7df492"},} | |
| | | 1555 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | Surgery (11) | MA11.100e | MA11.100 | 85257D39006E7945852584C8004B1B01 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | | |
| | | 1301 | Belimumab (Benlysta®) for Intravenous Use | Pharmacy (08) | MA08.057b | MA08.057 | 85257D39006E7945852584EB005E6F24 | Belimumab (Benlysta®) for Intravenous Use | Belimumab (Benlysta®) for Intravenous Use | | |
| | | 1671 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Pharmacy (08) | MA08.072f | MA08.072 | 4263464DFB2126FA852585690069FC94 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"1805":{"Id":1805,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"8FBA5543688BDE9E852585690069FC9F"},} | |
| | | 1577 | Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus | Administrative (00) | MA00.037h | MA00.037 | 85257D39006E7945852582BA004934E6 | 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 | {"1784":{"Id":1784,"MPAttachmentLetter":"A","Title":"CPT/HCPCS Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852582BA004934EC"},} | |
| | | 1448 | Biofeedback Therapy | Medicine (07) | MA07.010a | MA07.010 | 85257D39006E79458525847900620FF7 | Biofeedback Therapy | Biofeedback Therapy | | |
| | | 1625 | Bioimpedance for the Detection of Lymphedema | Medicine (07) | MA07.052 | MA07.052 | 85257D39006E7945852585350057717D | Bioimpedance for the Detection of Lymphedema | Bioimpedance for the Detection of Lymphedema | | |
| | | 1623 | Biomarkers for Oncology | Pathology and Laboratory (06) | MA06.022f | MA06.022 | 85257D39006E794585258535004891F6 | Biomarkers for Oncology | Biomarkers for Oncology | | |
| | | 1389 | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | Surgery (11) | MA11.047c | MA11.047 | 85257D39006E7945852583360046324E | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | {"1691":{"Id":1691,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525833600463254"},} | |
| | | 1411 | Blinatumomab (Blincyto®) | | MA08.058c | MA08.058 | 85257D39006E794585258400006DCAC0 | Blinatumomab (Blincyto®) | Blinatumomab (Blincyto®) | | |
| | | 1420 | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Surgery (11) | MA11.049c | MA11.049 | 85257D39006E7945852583F20049C506 | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | | |
| | | 1405 | Bortezomib (Bortezomib for Injection, Velcade®) | Pharmacy (08) | MA08.037f | MA08.037 | 85257D39006E79458525838400616E51 | Bortezomib (Bortezomib for Injection, Velcade®) | Bortezomib (Bortezomib for Injection, Velcade®) | | |
| | | 1298 | Botulinum Toxin Agents | Pharmacy (08) | MA08.017e | MA08.017 | 85257D39006E79458525853E00503779 | Botulinum Toxin Agents | Botulinum Toxin Agents | {"1822":{"Id":1822,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525853E00503797"},} | |
| | | 1541 | Brentuximab Vedotin (Adcetris®) | Pharmacy (08) | MA08.068d | MA08.068 | 85257D39006E79458525848D004D227B | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | {"1771":{"Id":1771,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525848D004D2283"},} | |
| | | 1363 | Bronchial Thermoplasty | Surgery (11) | MA11.006b | MA11.006 | 85257D39006E7945852585A400669A60 | Bronchial Thermoplasty | Bronchial Thermoplasty | | |
| | | 1452 | Burosumab-twza (Crysvita®) | | MA08.099a | MA08.099 | 85257D39006E79458525847E006E809D | Burosumab-twza (Crysvita®) | Burosumab-twza (Crysvita®) | | |
| | | 1353 | Cabazitaxel (Jevtana®) | Pharmacy (08) | MA08.054c | MA08.054 | 85257D39006E79458525853D005AB4DA | Cabazitaxel (Jevtana®) | Cabazitaxel (Jevtana®) | | |
| | | 1677 | Canakinumab (Ilaris®) | | MA08.101 | MA08.101 | 85257D39006E794585258566007371F0 | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | | |
| | | 1594 | Canes and Crutches | DME (05) | MA05.052b | MA05.052 | 85257D39006E794585258507004C92F8 | Canes and Crutches | Canes and Crutches | | |
| | | 1453 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Rehabilitation Services (10) | MA10.002b | MA10.002 | 85257D39006E79458525847E006B52C0 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"1715":{"Id":1715,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525847E006B52C5"},} | |
| | | 1566 | Care Management and Care Planning Services | Administrative (00) | MA00.006f | MA00.006 | 85257D39006E79458525847F0061B2D9 | Care Management and Care Planning Services | Care Management and Care Planning Services | | |
| | | 1428 | Carfilzomib (Kyprolis™) | Pharmacy (08) | MA08.062d | MA08.062 | 85257D39006E7945852583E60044123C | Carfilzomib (Kyprolis™) | Carfilzomib (Kyprolis™) | | |
| | | 1374 | Cast and Splint Applications and Associated Supplies Provided in the Office Setting | Administrative (00) | MA00.012b | MA00.012 | B62FA99106A1AEC1852581E9006281CE | Cast and Splint Applications and Associated Supplies Provided in the Office Setting | Cast and Splint Applications and Associated Supplies Provided in the Office Setting | {"1681":{"Id":1681,"MPAttachmentLetter":"A","Title":"No Title","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"A2DFF3878C4FCBD3852581E9006281DF"},} | |
| | | 1297 | Cataract Surgery | Surgery (11) | MA11.054c | MA11.054 | 85257D39006E79458525857500659EB8 | Cataract Surgery | Cataract Surgery | {"1821":{"Id":1821,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525857500659EED"},} | |
| | | 1471 | Catheter Ablation of Cardiac Arrhythmias | Surgery (11) | MA11.060c | MA11.060 | 85257D39006E7945852584120067A712 | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | | |
| | | 1880 | Cemiplimab-rwlc (LIBTAYO®) | | MA08.124 | MA08.124 | 85257D39006E79458525857B007B8F60 | Cemiplimab-rwlc (LIBTAYO®) | Cemiplimab-rwlc (LIBTAYO®) | | |
| | | 1628 | Cerliponase alfa (Brineura®) | | MA08.089c | MA08.089 | 85257D39006E7945852585340054CA80 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | | |
| | | 1414 | Cervical Traction Devices for In-home Use | DME (05) | MA05.009 | MA05.009 | 85257D39006E7945852583CC00559198 | Cervical Traction Devices for In-home Use | Cervical Traction Devices for In-home Use | | |
| | | 1507 | Cetuximab (Erbitux®) | Pharmacy (08) | MA08.031d | MA08.031 | 85257D39006E79458525846C00639663 | Cetuximab (Erbitux®) | Cetuximab (Erbitux®) | {"1762":{"Id":1762,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525846C0063966E"},"1763":{"Id":1763,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525846C00639677"},} | |
| | | 1463 | Chemical Peels | Surgery (11) | MA11.103a | MA11.103 | 85257D39006E794585258464005D9E28 | Chemical Peels | Chemical Peels | | |
| | | 1514 | Chimeric Antigen Receptor (CAR) Therapy | | MA08.093e | MA08.093 | 85257D39006E7945852584770059E7B0 | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | | |
| | | 1672 | Chiropractic Services | Rehabilitation Services (10) | MA10.004g | MA10.004 | 66554A217BE65DE68525856C00754BD5 | Chiropractic Services | Chiropractic Services | {"1806":{"Id":1806,"MPAttachmentLetter":"A","Title":"Medically neessary ICD-10 diagnosis codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"7F18E7EAF5BAB6D98525856C00754BE0"},} | |
| | | 1368 | Circulating Tumor Cell (CTC) Assay | Pathology and Laboratory (06) | MA06.030 | MA06.030 | F371FB2E48AFB33885257DBE00723399 | Circulating Tumor Cell (CTC) Assay | Circulating Tumor Cell (CTC) Assay | | |
| | | 1331 | Coagulation Factors | Pharmacy (08) | MA08.004q | MA08.004 | 85257D39006E7945852585830069B42A | Coagulation Factors | Coagulation Factors | | |
| | | 1361 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | | MA06.032 | MA06.032 | 85257D39006E7945852585A400689511 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | Cobalamin (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"},} | |
| | | 1564 | Cochlear Implantation | Surgery (11) | MA11.039d | MA11.039 | 85257D39006E7945852584C50059456D | Cochlear Implantation | Cochlear Implantation | | |
| | | 1590 | Cold Therapy Devices | DME (05) | MA05.035b | MA05.035 | 85257D39006E794585258507004C1178 | Cold Therapy Devices | Cold Therapy Devices | | |
| | | 1591 | Commode Chairs | DME (05) | MA05.036b | MA05.036 | 85257D39006E794585258507004F8C3D | Commode Chairs | Commode Chairs | | |
| | | 1668 | Complementary and Integrative Health Services | Miscellaneous (12) | MA12.001d | MA12.001 | 85257D39006E7945852585040068A7CD | Complementary and Integrative Health Services | Complementary and Integrative Health Services | | |
| | | 1511 | Complete Decongestive Therapy (CDT) | Medicine (07) | MA07.042 | MA07.042 | 85257D39006E7945852584A1004F1618 | Complete Decongestive Therapy (CDT) | Complete Decongestive Therapy (CDT) | | |
| | | 1293 | Composite Tissue Allotransplantation of the Hand(s) and Face | | MA11.112 | MA11.112 | 85257D39006E79458525853800640308 | Composite Tissue Allotransplantation of the Hand(s) and Face | Composite Tissue Allotransplantation of the Hand(s) and Face | | |
| | | 1355 | Compression Garments | DME (05) | MA05.045a | MA05.045 | 85257D39006E7945852585510077B9C7 | Compression Garments | Compression Garments | | |
| | | 1599 | Computer Aided Detection (CAD) System for Use with Chest Radiographs | Radiology (09) | MA09.014a | MA09.014 | 85257D39006E7945852584F2004CAC60 | Computer Aided Detection (CAD) System for Use with Chest Radiographs | Computer Aided Detection (CAD) System for Use with Chest Radiographs | | |
| | | 1662 | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Surgery (11) | MA11.088b | MA11.088 | 85257D39006E7945852584E90067CC1C | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | | |
| | | 1383 | Consultation Services | | MA00.049 | MA00.049 | 8DFCA2ECFC6B5415852582DC00509E93 | Consultation Services | Consultation Services | | |
| | | 1379 | Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS) | Administrative (00) | MA00.002f | MA00.002 | 85257D39006E794585258241006B8F07 | Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS) | Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS) | {"1686":{"Id":1686,"MPAttachmentLetter":"A","Title":"ICD-10: Short term CGM","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E794585258241006B8F0C"},"1687":{"Id":1687,"MPAttachmentLetter":"B","Title":"THERAPEUTIC LONG-TERM INTERSTITIAL CGMS","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E794585258241006B8F11"},} | |
| | | 1583 | Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump | Anesthesia (01) | MA01.004a | MA01.004 | 85257D39006E7945852584E9007261C1 | Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump | Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump | | |
| | | 1608 | Contrast Agents Used in Conjunction with Echocardiography | Radiology (09) | MA09.004b | MA09.004 | 85257D39006E79458525851B005C2382 | Contrast Agents Used in Conjunction with Echocardiography | Contrast Agents Used in Conjunction with Echocardiography | | |
| | | 1503 | Corneal Pachymetry Using Ultrasound | Medicine (07) | MA07.046e | MA07.046 | 85257D39006E7945852584B70053D84B | Corneal Pachymetry Using Ultrasound | Corneal Pachymetry Using Ultrasound | {"1750":{"Id":1750,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes Eligible to be Reported for Corneal Pachymetry Using Ultrasound","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B70053D852"},} | |
| | | 1410 | Cosmetic Procedures | | MA12.009 | MA12.009 | 85257D39006E7945852583CC00558475 | Cosmetic Procedures | Cosmetic Procedures | | |
| | | 1484 | Coverage of Medical Devices | DME (05) | MA05.040b | MA05.040 | 85257D39006E7945852583F90064AAD0 | Coverage of Medical Devices | Coverage of Medical Devices | | |
| | | 1545 | Cranial Electrotherapy Stimulation | | MA05.066a | MA05.066 | 85257D39006E7945852584C8004B297A | Cranial Electrotherapy Stimulation | Cranial Electrotherapy Stimulation | | |
| | | 1616 | Criteria for Reimbursement of Emergency Room Services | Administrative (00) | MA00.044b | MA00.044 | 85257D39006E7945852584FD00658A7A | Criteria for Reimbursement of Emergency Room Services | Criteria for Reimbursement of Emergency Room Services | | |
| | | 1925 | crizanlizumab-tmca(Adakveo®)MA08.109 | Pharmacy (08) | MA08.109 | MA08.109 | 5df6dd06-003e-4b4a-9610-98bd62b9e38c | crizanlizumab-tmca (Adakveo®) | crizanlizumab-tmca (Adakveo®) | | |
| | | 1630 | Cryosurgical Ablation of the Prostate Gland | Surgery (11) | MA11.022a | MA11.022 | 85257D39006E794585258535004D7D39 | Cryosurgical Ablation of the Prostate Gland | Cryosurgical Ablation of the Prostate Gland | | |
| | | 1882 | Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™) | Pharmacy (08) | MA08.079f | MA08.079 | 85257D39006E79458525856F0067C06A | Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™) | Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro™) | | |
| | | 1322 | Day Rehabilitation | Rehabilitation Services (10) | MA10.005b | MA10.005 | 85257D39006E794585258588004883FD | Day Rehabilitation | Day Rehabilitation | | |
| | | 1640 | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Surgery (11) | MA11.014e | MA11.014 | 85257D39006E7945852585270065A85E | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"1794":{"Id":1794,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585270065A868"},"1795":{"Id":1795,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585270065A86E"},"1796":{"Id":1796,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585270065A874"},"1797":{"Id":1797,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585270065A879"},"1798":{"Id":1798,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585270065A87F"},} | |
| | | 1438 | Deep Brain Stimulation (DBS) | Surgery (11) | MA11.005c | MA11.005 | 85257D39006E7945852583900059832C | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | | |
| | | 1313 | Denervation of the Spinal Nerves for Chronic Pain | Surgery (11) | MA11.102h | MA11.102 | 67CCEAB40582EA77852585880062CC28 | Denervation of the Spinal Nerves for Chronic Pain | Denervation of the Spinal Nerves for Chronic Pain | | |
| | | 1467 | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™) | Pharmacy (08) | MA08.052g | MA08.052 | 85257D39006E79458525847A0047B689 | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™) | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™) | {"1723":{"Id":1723,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525847A0047B692"},} | |
| | | 1338 | Deoxycholic Acid (Kybella™) | | MA08.074a | MA08.074 | 85257D39006E7945852585880063600E | Deoxycholic Acid (Kybella™) | Deoxycholic Acid (Kybella™) | | |
| | | 1472 | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | Administrative (00) | MA00.032b | MA00.032 | 85257D39006E7945852582CD00534D1B | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | | |
| | | 1362 | Dofetilide (Tikosyn®) Use in the Inpatient Setting | Pharmacy (08) | MA08.021b | MA08.021 | 85257D39006E7945852585A4006756E7 | Dofetilide (Tikosyn®) Use in the Inpatient Setting | Dofetilide (Tikosyn®) Use in the Inpatient Setting | | |
| | | 1516 | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | Medicine (07) | MA07.041b | MA07.041 | 85257D39006E7945852584A300471E42 | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | | |
| | | 1568 | Durable Medical Equipment (DME) | DME (05) | MA05.044g | MA05.044 | 85257D39006E7945852584D6005452FB | Durable Medical Equipment (DME) | Durable Medical Equipment (DME) | {"1778":{"Id":1778,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584D600545304"},"1779":{"Id":1779,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584D60054530C"},"1780":{"Id":1780,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584D600545312"},} | |
| | | 1392 | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | DME (05) | MA05.028d | MA05.028 | 85257D39006E794585258360004DFC78 | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | | |
| | | 1923 | Durvalumab(Imfinzi™)MA08.123 | Pharmacy (08) | MA08.123 | MA08.123 | 2cc301d3-5baf-4ab6-a6a5-21ce1991f10d | Durvalumab (Imfinzi™) | Durvalumab (Imfinzi™) | {"1924": {"Id":1924,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":4686,"PolicyAttachmentPageName":"2c353d16-201e-4684-9657-003c3bef9330"},} | |
| | | 1657 | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) | Pharmacy (08) | MA08.044f | MA08.044 | 85257D39006E7945852584C800670CC3 | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) | | |
| | | 1908 | Edaravone(Radicava™)MA08.092a | Pharmacy (08) | MA08.092a | MA08.092 | 43933fd6-a89a-46a8-89a2-430e9625b5f6 | Edaravone (Radicava™) | Edaravone (Radicava™) | | |
| | | 1595 | Electrical Continence Aid | DME (05) | MA05.059 | MA05.059 | 85257D39006E794585258507004E769F | Electrical Continence Aid | Electrical Continence Aid | | |
| | | 1465 | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | Medicine (07) | MA07.013d | MA07.013 | 85257D39006E7945852584770068838C | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | {"1722":{"Id":1722,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525847700688390"},} | |
| | | 1504 | Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG) | Medicine (07) | MA07.050f | MA07.050 | 85257D39006E7945852584B8006F6EFE | Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG) | Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG) | {"1751":{"Id":1751,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic Studies","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F09"},"1752":{"Id":1752,"MPAttachmentLetter":"B","Title":"ICD-10","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F0C"},"1753":{"Id":1753,"MPAttachmentLetter":"C","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F10"},"1754":{"Id":1754,"MPAttachmentLetter":"D","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F15"},"1755":{"Id":1755,"MPAttachmentLetter":"E","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F20"},"1756":{"Id":1756,"MPAttachmentLetter":"F","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F1B"},"1757":{"Id":1757,"MPAttachmentLetter":"G","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F25"},"1758":{"Id":1758,"MPAttachmentLetter":"H","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F29"},"1759":{"Id":1759,"MPAttachmentLetter":"I","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F2E"},"1760":{"Id":1760,"MPAttachmentLetter":"J","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F34"},"1761":{"Id":1761,"MPAttachmentLetter":"K","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584B8006F6F38"},} | |
