|  | | 3582 | Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028g | Pharmacy (08) | MA08.028g | MA08.028 | b00ed136-3352-4223-b636-58021431bded | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"3583": {"Id":3583,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6282,"PolicyAttachmentPageName":"cf45094d-bd05-4d93-993e-aa5a18b82368"},} | |
|  | | 4016 | AbortionMA11.010a | Surgery (11) | MA11.010a | MA11.010 | 0fd171f7-f2b4-4b69-8563-7bdd2258b528 | Abortion | Abortion | | |
|  | | 3752 | AcupunctureMA12.004c | Miscellaneous (12) | MA12.004c | MA12.004 | ba6bd7ca-d349-4200-b14d-b89ece686f02 | Acupuncture | Acupuncture | {"3753": {"Id":3753,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":6538,"PolicyAttachmentPageName":"6f541d12-71dd-4931-ad62-8855a8184bf8"},} | |
|  | | 3936 | AcuteCareFacilityInpatientTransfersMA12.003b | Miscellaneous (12) | MA12.003b | MA12.003 | 2dd8737a-eb29-4514-acbd-7186ea78b680 | Acute Care Facility Inpatient Transfers | Acute Care Facility Inpatient Transfers | | |
|  | | 4094 | Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066f | Pharmacy (08) | MA08.066f | MA08.066 | 62e04270-b09a-42de-9ba4-248feb04627e | Ado-Trastuzumab Emtansine (Kadcyla®) | Ado-Trastuzumab Emtansine (Kadcyla®) | {"4095": {"Id":4095,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6793,"PolicyAttachmentPageName":"16b65577-4b46-4911-94f6-c3c03734729f"},} | |
|  | | 3434 | Agalsidasebeta(Fabrazyme®)MA08.033c | Pharmacy (08) | MA08.033c | MA08.033 | 72b0047c-3b34-4685-ad68-a0a2b71933b1 | Agalsidase beta (Fabrazyme®) | Agalsidase beta (Fabrazyme®) | | |
|  | | 4020 | AirAmbulanceServicesMA12.007b | Miscellaneous (12) | MA12.007b | MA12.007 | 119bad1e-0fbf-441f-81d6-265b76cc87b6 | Air Ambulance Services | Air Ambulance Services | | |
|  | | 3568 | Alemtuzumab(Lemtrada®)MA08.015d | Pharmacy (08) | MA08.015d | MA08.015 | 1f566b6c-8a94-4447-8e00-fe6c78c20462 | Alemtuzumab (Lemtrada®) | Alemtuzumab (Lemtrada®) | | |
|  | | 3525 | Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®)MA08.036f | Pharmacy (08) | MA08.036f | MA08.036 | e5598147-140e-442f-b181-fb610293bd70 | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ) | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ) | | |
|  | | 4006 | AllergyImmunotherapyMA07.055d | Medicine (07) | MA07.055d | MA07.055 | 2e1aa0fd-b9e3-4e44-b29c-e5b32a36e6de | Allergy Immunotherapy | Allergy Immunotherapy | | |
|  | | 3569 | Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050b | Pharmacy (08) | MA08.050b | MA08.050 | 1200bd89-d573-4716-a175-5c772b242da4 | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | | |
|  | | 4193 | AlwaysBundledProcedureCodesMA00.026o | Administrative (00) | MA00.026o | MA00.026 | aace969a-94c9-4637-9bf9-6ab17ccbcd0e | Always Bundled Procedure Codes | Always Bundled Procedure Codes | {"4194": {"Id":4194,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":7151,"PolicyAttachmentPageName":"c9a1ed65-a8a9-45b1-a2a7-6d991131205a"},"4195": {"Id":4195,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (MPFSD Indicator B)","MPPolicyAttachmentInternalSourceId":7152,"PolicyAttachmentPageName":"bb4c0919-039e-4336-84f2-5186fcd79b07"},"4196": {"Id":4196,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":7153,"PolicyAttachmentPageName":"e9feb58d-896e-42f2-b0ad-b42438232ce7"},} | |
|  | | 3955 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005c | Medicine (07) | MA07.005c | MA07.005 | 561210e3-3390-4956-b296-c2c2ef91b2f9 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | | |
|  | | 4121 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026k | Medicine (07) | MA07.026k | MA07.026 | 20d4debf-c979-474b-b325-3dcc70336021 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | | |
|  | | 3813 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008a | Anesthesia (01) | MA01.008a | MA01.008 | 6a1b55c5-5993-4f32-a0ed-4fd61d9d86ac | 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 | {} | |
|  | | 3571 | Anifrolumab-fnia(Saphnelo™)MA08.140b | Pharmacy (08) | MA08.140b | MA08.140 | 2997254c-1be9-4fd5-9b6b-394b8f40bf96 | Anifrolumab-fnia (Saphnelo™) | Anifrolumab-fnia (Saphnelo™) | | |
|  | | 2830 | Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010g | DME (05) | MA05.010g | MA05.010 | 4381bbfc-9be4-4c1d-be48-104f3d74cddf | Ankle-Foot/Knee-Ankle-Foot Orthoses | Ankle-Foot/Knee-Ankle-Foot Orthoses | {"2831": {"Id":2831,"MPAttachmentLetter":"A","Title":"HCPCS CODES FOR ANKLE-FOOT/ KNEE-ANKLE FOOT ORTHOSIS","MPPolicyAttachmentInternalSourceId":5438,"PolicyAttachmentPageName":"abe26858-dc87-4040-a463-5b67d4bafc0c"},} | |
|  | | 3503 | AnorectalManometry,Electromyography(EMG)ofAnorectalorUrethralSphincters;BiofeedbackTrainingforPerinealMusclesandAnorectalorUrethralSphinctersMA07.018b | Medicine (07) | MA07.018b | MA07.018 | 6784e81c-0d85-46ea-8570-0305b1408593 | 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 | | |
|  | | 2179 | ApheresisTherapyMA06.001e | Pathology and Laboratory (06) | MA06.001e | MA06.001 | a8e854f7-94e7-4833-a02c-b7fb4214ff25 | Apheresis Therapy | Apheresis Therapy | | |
|  | | 3515 | ApplicationandRemovalofTattoosMA11.072 | Surgery (11) | MA11.072 | MA11.072 | 5e7b3431-7254-494b-91b5-f3edb685eb24 | Application and Removal of Tattoos | Application and Removal of Tattoos | | |
|  | | 4132 | Aprepitant(Cinvanti™),FosaprepitantDimeglumine(Emend®),Granisetron(Sustol®),andRolapitant(Varubi®)MA08.091e | Pharmacy (08) | MA08.091e | MA08.091 | ff104db5-0a07-4d08-9240-ca4aede56f1f | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | {"4133": {"Id":4133,"MPAttachmentLetter":"A","Title":"Risk of Emesis Without Prophylaxis: Intravenous and Oral Antineoplastic Agents","MPPolicyAttachmentInternalSourceId":7123,"PolicyAttachmentPageName":"558f07dc-00a1-44ad-bfa2-15f8d10d97c4"},} | |
|  | | 4137 | AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105j | Surgery (11) | MA11.105j | MA11.105 | df24c7d1-3b2b-41a3-ba0a-d25c9c5e7d70 | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | {"4138": {"Id":4138,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7062,"PolicyAttachmentPageName":"bad39d3e-be8b-4144-b280-a37f967082f1"},} | |
|  | | 4129 | ArtificialIntervertebralLumbarDiscInsertionMA11.114b | Surgery (11) | MA11.114b | MA11.114 | 4d0593ea-c69f-4b0e-8370-ebed3c66e12f | Artificial Intervertebral Lumbar Disc Insertion | Artificial Intervertebral Lumbar Disc Insertion | | |
|  | | 3742 | Asparaginaseerwiniachrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze™)MA08.085f | Pharmacy (08) | MA08.085f | MA08.085 | 53bac0ed-9c15-45d1-a6eb-df0442a11e2a | Asparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™) | Asparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™) | | |
|  | | 3391 | Atezolizumab(Tecentriq®)MA08.127b | Pharmacy (08) | MA08.127b | MA08.127 | cde82c5a-0a80-4bfb-9c2f-a6bec18e4a07 | Atezolizumab (Tecentriq®) | Atezolizumab (Tecentriq®) | {"3392": {"Id":3392,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":6122,"PolicyAttachmentPageName":"1f3a7a81-eda4-44e7-a9a5-f6286558df75"},} | |
|  | | 4023 | AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)MA05.005f | DME (05) | MA05.005f | MA05.005 | 31ffd380-3f3a-469d-8a3d-744ef976f1ed | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"4024": {"Id":4024,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":6579,"PolicyAttachmentPageName":"6ccb9941-dadc-469b-b13e-a3d12330977d"},"4025": {"Id":4025,"MPAttachmentLetter":"A","Title":"ICD-10 codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":6580,"PolicyAttachmentPageName":"7ee43fa7-62c0-4602-9074-b222f08585e0"},} | |
|  | | 3819 | AutonomicNervousSystemTestingMA07.027f | Medicine (07) | MA07.027f | MA07.027 | 3af75148-49ba-4d1c-ba97-554d5699a376 | Autonomic Nervous System Testing | Autonomic Nervous System Testing | | |
|  | | 4105 | Avelumab(Bavencio®)MA08.122b | Pharmacy (08) | MA08.122b | MA08.122 | 2940ef19-00de-46de-bbaa-aef9985a3ac2 | Avelumab (Bavencio®) | Avelumab (Bavencio®) | {"4106": {"Id":4106,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7009,"PolicyAttachmentPageName":"15c6ab29-ebb0-4244-b462-2756d4f993b8"},} | |
|  | | 3619 | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisMA11.100e | Surgery (11) | MA11.100e | MA11.100 | cabedfbf-0373-4c4a-92e4-36c05c25ded0 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | | |
|  | | 3532 | belantamabmafodotin-blmf(Blenrep)MA08.119b | Pharmacy (08) | MA08.119b | MA08.119 | cf4b9338-44d8-4be3-b8af-86f6920be908 | belantamab mafodotin-blmf (Blenrep) | belantamab mafodotin-blmf (Blenrep) | | |
|  | | 3930 | Belimumab(Benlysta®)forIntravenousUseMA08.057d | Pharmacy (08) | MA08.057d | MA08.057 | 9903914d-e3cf-4399-ae00-108494eae90c | Belimumab (Benlysta®) for Intravenous Use | Belimumab (Benlysta®) for Intravenous Use | | |
|  | | 4141 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072k | Pharmacy (08) | MA08.072k | MA08.072 | 19d36ffa-eed6-4945-a394-53539c3e6c01 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"4142": {"Id":4142,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":7071,"PolicyAttachmentPageName":"2c3b26d2-0a68-4b59-9705-a47340a08517"},} | |
|  | | 3321 | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037k | Administrative (00) | MA00.037k | MA00.037 | fa386a65-d740-4764-878d-b0c03ccee966 | 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 | {"3322": {"Id":3322,"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":6120,"PolicyAttachmentPageName":"59902f83-9042-435b-95fb-a2fc79a83db1"},} | |
|  | | 3644 | BiofeedbackTherapyMA07.010a | Medicine (07) | MA07.010a | MA07.010 | cd3494a3-4f4f-4dc3-b0ae-c7e16e45d55f | Biofeedback Therapy | Biofeedback Therapy | | |
|  | | 3618 | BioimpedancefortheDetectionofLymphedemaMA07.052 | Medicine (07) | MA07.052 | MA07.052 | fc94fb44-a8a9-41f6-8fe6-687483a6ebc6 | Bioimpedance for the Detection of Lymphedema | Bioimpedance for the Detection of Lymphedema | | |
|  | | 4004 | Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/CanthopexyMA11.047d | Surgery (11) | MA11.047d | MA11.047 | 471e433d-f780-4d16-882b-1406395273b3 | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | {"4005": {"Id":4005,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":6998,"PolicyAttachmentPageName":"dacc12f4-b2a3-4a21-9dd1-580964f7c079"},} | |
|  | | 3631 | Blinatumomab(Blincyto®)MA08.058e | Pharmacy (08) | MA08.058e | MA08.058 | 9169d365-5d9b-44b4-a3f9-3fa88e9a4a1a | Blinatumomab (Blincyto®) | Blinatumomab (Blincyto®) | | |
|  | | 4164 | Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049e | Surgery (11) | MA11.049e | MA11.049 | cc5a905b-ad8a-487c-a688-6d3af1a4311a | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | | |
|  | | 4160 | Bortezomib(BortezomibforInjection,Velcade®)MA08.037i | Pharmacy (08) | MA08.037i | MA08.037 | ae53fe4a-bce1-43e4-8f29-b3bfd9e5b0f5 | Bortezomib (Bortezomib for Injection, Velcade®) | Bortezomib (Bortezomib for Injection, Velcade®) | {"4161": {"Id":4161,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7119,"PolicyAttachmentPageName":"571ad3d2-dde6-4cfa-a4f7-d851871d9e28"},} | |
|  | | 3855 | BotulinumToxinAgentsMA08.017h | Pharmacy (08) | MA08.017h | MA08.017 | 18450aea-5590-4c1c-93f7-b826767af30c | Botulinum Toxin Agents | Botulinum Toxin Agents | {"3856": {"Id":3856,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":6761,"PolicyAttachmentPageName":"c95eeb16-1e5d-46bb-8ec4-68f43aee9c3f"},} | |
|  | | 3792 | BrentuximabVedotin(Adcetris®)MA08.068h | Pharmacy (08) | MA08.068h | MA08.068 | 5de87146-f5e7-4927-8264-ff5c323d17a9 | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | {"3793": {"Id":3793,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6763,"PolicyAttachmentPageName":"53f87106-7279-43a6-9fb7-e70e019e1292"},} | |
|  | | 3417 | BronchialValvesMA11.020 | Surgery (11) | MA11.020 | MA11.020 | 69c14601-19f4-4a22-869a-ce88af536766 | Bronchial Valves | Bronchial Valves | | |
|  | | 3524 | Burosumab-twza(Crysvita®)MA08.099b | Pharmacy (08) | MA08.099b | MA08.099 | 6fab4e9d-5e32-4f2d-a48f-3b3b7d31608f | Burosumab-twza (Crysvita®) | Burosumab-twza (Crysvita®) | | |
|  | | 3402 | Canakinumab(Ilaris®)MA08.101a | Pharmacy (08) | MA08.101a | MA08.101 | a9edc4ba-8e39-4e75-93f1-eccdd1d9391e | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | | |
|  | | 3401 | CanesandCrutchesMA05.052b | DME (05) | MA05.052b | MA05.052 | 9ed71d16-85d6-476c-9ed2-2e1a6fb65333 | Canes and Crutches | Canes and Crutches | | |
|  | | 4118 | CapsuleEndoscopyMA07.022e | Medicine (07) | MA07.022e | MA07.022 | bde6f5bb-a063-46ae-872f-2574f19b4f0e | Capsule Endoscopy | Capsule Endoscopy | | |
|  | | 3807 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002c | Rehabilitation Services (10) | MA10.002c | MA10.002 | de73d54c-e82e-406d-a1d8-c94d36bf4fc5 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"3808": {"Id":3808,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6702,"PolicyAttachmentPageName":"8a00fdd6-dd29-4596-b900-0e494b1c1ce9"},} | |
|  | | 3878 | CareManagementandCarePlanningServicesMA00.006l | Administrative (00) | MA00.006l | MA00.006 | 2411d8e2-991c-4860-a612-ba7bb8056705 | Care Management and Care Planning Services | Care Management and Care Planning Services | | |
|  | | 3969 | Carfilzomib(Kyprolis™)MA08.062g | Pharmacy (08) | MA08.062g | MA08.062 | cc00c34c-5b11-4450-9824-79ca51259fae | Carfilzomib (Kyprolis™) | Carfilzomib (Kyprolis™) | | |
|  | | 3612 | CastandSplintApplicationsandAssociatedSuppliesMA00.012c | Administrative (00) | MA00.012c | MA00.012 | b86099e5-ed74-4f52-9ab4-c534c779cb23 | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"3613": {"Id":3613,"MPAttachmentLetter":"A","Title":"Procedures Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":6422,"PolicyAttachmentPageName":"eec4f404-030d-42ce-855c-d06522638dd4"},} | |
|  | | 4010 | CataractSurgeryMA11.054d | Surgery (11) | MA11.054d | MA11.054 | 35d53c26-0c5b-4b14-b8b8-a5597e77fe0c | Cataract Surgery | Cataract Surgery | {"4011": {"Id":4011,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6669,"PolicyAttachmentPageName":"00eafbe0-27dc-4b22-bec7-d83dddcb66d7"},} | |
|  | | 3809 | CatheterAblationofCardiacArrhythmiasMA11.060e | Surgery (11) | MA11.060e | MA11.060 | d64fed48-4aef-4817-967f-2e50017c1cb0 | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | | |
|  | | 4103 | Cemiplimab-rwlc(Libtayo®)MA08.124b | Pharmacy (08) | MA08.124b | MA08.124 | 43307a95-4d17-43d5-ae1d-447dee061b11 | Cemiplimab-rwlc (Libtayo®) | Cemiplimab-rwlc (Libtayo®) | | |
|  | | 3526 | Cerliponasealfa(Brineura®)MA08.089c | Pharmacy (08) | MA08.089c | MA08.089 | af3e4f67-0660-4149-b715-205f07d43919 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | | |
|  | | 3438 | CervicalTractionDevicesforIn-homeUseMA05.009a | DME (05) | MA05.009a | MA05.009 | c98e6881-f694-4a4a-93e0-12285cfbf202 | Cervical Traction Devices for In-home Use | Cervical Traction Devices for In-home Use | | |
|  | | 4156 | Cetuximab(Erbitux®)MA08.031f | Pharmacy (08) | MA08.031f | MA08.031 | da641a6d-6927-4908-a969-1856f88de703 | Cetuximab (Erbitux®) | Cetuximab (Erbitux®) | {"4157": {"Id":4157,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":7027,"PolicyAttachmentPageName":"d0267e57-e63e-4c96-8294-a9d0b160eff9"},"4158": {"Id":4158,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":7028,"PolicyAttachmentPageName":"22127d10-f3f4-472d-9c56-cab879c5de3a"},} | |
|  | | 3787 | ChemicalPeelsMA11.103b | Surgery (11) | MA11.103b | MA11.103 | b89e88bc-c37b-4819-a4ea-af219a5cf05d | Chemical Peels | Chemical Peels | | |
|  | | 3790 | ChimericAntigenReceptor(CAR)TherapyMA08.093k | Pharmacy (08) | MA08.093k | MA08.093 | 2aa985e5-66d4-4c33-9b92-cffca516451e | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | {"3791": {"Id":3791,"MPAttachmentLetter":"A","Title":"ICD 10 codes","MPPolicyAttachmentInternalSourceId":6561,"PolicyAttachmentPageName":"c52d4929-1636-4076-b07d-a4a95bdbcd52"},} | |
|  | | 3978 | ChiropracticServicesMA10.004h | Rehabilitation Services (10) | MA10.004h | MA10.004 | 7d3057f3-c09c-492e-8583-c5300b165742 | Chiropractic Services | Chiropractic Services | {"3979": {"Id":3979,"MPAttachmentLetter":"A","Title":"Medically neessary ICD-10 diagnosis codes","MPPolicyAttachmentInternalSourceId":6877,"PolicyAttachmentPageName":"2fddedd7-0de5-4a26-83a9-310b2f845333"},} | |
|  | | 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 | | |
|  | | 3958 | CoagulationFactorsMA08.004t | Pharmacy (08) | MA08.004t | MA08.004 | 560ab61f-50a9-4fb5-9b2f-45445ab7a909 | Coagulation Factors | Coagulation Factors | | |
|  | | 4206 | Cobalamin(VitaminB12),FolicAcid,andHomocysteineTestingMA06.032a | Pathology and Laboratory (06) | MA06.032a | MA06.032 | 08299b3d-e691-4b8a-b760-476b6013cdcf | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | {"4207": {"Id":4207,"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":7157,"PolicyAttachmentPageName":"6730a75f-3149-47c6-90ac-aee646ce81f2"},} | |
|  | | 2505 | CochlearImplantationMA11.039d | Surgery (11) | MA11.039d | MA11.039 | 2ff992d2-ca4a-42b9-b321-e387ed4804fd | Cochlear Implantation | Cochlear Implantation | | |
|  | | 3437 | Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo™)MA08.128 | Pharmacy (08) | MA08.128 | MA08.128 | c4e07093-c912-4146-8bab-3e038ab4fbce | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™) | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™) | | |
|  | | 3383 | CommodeChairsMA05.036b | DME (05) | MA05.036b | MA05.036 | b54c4527-287c-44b4-ba99-2781f6ea0463 | Commode Chairs | Commode Chairs | | |
|  | | 3614 | ComplementaryandIntegrativeHealthServicesMA12.001d | Miscellaneous (12) | MA12.001d | MA12.001 | a62fd0fa-8e7b-4ed1-bb67-fd235c1159f0 | Complementary and Integrative Health Services | Complementary and Integrative Health Services | | |
|  | | 3617 | CompleteDecongestiveTherapy(CDT)MA07.042 | Medicine (07) | MA07.042 | MA07.042 | 74c1970e-fa1e-40e5-91ce-bd5dd3e8a6f5 | Complete Decongestive Therapy (CDT) | Complete Decongestive Therapy (CDT) | | |
|  | | 3648 | CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112 | Surgery (11) | MA11.112 | MA11.112 | 1361257a-290f-4536-95f4-94e8c6ac325a | Composite Tissue Allotransplantation of the Hand(s) and Face | Composite Tissue Allotransplantation of the Hand(s) and Face | | |
|  | | 3640 | CompressionGarmentsMA05.045a | DME (05) | MA05.045a | MA05.045 | 55f0dbf5-ae18-4373-b456-a221e9d39c1c | Compression Garments | Compression Garments | | |
|  | | 3685 | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014a | Radiology (09) | MA09.014a | MA09.014 | 0e3d12af-5a08-4b0c-8211-19ac349faf3b | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | | |
|  | | 3605 | Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088c | Surgery (11) | MA11.088c | MA11.088 | 6c50e1d0-0b77-45d9-abd2-9c2633dc200e | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | | |
|  | | 3588 | ConsultationServicesMA00.049a | Administrative (00) | MA00.049a | MA00.049 | 57649d5c-49aa-4216-9686-3c820b5d1237 | Consultation Services | Consultation Services | | |
|  | | 4122 | ContinuousGlucoseMonitorsandHomeBloodGlucoseMonitorsandSuppliesMA00.002j | Administrative (00) | MA00.002j | MA00.002 | 9cc59b93-9d13-4ffd-960e-be24eec1994b | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | {"4123": {"Id":4123,"MPAttachmentLetter":"A","Title":"ICD10: Short-Term Interstitial CGMS","MPPolicyAttachmentInternalSourceId":7063,"PolicyAttachmentPageName":"d99c2a3b-d2ba-45dc-876b-ff7bfd9531e7"},"4124": {"Id":4124,"MPAttachmentLetter":"B","Title":"ICD10: Long-Term Interstitial CGMS","MPPolicyAttachmentInternalSourceId":7064,"PolicyAttachmentPageName":"d56aab3f-53f6-4c62-b959-ef964e165dc7"},"4125": {"Id":4125,"MPAttachmentLetter":"C","Title":"ICD10: Home Blood Glucose Monitors and Supplies","MPPolicyAttachmentInternalSourceId":7065,"PolicyAttachmentPageName":"4ad24d57-1c97-4787-ac55-811b9b82482e"},} | |
|  | | 2532 | ContrastAgentsUsedinConjunctionwithEchocardiographyMA09.004c | Radiology (09) | MA09.004c | MA09.004 | 16379ab5-1c4e-4ad3-9aa8-49dea5cd3d30 | Contrast Agents Used in Conjunction with Echocardiography | Contrast Agents Used in Conjunction with Echocardiography | | |
|  | | 3636 | CornealPachymetryUsingUltrasoundMA07.046g | Medicine (07) | MA07.046g | MA07.046 | 0d262908-e6ab-4ad9-a017-96491fb35ed8 | Corneal Pachymetry Using Ultrasound | Corneal Pachymetry Using Ultrasound | {"3637": {"Id":3637,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes Eligible to be Reported for Corneal Pachymetry Using Ultrasound","MPPolicyAttachmentInternalSourceId":6352,"PolicyAttachmentPageName":"67d2afd6-52ba-486d-b170-3ac791273313"},} | |
|  | | 4014 | CosmeticProceduresMA12.009a | Miscellaneous (12) | MA12.009a | MA12.009 | 13c34059-266d-452b-a086-b5e79450d900 | Cosmetic Procedures | Cosmetic Procedures | | |
|  | | 3048 | CoverageofMedicalDevicesMA05.040b | DME (05) | MA05.040b | MA05.040 | 69c3f8a1-1044-489c-869e-7e78dbb55b06 | Coverage of Medical Devices | Coverage of Medical Devices | | |
|  | | 3935 | CranialElectrotherapyStimulationMA05.066c | DME (05) | MA05.066c | MA05.066 | 14ef6470-44f4-4099-881a-21521d12fec8 | Cranial Electrotherapy Stimulation | Cranial Electrotherapy Stimulation | | |
|  | | 4169 | CriteriaforReimbursementofEmergencyRoomServicesMA00.044c | Administrative (00) | MA00.044c | MA00.044 | bd8724e2-053c-46e0-ad5a-4e5dbf9cf587 | Criteria for Reimbursement of Emergency Room Services | Criteria for Reimbursement of Emergency Room Services | | |
|  | | 3387 | crizanlizumab-tmca(Adakveo®)MA08.109a | Pharmacy (08) | MA08.109a | MA08.109 | 5c85f061-d9b8-458b-977b-a6d0470b0e1f | crizanlizumab-tmca (Adakveo®) | crizanlizumab-tmca (Adakveo®) | | |
|  | | 3623 | CryosurgicalAblationoftheProstateGlandMA11.022a | Surgery (11) | MA11.022a | MA11.022 | 4262ba16-e187-42a1-a358-5309ce6b6ea5 | Cryosurgical Ablation of the Prostate Gland | Cryosurgical Ablation of the Prostate Gland | | |
|  | | 3746 | Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro®)MA08.079j | Pharmacy (08) | MA08.079j | MA08.079 | fc8bc0fe-8bb5-4590-830c-71eb68cd8fce | Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®) | Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®) | | |
|  | | 3767 | DayRehabilitationMA10.005b | Rehabilitation Services (10) | MA10.005b | MA10.005 | c7e08d9f-c93b-4f1c-a093-ee818b303290 | Day Rehabilitation | Day Rehabilitation | | |
|  | | 3688 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014g | Surgery (11) | MA11.014g | MA11.014 | 5b93c7e1-f677-4375-922a-ca9531f9db6e | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"3689": {"Id":3689,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":6449,"PolicyAttachmentPageName":"fa3bedd1-18ca-4565-9102-1ae7d787fc51"},"3690": {"Id":3690,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":6450,"PolicyAttachmentPageName":"b5acd45e-8f7c-41e5-976a-de72f1e247f6"},"3691": {"Id":3691,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":6451,"PolicyAttachmentPageName":"c2fd6656-b39b-4a7a-b49b-5c00835af755"},"3692": {"Id":3692,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":6452,"PolicyAttachmentPageName":"ca504ebb-8059-4a02-b7f5-4a19e4404a3d"},"3693": {"Id":3693,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":6453,"PolicyAttachmentPageName":"b994a1dd-4f7a-4c91-84e2-ad574be4e4f1"},} | |
|  | | 3941 | DeepBrainStimulation(DBS)MA11.005e | Surgery (11) | MA11.005e | MA11.005 | fa45f706-4ac4-436e-9728-ae8a125450df | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | | |
|  | | 3522 | Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)MA08.052j | Pharmacy (08) | MA08.052j | MA08.052 | 116bf5f6-59fe-4c5b-b271-9a90bf62beb6 | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | {"3523": {"Id":3523,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":6189,"PolicyAttachmentPageName":"dd04c740-d70b-48c8-b128-cde0f0c0b1f9"},} | |
|  | | 4139 | DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099c | Surgery (11) | MA11.099c | MA11.099 | 0254b636-2a8f-4b02-a7ca-0ea8002e8852 | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | | |
|  | | 3346 | DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032d | Administrative (00) | MA00.032d | MA00.032 | 3cc570f5-3a08-4974-a65d-e95d42146963 | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | {} | |
|  | | 3575 | Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021b | Pharmacy (08) | MA08.021b | MA08.021 | 062b48a0-26a9-4077-805d-713072908f88 | Dofetilide (Tikosyn®) Use in the Inpatient Setting | Dofetilide (Tikosyn®) Use in the Inpatient Setting | | |
|  | | 3413 | Dostarlimab-gxly(Jemperli)MA08.136c | Pharmacy (08) | MA08.136c | MA08.136 | c37d9c69-6413-4a3b-872a-d26735e8bd34 | Dostarlimab-gxly (Jemperli) | Dostarlimab-gxly (Jemperli) | | |
|  | | 3916 | Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041b | Medicine (07) | MA07.041b | MA07.041 | 9b4d3cea-ae30-4134-98bd-9481da9fc035 | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | | |
|  | | 3912 | DurableMedicalEquipment(DME)MA05.044m | DME (05) | MA05.044m | MA05.044 | 7b2483b4-e675-4145-81dd-85fc1297f34d | Durable Medical Equipment (DME) | Durable Medical Equipment (DME) | {"3913": {"Id":3913,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":6892,"PolicyAttachmentPageName":"dd825de3-651a-4b87-b75e-320e95f2e664"},"3914": {"Id":3914,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":6893,"PolicyAttachmentPageName":"bb9284b2-d69d-4515-bbe9-c873bf42e1b2"},"3915": {"Id":3915,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":6894,"PolicyAttachmentPageName":"3abcdc4e-7acd-4813-afc5-9e4fd85d9c01"},} | |
|  | | 4015 | DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028e | DME (05) | MA05.028e | MA05.028 | 1b12ffb5-60aa-4123-895e-6165136f7204 | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | | |
|  | | 4113 | Durvalumab(Imfinzi®)MA08.123b | Pharmacy (08) | MA08.123b | MA08.123 | 2c99c5d8-b866-4945-9fed-9fbc3712a42c | Durvalumab (Imfinzi®) | Durvalumab (Imfinzi®) | {"4114": {"Id":4114,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":6592,"PolicyAttachmentPageName":"bf714cae-91e4-4520-bd99-4856938f8f7a"},} | |
|  | | 3780 | Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)MA08.044h | Pharmacy (08) | MA08.044h | MA08.044 | 64ae9bd8-5b3d-49cd-a026-e438e17df1f1 | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) | | |
|  | | 3578 | Edaravone(Radicava®)MA08.092a | Pharmacy (08) | MA08.092a | MA08.092 | 93ee35b6-d0d3-4c1a-b0e0-152e9dd153e8 | Edaravone (Radicava®) | Edaravone (Radicava®) | | |
|  | | 3675 | Efgartigimod-alfa(VyvgartTM)MA08.142a | Pharmacy (08) | MA08.142a | MA08.142 | 8c9b2f4f-e061-48c5-8b0c-6da861903805 | Efgartigimod-alfa (VyvgartTM) | Efgartigimod-alfa (VyvgartTM) | | |
|  | | 4017 | Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082i | Pharmacy (08) | MA08.082i | MA08.082 | faaaec04-b9fb-4119-9362-7725b156db87 | Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | {"4018": {"Id":4018,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":6593,"PolicyAttachmentPageName":"ef81d4cd-efe9-4e4a-bb12-b87cbd538c23"},} | |
|  | | 3511 | ElectricalStimulationandElectromagneticStimulationfortheTreatmentofWoundsMA07.013d | Medicine (07) | MA07.013d | MA07.013 | 9c10b787-7936-43dc-85af-d1b5f8b51d28 | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | {"3512": {"Id":3512,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":6285,"PolicyAttachmentPageName":"30a7a7ad-1cae-4a55-857c-5dcd42b5d7e4"},} | |
|  | | 3937 | ElectroconvulsiveTherapy(ECT)MA14.001 | Behavioral Health (14) | MA14.001 | MA14.001 | 78280621-f992-4f8a-9825-368ec185cde4 | Electroconvulsive Therapy (ECT) | Electroconvulsive Therapy (ECT) | | |