|  | | 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"},} | |
| | | 7491 | AblationofLungTumorsMA11.052f | Surgery (11) | MA11.052f | MA11.052 | e6b1647c-4a8d-413b-bb25-c92cdabf1c9d | Ablation of Lung Tumors | Ablation of Lung Tumors | | |
| | | 7299 | AbortionMA11.010d | Surgery (11) | MA11.010d | MA11.010 | 0a2e7306-c89b-4dcf-a5c7-ffd1771d49f3 | Abortion | Abortion | | |
| | | 7122 | AcupunctureMA12.004e | Miscellaneous (12) | MA12.004e | MA12.004 | 9366e796-ed38-4d5d-8599-8869c292b604 | Acupuncture | Acupuncture | {"7123": {"Id":7123,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":10301,"PolicyAttachmentPageName":"e290996c-8fbe-4840-ae9d-fba89f496e33"},} | |
| | | 7701 | AcuteCareFacilityInpatientTransfersMA12.003b | Miscellaneous (12) | MA12.003b | MA12.003 | 5d2bc22a-b396-45e1-9385-3c62529eb9f9 | 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) | | |
| | | 7626 | Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066i | Pharmacy (08) | MA08.066i | MA08.066 | 659c1724-6aa3-479f-ae88-c059799fef78 | Ado-Trastuzumab Emtansine (Kadcyla®) | Ado-Trastuzumab Emtansine (Kadcyla®) | | |
| | | 7217 | Agalsidasebeta(Fabrazyme)andpegunigalsidasealfa-iwxj(Elfabrio)MA08.033d | Pharmacy (08) | MA08.033d | MA08.033 | a15b90a4-136e-4ae5-a39d-f96e973ec0b9 | 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 | | |
| | | 7710 | Alemtuzumab(Lemtrada®)MA08.015e | Pharmacy (08) | MA08.015e | MA08.015 | ab0c4be5-253f-4e73-b88e-8907f73da301 | Alemtuzumab (Lemtrada®) | Alemtuzumab (Lemtrada®) | | |
| | | 7348 | Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)MA08.036g | Pharmacy (08) | MA08.036g | MA08.036 | c03de5fe-1748-4099-8c09-18c8fb53bb04 | 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™ ) | | |
| | | 7310 | AllergyImmunotherapyMA07.055e | Medicine (07) | MA07.055e | MA07.055 | 70a1011d-4147-4b1b-9683-1ab29a7ac2dc | Allergy Immunotherapy | Allergy Immunotherapy | | |
| | | 7420 | Alpha-1AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050c | Pharmacy (08) | MA08.050c | MA08.050 | ccf2701d-74df-47be-96bc-167b947a0326 | Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | | |
| | | 7329 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005d | Medicine (07) | MA07.005d | MA07.005 | f7036693-a2f7-480a-9518-268e54487279 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | | |
| | | 7487 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026r | Medicine (07) | MA07.026r | MA07.026 | fdd7911a-4c63-47f6-bc14-b281f46d06d9 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | | |
| | | 7572 | Amivantamab-vmjw(Rybrevant®)andAmivantamabandhyaluronidase-lpuj(RybrevantFaspro™)MA08.148d | Pharmacy (08) | MA08.148d | MA08.148 | 8460f305-8afb-42a4-bc99-2f441817eb13 | Amivantamab-vmjw (Rybrevant®) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro™) | Amivantamab-vmjw (Rybrevant®) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro™) | | |
| | | 7192 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008d | Anesthesia (01) | MA01.008d | MA01.008 | 7d52c3de-a856-4398-adfd-795439dff22f | 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 | {"7193": {"Id":7193,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":10364,"PolicyAttachmentPageName":"a597add0-5771-402d-a03b-2ef6ab7f26ee"},} | |
| | | 7433 | Anifrolumab-fnia(Saphnelo®)MA08.140c | Pharmacy (08) | MA08.140c | MA08.140 | 89403fb2-d745-4122-bd2b-4c25c72c1fff | Anifrolumab-fnia (Saphnelo®) | Anifrolumab-fnia (Saphnelo®) | | |
| | | 7564 | Ankle-Foot/Knee-Ankle-FootOrthosisMA05.010l | DME (05) | MA05.010l | MA05.010 | 31a767c0-7755-4f1c-bc56-6caf4a55ede8 | Ankle-Foot/Knee-Ankle-Foot Orthosis | Ankle-Foot/Knee-Ankle-Foot Orthosis | {"7565": {"Id":7565,"MPAttachmentLetter":"A","Title":"HCPCS CODES FOR ANKLE-FOOT/ KNEE-ANKLE FOOT ORTHOSIS","MPPolicyAttachmentInternalSourceId":10488,"PolicyAttachmentPageName":"c7feefa3-3898-4b62-bf85-3dfb7b157478"},} | |
| | | 7234 | ApheresisTherapyMA06.001g | Pathology and Laboratory (06) | MA06.001g | MA06.001 | ef320fac-4063-42a5-8398-f3f79f4139c1 | 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 | | |
| | | 7197 | ApplicationandRemovalofTattoosMA11.072 | Surgery (11) | MA11.072 | MA11.072 | 9fca0d03-159c-4241-8592-6af0ee69aa9c | Application and Removal of Tattoos | Application and Removal of Tattoos | | |
| | | 7668 | AqueousShunts,MinimallyInvasiveGlaucomaSurgeries(includingMicrostents),Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105l | Surgery (11) | MA11.105l | MA11.105 | 0bdbec24-4365-4778-b907-3394cf0a287d | Aqueous Shunts, Minimally Invasive Glaucoma Surgeries (including Microstents), Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Aqueous Shunts, Minimally Invasive Glaucoma Surgeries (including Microstents), Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | {"7669": {"Id":7669,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":10551,"PolicyAttachmentPageName":"e68c2f7e-1287-4264-acba-d1b2049f63be"},} | |
| | | 7435 | AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)MA08.085k | Pharmacy (08) | MA08.085k | MA08.085 | ed544b45-1f85-413f-b1c9-13af9919bfce | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | | |
| | | 7694 | Atezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybreza™)MA08.127g | Pharmacy (08) | MA08.127g | MA08.127 | f11d9fb0-c641-438c-aa1c-0c3b0fa63bca | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) | {"7695": {"Id":7695,"MPAttachmentLetter":"A","Title":"Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™)","MPPolicyAttachmentInternalSourceId":10705,"PolicyAttachmentPageName":"c6f776cb-f963-49c1-8c34-78116711c9fd"},} | |
| | | 7453 | AuricularProsthesesMA05.068 | DME (05) | MA05.068 | MA05.068 | 644d987e-9c04-494a-997c-63d54454ba22 | 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"},} | |
| | | 7203 | AutonomicNervousSystemTestingMA07.027h | Medicine (07) | MA07.027h | MA07.027 | 2e3774e4-63d7-4e00-a06a-d9fffaec0c43 | 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®) | | |
| | | 7313 | Axatilimab-csfr(Niktimvo™)forIntravenousUseMA08.180 | Pharmacy (08) | MA08.180 | MA08.180 | 00939922-b74a-4f0b-9408-4c653d7b3ad6 | 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 | | |
| | | 7579 | Belantamabmafodotin-blmf(Blenrep)MA08.192a | Pharmacy (08) | MA08.192a | MA08.192 | 0ce4af70-cb36-46dd-a4bb-adb43cfc22fe | Belantamab mafodotin-blmf (Blenrep) | Belantamab mafodotin-blmf (Blenrep) | | |
| | | 7644 | Belimumab(Benlysta®)forIntravenousUseMA08.057d | Pharmacy (08) | MA08.057d | MA08.057 | 9adefd6a-7d13-46bb-a2e8-5831a9283537 | Belimumab (Benlysta®) for Intravenous Use | Belimumab (Benlysta®) for Intravenous Use | | |
| | | 7383 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072p | Pharmacy (08) | MA08.072p | MA08.072 | be047316-8f8a-4767-8879-b46ae89dc0ab | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"7384": {"Id":7384,"MPAttachmentLetter":"A","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":10204,"PolicyAttachmentPageName":"6c90f036-cacd-44ee-afd4-5256b469f3c4"},} | |
| | | 7608 | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037o | Administrative (00) | MA00.037o | MA00.037 | 16577dd7-725d-4084-99fe-077e5e06d7a3 | 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 | {"7609": {"Id":7609,"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":10684,"PolicyAttachmentPageName":"70e9b3cb-1474-4b83-9409-36a6d1887496"},} | |
| | | 7300 | BiofeedbackTherapyMA07.010c | Medicine (07) | MA07.010c | MA07.010 | af947cab-4f5d-4199-a72b-5f05b7704d74 | Biofeedback Therapy | Biofeedback Therapy | | |
| | | 7703 | BioimpedancefortheDetectionofLymphedemaMA07.052a | Medicine (07) | MA07.052a | MA07.052 | 0cb4bfd9-5e56-47bc-8fc1-a8840252c732 | 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®) | | |
| | | 7454 | Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049h | Surgery (11) | MA11.049h | MA11.049 | fc1f5713-90ec-465c-b200-001c6c786404 | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | | |
| | | 7544 | BotulinumToxinAgentsMA08.017n | Pharmacy (08) | MA08.017n | MA08.017 | d2b4b66d-6383-46a9-8341-7ed4386734aa | Botulinum Toxin Agents | Botulinum Toxin Agents | {"7545": {"Id":7545,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":10527,"PolicyAttachmentPageName":"f69072f4-6ab0-424c-9514-0474611a5ef1"},} | |
| | | 6844 | BrentuximabVedotin(Adcetris®)MA08.068l | Pharmacy (08) | MA08.068l | MA08.068 | f1166ac8-5ed4-4079-b12f-8d635e22deb0 | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | | |
| | | 7615 | BronchialValvesMA11.020 | Surgery (11) | MA11.020 | MA11.020 | d17c48fd-660a-4f2e-b689-47f63e921144 | Bronchial Valves | Bronchial Valves | | |
| | | 7539 | BundledProcedureCodesMA00.026aa | Administrative (00) | MA00.026aa | MA00.026 | 4830e045-77c7-4c01-b61c-259be6bf4eac | Bundled Procedure Codes | Bundled Procedure Codes | {"7540": {"Id":7540,"MPAttachmentLetter":"D","Title":"Procedures and Services Not Eligible for Separate Reimbursement When Reported With Another Specific Procedure or Service","MPPolicyAttachmentInternalSourceId":10800,"PolicyAttachmentPageName":"b2bfb5c0-37f2-4fff-9cb5-560f5b68c10e"},"7541": {"Id":7541,"MPAttachmentLetter":"C","Title":"Procedures and Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":10801,"PolicyAttachmentPageName":"2f1befce-fbeb-400a-98e1-628c2dc224c7"},"7542": {"Id":7542,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures and Services (Status B); Bundled Procedures and Services (Status T)","MPPolicyAttachmentInternalSourceId":10802,"PolicyAttachmentPageName":"9ba1a2d9-711a-429d-99a7-89f2c5dea372"},"7543": {"Id":7543,"MPAttachmentLetter":"B","Title":"Procedures and Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":10803,"PolicyAttachmentPageName":"9855551c-bb00-4e04-81c0-4dba712cbfbe"},} | |
| | | 7636 | Burosumab-twza(Crysvita®)MA08.099b | Pharmacy (08) | MA08.099b | MA08.099 | bd6f8ae8-c872-4b05-ada1-221dd3eec917 | 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"},} | |
| | | 7199 | CanesandCrutchesMA05.052c | DME (05) | MA05.052c | MA05.052 | 9f6208e2-4108-4998-ab94-49ff7f9f73d1 | Canes and Crutches | Canes and Crutches | | |
| | | 7311 | CapsuleEndoscopyMA07.022f | Medicine (07) | MA07.022f | MA07.022 | e845a61d-1d8e-4e76-a213-930bb25853f2 | Capsule Endoscopy | Capsule Endoscopy | | |
| | | 7279 | CardiacContractilityModulationMA05.038 | DME (05) | MA05.038 | MA05.038 | a13a6242-036a-4bb3-8ae8-465e608eb6cf | Cardiac Contractility Modulation | Cardiac Contractility Modulation | | |
| | | 7440 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002g | Rehabilitation Services (10) | MA10.002g | MA10.002 | cc89a8de-7dbb-42dc-b555-c93df2c63e39 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"7441": {"Id":7441,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":10309,"PolicyAttachmentPageName":"d53a448f-95ae-40bf-987e-8f484c546473"},} | |
| | | 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®) | | |
| | | 7548 | CastandSplintApplicationsandAssociatedSuppliesMA00.012d | Administrative (00) | MA00.012d | MA00.012 | a86573f6-2f31-4a60-a803-179bc4701471 | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"7549": {"Id":7549,"MPAttachmentLetter":"A","Title":"Procedures Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":10710,"PolicyAttachmentPageName":"65828802-a59b-4e2c-8db9-bb12563f4ee7"},} | |
| | | 7460 | CataractSurgeryMA11.054e | Surgery (11) | MA11.054e | MA11.054 | fdf3d86b-d440-4e5b-90ef-37a1834d21a3 | Cataract Surgery | Cataract Surgery | {"7461": {"Id":7461,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":10687,"PolicyAttachmentPageName":"80f76dab-517a-4613-8fce-186b39578828"},} | |
| | | 7495 | CatheterAblationofCardiacArrhythmiasMA11.060h | Surgery (11) | MA11.060h | MA11.060 | de158e20-ea8b-4509-af48-346ce56fdab7 | 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®) | | |
| | | 7610 | Cerliponasealfa(Brineura®)MA08.089d | Pharmacy (08) | MA08.089d | MA08.089 | 3c7dddad-0064-4f15-98a6-a547f9e3dd87 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | {"7611": {"Id":7611,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Cerliponase alfa (Brineura®)","MPPolicyAttachmentInternalSourceId":10715,"PolicyAttachmentPageName":"ae524565-bc7a-48b8-9b44-b94fd221283d"},} | |
| | | 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"},} | |
| | | 7204 | ChemicalPeelsMA11.103c | Surgery (11) | MA11.103c | MA11.103 | dbf89dd3-ad50-4612-82f6-c24bd9f2428b | Chemical Peels | Chemical Peels | | |
| | | 7170 | ChimericAntigenReceptor(CART)Therapy:YescartaTecartus,Breyanzi,KymriahandAucatzylMA08.093q | Pharmacy (08) | MA08.093q | MA08.093 | fe028e42-9dee-473f-bbe2-af32b38214ad | Chimeric Antigen Receptor (CART) Therapy: Yescarta Tecartus, Breyanzi, Kymriah and Aucatzyl | Chimeric Antigen Receptor (CART) Therapy: Yescarta Tecartus, Breyanzi, Kymriah and Aucatzyl | | |
| | | 7171 | ChimericAntigenReceptorT-cell(CAR-T)Therapy:Carvykti®andAbecma®MA08.190 | Pharmacy (08) | MA08.190 | MA08.190 | cdeb3519-0a12-4bea-8549-bcfd8dfd1551 | Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Carvykti® and Abecma® | Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Carvykti® and Abecma® | | |
| | | 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"},} | |
| | | 7464 | CochlearImplantationMA11.039e | Surgery (11) | MA11.039e | MA11.039 | 853b7815-338d-4581-8240-2099ecbc7886 | Cochlear Implantation | Cochlear Implantation | | |
| | | 7619 | Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)MA08.128 | Pharmacy (08) | MA08.128 | MA08.128 | 2d976288-c47e-4f6d-a8f5-bebc6fc6c715 | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | | |
| | | 7207 | CommodeChairsMA05.036c | DME (05) | MA05.036c | MA05.036 | 354b0222-3888-4ca0-8de2-915494bd124d | 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 | | |
| | | 7523 | CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112 | Surgery (11) | MA11.112 | MA11.112 | 08196c1d-a707-42b8-aa06-b87a7034070a | Composite Tissue Allotransplantation of the Hand(s) and Face | Composite Tissue Allotransplantation of the Hand(s) and Face | | |
| | | 7528 | CompressionGarmentsMA05.045g | DME (05) | MA05.045g | MA05.045 | 17bda5b7-caaf-4952-8a23-b6dc54a5d1c8 | Compression Garments | Compression Garments | | |
| | | 7635 | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014b | Radiology (09) | MA09.014b | MA09.014 | 84be22e4-a58d-42b8-8af9-6d395076bf70 | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | | |
| | | 7189 | Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088c | Surgery (11) | MA11.088c | MA11.088 | d4eb2e41-f216-455d-8295-9d6435dde85d | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | | |
| | | 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 | | |
| | | 7704 | CornealPachymetryUsingUltrasoundMA07.046h | Medicine (07) | MA07.046h | MA07.046 | 53ad08b0-7958-49ec-bf17-eac8c785505b | Corneal Pachymetry Using Ultrasound | Corneal Pachymetry Using Ultrasound | {"7705": {"Id":7705,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes Eligible to be Reported for Corneal Pachymetry Using Ultrasound","MPPolicyAttachmentInternalSourceId":10772,"PolicyAttachmentPageName":"e9f3fadf-3ebb-4072-bbd0-af3af27bd539"},} | |
| | | 7478 | Cosibelimab-ipdl(Unloxcyt™)MA08.184a | Pharmacy (08) | MA08.184a | MA08.184 | 8c69f616-4d5b-4a06-afb1-ec82f092681d | Cosibelimab-ipdl (Unloxcyt™) | Cosibelimab-ipdl (Unloxcyt™) | | |
| | | 7531 | CosmeticProceduresMA12.009a | Miscellaneous (12) | MA12.009a | MA12.009 | 88592ac0-ac97-4a49-85cc-e8024334a362 | 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 | | |
| | | 7530 | Crizanlizumab-tmca(Adakveo®) MA08.109c | Pharmacy (08) | MA08.109c | MA08.109 | 780b8e85-25bb-4728-8d90-b074774760e2 | 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) | | |
| | | 7126 | CryosurgicalAblationoftheProstateGlandMA11.022a | Surgery (11) | MA11.022a | MA11.022 | 44f4be67-b467-4fda-b9ab-6a58eff7cba9 | Cryosurgical Ablation of the Prostate Gland | Cryosurgical Ablation of the Prostate Gland | | |
| | | 7687 | Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)MA08.079n | Pharmacy (08) | MA08.079n | MA08.079 | af84c666-62de-44d7-a30d-1ea4466c4c2b | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | {"7688": {"Id":7688,"MPAttachmentLetter":"A","Title":"Duration of Treatment Requirements For Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)","MPPolicyAttachmentInternalSourceId":10706,"PolicyAttachmentPageName":"b80b8af7-3e16-4f6f-98e9-fcb7897a5579"},} | |
| | | 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 | | |
| | | 7304 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014h | Surgery (11) | MA11.014h | MA11.014 | 030e5c23-0056-4424-ab90-f8a59f0bd5f6 | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"7305": {"Id":7305,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":10475,"PolicyAttachmentPageName":"93d5ebb2-c14a-48e1-aa8d-5f3a5dba561b"},"7306": {"Id":7306,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":10476,"PolicyAttachmentPageName":"46517c29-4163-4789-9474-72e7ae6fef1f"},"7307": {"Id":7307,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":10477,"PolicyAttachmentPageName":"ac9860e6-562a-4977-a85b-6979a44bae09"},"7308": {"Id":7308,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":10478,"PolicyAttachmentPageName":"83723525-2800-4213-9752-b226e56ad656"},"7309": {"Id":7309,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":10479,"PolicyAttachmentPageName":"d77d8984-9be0-45e1-8767-71bf6b61a78b"},} | |
| | | 6933 | DeepBrainStimulation(DBS)MA11.005h | Surgery (11) | MA11.005h | MA11.005 | 778dbe91-6682-4915-9325-2bf4842348c5 | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | | |
| | | 7588 | Denosumab(Prolia®,Xgeva®)andrelatedbiosimilars,andRomosozumab-aqqg(Evenity®)MA08.052q | Pharmacy (08) | MA08.052q | MA08.052 | ad8aa398-f319-4fd2-94cf-168b77c8f279 | Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®) | Denosumab (Prolia®, Xgeva®) and related biosimilars, and Romosozumab-aqqg (Evenity®) | {"7589": {"Id":7589,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":10752,"PolicyAttachmentPageName":"c4896699-0eae-4003-bd23-31a0b8634fb4"},} | |
| | | 7235 | DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099f | Surgery (11) | MA11.099f | MA11.099 | c7b9be3a-6016-4ce5-b555-3ed47d28451a | 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 | {} | |
| | | 7490 | DirectEndoscopicNecrosectomy(DEN)fortheTreatmentofPancreaticNecrosisMA11.115 | Surgery (11) | MA11.115 | MA11.115 | 68e78f38-b48c-4bb2-9abe-9f74a57f783e | Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis | Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis | | |
| | | 7330 | Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021c | Pharmacy (08) | MA08.021c | MA08.021 | 8b1f436c-1b91-4728-b237-d14cedece949 | Dofetilide (Tikosyn®) Use in the Inpatient Setting | Dofetilide (Tikosyn®) Use in the Inpatient Setting | | |
| | | 7477 | Dostarlimab-gxly(Jemperli)MA08.136g | Pharmacy (08) | MA08.136g | MA08.136 | b964d21a-24bb-4aaf-a67e-8653ed7255ca | Dostarlimab-gxly (Jemperli) | Dostarlimab-gxly (Jemperli) | | |
| | | 7252 | Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041c | Medicine (07) | MA07.041c | MA07.041 | c965d653-9238-4ea0-a9a9-e667551450bc | 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 | | |
| | | 7692 | Durvalumab(Imfinzi®)andTremelimumab-actl(Imjudo®)MA08.123f | Pharmacy (08) | MA08.123f | MA08.123 | a879f55b-2598-4f17-b51f-b6209b5500ce | Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) | Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) | {"7693": {"Id":7693,"MPAttachmentLetter":"A","Title":"Duration of Treatment Requirements For Durvalumab (Imfinzi®)","MPPolicyAttachmentInternalSourceId":10702,"PolicyAttachmentPageName":"e226cccf-5e40-4376-acd4-4eced015478a"},} | |
| | | 7622 | Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)forintravenousadministrationMA08.044l | Pharmacy (08) | MA08.044l | MA08.044 | 0a3fe415-e4e3-4f85-b536-058b54d1fad6 | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration | {"7623": {"Id":7623,"MPAttachmentLetter":"A","Title":"Dosing and Frequency","MPPolicyAttachmentInternalSourceId":10713,"PolicyAttachmentPageName":"9e6e168c-8d56-4c19-8c3a-06637caa8257"},} | |
| | | 7573 | Efbemalenograstimalfa-vuxw(Ryzneuta®),Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082q | Pharmacy (08) | MA08.082q | MA08.082 | 1daa0e88-971a-4212-969f-c06d7cd49884 | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | {"7574": {"Id":7574,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":10760,"PolicyAttachmentPageName":"0e861c22-7397-49cf-8dcb-7c0f09e3543d"},} | |
| | | 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) | | |
