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b00ed136-3352-4223-b636-58021431bded.aspx
  
3582Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028gPharmacy (08)MA08.028gMA08.028b00ed136-3352-4223-b636-58021431bdedAbatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use
{"3583": {"Id":3583,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6282,"PolicyAttachmentPageName":"cf45094d-bd05-4d93-993e-aa5a18b82368"},}
253e7c6f-dfb2-4f79-b7e7-c62680bc12c3.aspx
  
4328AbortionMA11.010aSurgery (11)MA11.010aMA11.010253e7c6f-dfb2-4f79-b7e7-c62680bc12c3AbortionAbortion
fe2f068a-caa7-4337-940c-21fff6e5379a.aspx
  
4499AcupunctureMA12.004cMiscellaneous (12)MA12.004cMA12.004fe2f068a-caa7-4337-940c-21fff6e5379aAcupunctureAcupuncture
{"4500": {"Id":4500,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":7394,"PolicyAttachmentPageName":"58c5c20d-3385-48f1-ae19-ca766547253b"},}
2dd8737a-eb29-4514-acbd-7186ea78b680.aspx
  
3936AcuteCareFacilityInpatientTransfersMA12.003bMiscellaneous (12)MA12.003bMA12.0032dd8737a-eb29-4514-acbd-7186ea78b680Acute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers
62e04270-b09a-42de-9ba4-248feb04627e.aspx
  
4094Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066fPharmacy (08)MA08.066fMA08.06662e04270-b09a-42de-9ba4-248feb04627eAdo-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"},}
899c9577-2cf3-4cf9-80dd-865bc7bd577d.aspx
  
4316Agalsidasebeta(Fabrazyme®)MA08.033cPharmacy (08)MA08.033cMA08.033899c9577-2cf3-4cf9-80dd-865bc7bd577dAgalsidase beta (Fabrazyme®)Agalsidase beta (Fabrazyme®)
119bad1e-0fbf-441f-81d6-265b76cc87b6.aspx
  
4020AirAmbulanceServicesMA12.007bMiscellaneous (12)MA12.007bMA12.007119bad1e-0fbf-441f-81d6-265b76cc87b6Air Ambulance ServicesAir Ambulance Services
8067664a-80c3-4d44-a11e-3ced21699339.aspx
  
4438Alemtuzumab(Lemtrada®)MA08.015dPharmacy (08)MA08.015dMA08.0158067664a-80c3-4d44-a11e-3ced21699339Alemtuzumab (Lemtrada®)Alemtuzumab (Lemtrada®)
1ae76050-dc9f-4acc-8570-eedd1dd4bb9b.aspx
  
4476Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®)MA08.036fPharmacy (08)MA08.036fMA08.0361ae76050-dc9f-4acc-8570-eedd1dd4bb9bAlglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )
2e1aa0fd-b9e3-4e44-b29c-e5b32a36e6de.aspx
  
4006AllergyImmunotherapyMA07.055dMedicine (07)MA07.055dMA07.0552e1aa0fd-b9e3-4e44-b29c-e5b32a36e6deAllergy ImmunotherapyAllergy Immunotherapy
18476a80-146f-492a-bf5d-642fda50dc24.aspx
  
4383Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050bPharmacy (08)MA08.050bMA08.05018476a80-146f-492a-bf5d-642fda50dc24Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)
e2563703-a9c3-467d-acee-3661690a1e68.aspx
  
4377AlwaysBundledProcedureCodesMA00.026qAdministrative (00)MA00.026qMA00.026e2563703-a9c3-467d-acee-3661690a1e68Always Bundled Procedure CodesAlways Bundled Procedure Codes
{"4378": {"Id":4378,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (MPFSD Indicator B)","MPPolicyAttachmentInternalSourceId":7239,"PolicyAttachmentPageName":"575d2f5f-bdbb-4545-b891-a4c65f6bda84"},"4379": {"Id":4379,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":7240,"PolicyAttachmentPageName":"fb8d864c-b5ba-4b9c-a071-de794b3cc1e9"},"4380": {"Id":4380,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":7241,"PolicyAttachmentPageName":"91658153-1f1c-481a-89db-1f03e8130ca0"},}
561210e3-3390-4956-b296-c2c2ef91b2f9.aspx
  
3955AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005cMedicine (07)MA07.005cMA07.005561210e3-3390-4956-b296-c2c2ef91b2f9Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) DevicesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
20d4debf-c979-474b-b325-3dcc70336021.aspx
  
4121AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026kMedicine (07)MA07.026kMA07.02620d4debf-c979-474b-b325-3dcc70336021Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
81ec86c6-5be6-4330-914c-0b9ce09b542a.aspx
  
4498AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008aAnesthesia (01)MA01.008aMA01.00881ec86c6-5be6-4330-914c-0b9ce09b542aAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint ManagementAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
{}
2997254c-1be9-4fd5-9b6b-394b8f40bf96.aspx
  
3571Anifrolumab-fnia(Saphnelo™)MA08.140bPharmacy (08)MA08.140bMA08.1402997254c-1be9-4fd5-9b6b-394b8f40bf96Anifrolumab-fnia (Saphnelo™)Anifrolumab-fnia (Saphnelo™)
acabd5b9-f1d1-4bdd-ae49-da518c2798e8.aspx
  
4312Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010hDME (05)MA05.010hMA05.010acabd5b9-f1d1-4bdd-ae49-da518c2798e8Ankle-Foot/Knee-Ankle-Foot OrthosesAnkle-Foot/Knee-Ankle-Foot Orthoses
{"4313": {"Id":4313,"MPAttachmentLetter":"A","Title":"HCPCS CODES FOR ANKLE-FOOT/ KNEE-ANKLE FOOT ORTHOSIS","MPPolicyAttachmentInternalSourceId":7045,"PolicyAttachmentPageName":"9b6beacb-0a52-4a50-b171-447055ee9c4f"},}
de604fb8-ee97-41c4-b98a-5bb8b7fb8a4c.aspx
  
4398AnorectalManometry,Electromyography(EMG)ofAnorectalorUrethralSphincters;BiofeedbackTrainingforPerinealMusclesandAnorectalorUrethralSphinctersMA07.018cMedicine (07)MA07.018cMA07.018de604fb8-ee97-41c4-b98a-5bb8b7fb8a4cAnorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral SphinctersAnorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
a8e854f7-94e7-4833-a02c-b7fb4214ff25.aspx
  
2179ApheresisTherapyMA06.001ePathology and Laboratory (06)MA06.001eMA06.001a8e854f7-94e7-4833-a02c-b7fb4214ff25Apheresis TherapyApheresis Therapy
879ce4a4-c22d-428a-85bb-ad1c18403124.aspx
  
4262ApplicationandRemovalofTattoosMA11.072Surgery (11)MA11.072MA11.072879ce4a4-c22d-428a-85bb-ad1c18403124Application and Removal of TattoosApplication and Removal of Tattoos
ff104db5-0a07-4d08-9240-ca4aede56f1f.aspx
  
4132Aprepitant(Cinvanti™),FosaprepitantDimeglumine(Emend®),Granisetron(Sustol®),andRolapitant(Varubi®)MA08.091ePharmacy (08)MA08.091eMA08.091ff104db5-0a07-4d08-9240-ca4aede56f1fAprepitant (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"},}
df24c7d1-3b2b-41a3-ba0a-d25c9c5e7d70.aspx
  
4137AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105jSurgery (11)MA11.105jMA11.105df24c7d1-3b2b-41a3-ba0a-d25c9c5e7d70Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaAqueous 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"},}
4d0593ea-c69f-4b0e-8370-ebed3c66e12f.aspx
  
4129ArtificialIntervertebralLumbarDiscInsertionMA11.114bSurgery (11)MA11.114bMA11.1144d0593ea-c69f-4b0e-8370-ebed3c66e12fArtificial Intervertebral Lumbar Disc InsertionArtificial Intervertebral Lumbar Disc Insertion
53bac0ed-9c15-45d1-a6eb-df0442a11e2a.aspx
  
3742Asparaginaseerwiniachrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze™)MA08.085fPharmacy (08)MA08.085fMA08.08553bac0ed-9c15-45d1-a6eb-df0442a11e2aAsparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)Asparaginase erwinia chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)
38d9e3e1-1b0d-4386-b60a-9b0787ca330f.aspx
  
4272Atezolizumab(Tecentriq®)MA08.127cPharmacy (08)MA08.127cMA08.12738d9e3e1-1b0d-4386-b60a-9b0787ca330fAtezolizumab (Tecentriq®)Atezolizumab (Tecentriq®)
{"4273": {"Id":4273,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7180,"PolicyAttachmentPageName":"9eff91d7-0b43-4fb4-9ac9-6c07148a0eff"},}
31ffd380-3f3a-469d-8a3d-744ef976f1ed.aspx
  
4023AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)MA05.005fDME (05)MA05.005fMA05.00531ffd380-3f3a-469d-8a3d-744ef976f1edAutomatic 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"},}
ff1221f9-30d9-4ac7-bbab-964e32913b1c.aspx
  
4469AutonomicNervousSystemTestingMA07.027fMedicine (07)MA07.027fMA07.027ff1221f9-30d9-4ac7-bbab-964e32913b1cAutonomic Nervous System TestingAutonomic Nervous System Testing
2940ef19-00de-46de-bbaa-aef9985a3ac2.aspx
  
4105Avelumab(Bavencio®)MA08.122bPharmacy (08)MA08.122bMA08.1222940ef19-00de-46de-bbaa-aef9985a3ac2Avelumab (Bavencio®)Avelumab (Bavencio®)
{"4106": {"Id":4106,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7009,"PolicyAttachmentPageName":"15c6ab29-ebb0-4244-b462-2756d4f993b8"},}
6a0c5929-9fd0-40f2-8aee-a03e3c5d7160.aspx
  
4250BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisMA11.100eSurgery (11)MA11.100eMA11.1006a0c5929-9fd0-40f2-8aee-a03e3c5d7160Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic RhinosinusitisBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
cf4b9338-44d8-4be3-b8af-86f6920be908.aspx
  
3532belantamabmafodotin-blmf(Blenrep)MA08.119bPharmacy (08)MA08.119bMA08.119cf4b9338-44d8-4be3-b8af-86f6920be908belantamab mafodotin-blmf (Blenrep) belantamab mafodotin-blmf (Blenrep)
bccd1651-281b-4398-bd5c-64d796fe33fb.aspx
  
4436Belimumab(Benlysta®)forIntravenousUseMA08.057dPharmacy (08)MA08.057dMA08.057bccd1651-281b-4398-bd5c-64d796fe33fbBelimumab (Benlysta®) for Intravenous UseBelimumab (Benlysta®) for Intravenous Use
46cea12e-7050-4ace-8a7f-113e18bd0426.aspx
  
4502Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072mPharmacy (08)MA08.072mMA08.07246cea12e-7050-4ace-8a7f-113e18bd0426Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
{"4503": {"Id":4503,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":7281,"PolicyAttachmentPageName":"801fe1a9-7997-4d08-9710-3e524241440b"},"4504": {"Id":4504,"MPAttachmentLetter":"B","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":7323,"PolicyAttachmentPageName":"ad90e584-84ce-4f28-8798-8e3380ae2f1f"},}
0a1fbcc2-67dd-4f2a-b41a-45331a445dce.aspx
  
4226BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037lAdministrative (00)MA00.037lMA00.0370a1fbcc2-67dd-4f2a-b41a-45331a445dceBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility CampusBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
{"4227": {"Id":4227,"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":7192,"PolicyAttachmentPageName":"8a9fe128-887e-4070-89b1-d494ccae3f93"},}
186e43b9-48ee-4ef3-842d-adf5eef12376.aspx
  
4276BiofeedbackTherapyMA07.010aMedicine (07)MA07.010aMA07.010186e43b9-48ee-4ef3-842d-adf5eef12376Biofeedback TherapyBiofeedback Therapy
fc94fb44-a8a9-41f6-8fe6-687483a6ebc6.aspx
  
3618BioimpedancefortheDetectionofLymphedemaMA07.052Medicine (07)MA07.052MA07.052fc94fb44-a8a9-41f6-8fe6-687483a6ebc6Bioimpedance for the Detection of LymphedemaBioimpedance for the Detection of Lymphedema
471e433d-f780-4d16-882b-1406395273b3.aspx
  
4004Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/CanthopexyMA11.047dSurgery (11)MA11.047dMA11.047471e433d-f780-4d16-882b-1406395273b3Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/CanthopexyBlepharoplasty, 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"},}
03966d42-a58c-417b-ad2a-bd444959368a.aspx
  
4269Blinatumomab(Blincyto®)MA08.058fPharmacy (08)MA08.058fMA08.05803966d42-a58c-417b-ad2a-bd444959368aBlinatumomab (Blincyto®)Blinatumomab (Blincyto®)
cc5a905b-ad8a-487c-a688-6d3af1a4311a.aspx
  
4164Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049eSurgery (11)MA11.049eMA11.049cc5a905b-ad8a-487c-a688-6d3af1a4311aBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
ae53fe4a-bce1-43e4-8f29-b3bfd9e5b0f5.aspx
  
4160Bortezomib(BortezomibforInjection,Velcade®)MA08.037iPharmacy (08)MA08.037iMA08.037ae53fe4a-bce1-43e4-8f29-b3bfd9e5b0f5Bortezomib (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"},}
68afc6b8-66ce-454a-b8ae-8225ca1a74aa.aspx
  
4389BotulinumToxinAgentsMA08.017iPharmacy (08)MA08.017iMA08.01768afc6b8-66ce-454a-b8ae-8225ca1a74aaBotulinum Toxin AgentsBotulinum Toxin Agents
{"4390": {"Id":4390,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":7187,"PolicyAttachmentPageName":"244ed399-eee3-4e6c-a4bd-c09c6c04da73"},}
5de87146-f5e7-4927-8264-ff5c323d17a9.aspx
  
3792BrentuximabVedotin(Adcetris®)MA08.068hPharmacy (08)MA08.068hMA08.0685de87146-f5e7-4927-8264-ff5c323d17a9Brentuximab Vedotin (Adcetris®)Brentuximab Vedotin (Adcetris®)
{"3793": {"Id":3793,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6763,"PolicyAttachmentPageName":"53f87106-7279-43a6-9fb7-e70e019e1292"},}
69c14601-19f4-4a22-869a-ce88af536766.aspx
  
3417BronchialValvesMA11.020Surgery (11)MA11.020MA11.02069c14601-19f4-4a22-869a-ce88af536766Bronchial ValvesBronchial Valves
139fe438-ff72-40f7-98d1-4bfe79daf96e.aspx
  
4477Burosumab-twza(Crysvita®)MA08.099bPharmacy (08)MA08.099bMA08.099139fe438-ff72-40f7-98d1-4bfe79daf96eBurosumab-twza (Crysvita®)Burosumab-twza (Crysvita®)
e823b28a-58d2-4201-8b11-a1e4fd9480f8.aspx
  
4484Canakinumab(Ilaris®)MA08.101bPharmacy (08)MA08.101bMA08.101e823b28a-58d2-4201-8b11-a1e4fd9480f8Canakinumab (Ilaris®)Canakinumab (Ilaris®)
b9a4e942-4f22-4e46-b71d-bb61455dd52a.aspx
  
4246CanesandCrutchesMA05.052bDME (05)MA05.052bMA05.052b9a4e942-4f22-4e46-b71d-bb61455dd52aCanes and CrutchesCanes and Crutches
f1b3ebed-0d89-4fc1-bfb7-384ea15ad86f.aspx
  
4492CapsuleEndoscopyMA07.022eMedicine (07)MA07.022eMA07.022f1b3ebed-0d89-4fc1-bfb7-384ea15ad86fCapsule EndoscopyCapsule Endoscopy
de73d54c-e82e-406d-a1d8-c94d36bf4fc5.aspx
  
3807CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002cRehabilitation Services (10)MA10.002cMA10.002de73d54c-e82e-406d-a1d8-c94d36bf4fc5Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsCardiac 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"},}
e172f03c-54fe-4e01-8357-866843b8d2b5.aspx
  
4228CareManagementandCarePlanningServicesMA00.006mAdministrative (00)MA00.006mMA00.006e172f03c-54fe-4e01-8357-866843b8d2b5Care Management and Care Planning ServicesCare Management and Care Planning Services
cc00c34c-5b11-4450-9824-79ca51259fae.aspx
  
3969Carfilzomib(Kyprolis™)MA08.062gPharmacy (08)MA08.062gMA08.062cc00c34c-5b11-4450-9824-79ca51259faeCarfilzomib (Kyprolis™)Carfilzomib (Kyprolis™)
b86099e5-ed74-4f52-9ab4-c534c779cb23.aspx
  
3612CastandSplintApplicationsandAssociatedSuppliesMA00.012cAdministrative (00)MA00.012cMA00.012b86099e5-ed74-4f52-9ab4-c534c779cb23Cast and Splint Applications and Associated SuppliesCast 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"},}
35d53c26-0c5b-4b14-b8b8-a5597e77fe0c.aspx
  
4010CataractSurgeryMA11.054dSurgery (11)MA11.054dMA11.05435d53c26-0c5b-4b14-b8b8-a5597e77fe0cCataract SurgeryCataract Surgery
{"4011": {"Id":4011,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6669,"PolicyAttachmentPageName":"00eafbe0-27dc-4b22-bec7-d83dddcb66d7"},}
d64fed48-4aef-4817-967f-2e50017c1cb0.aspx
  
3809CatheterAblationofCardiacArrhythmiasMA11.060eSurgery (11)MA11.060eMA11.060d64fed48-4aef-4817-967f-2e50017c1cb0Catheter Ablation of Cardiac ArrhythmiasCatheter Ablation of Cardiac Arrhythmias
43307a95-4d17-43d5-ae1d-447dee061b11.aspx
  
4103Cemiplimab-rwlc(Libtayo®)MA08.124bPharmacy (08)MA08.124bMA08.12443307a95-4d17-43d5-ae1d-447dee061b11Cemiplimab-rwlc (Libtayo®)Cemiplimab-rwlc (Libtayo®)
cbcee004-59ba-4f3d-ace3-5dd2bb9e1992.aspx
  
4473Cerliponasealfa(Brineura®)MA08.089cPharmacy (08)MA08.089cMA08.089cbcee004-59ba-4f3d-ace3-5dd2bb9e1992Cerliponase alfa (Brineura®)Cerliponase alfa (Brineura®)
758792dc-b695-4e8f-8010-624a774b081b.aspx
  
4333CervicalTractionDevicesforIn-homeUseMA05.009aDME (05)MA05.009aMA05.009758792dc-b695-4e8f-8010-624a774b081bCervical Traction Devices for In-home UseCervical Traction Devices for In-home Use
da641a6d-6927-4908-a969-1856f88de703.aspx
  
4156Cetuximab(Erbitux®)MA08.031fPharmacy (08)MA08.031fMA08.031da641a6d-6927-4908-a969-1856f88de703Cetuximab (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"},}
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3787ChemicalPeelsMA11.103bSurgery (11)MA11.103bMA11.103b89e88bc-c37b-4819-a4ea-af219a5cf05dChemical PeelsChemical Peels
2aa985e5-66d4-4c33-9b92-cffca516451e.aspx
  
3790ChimericAntigenReceptor(CAR)TherapyMA08.093kPharmacy (08)MA08.093kMA08.0932aa985e5-66d4-4c33-9b92-cffca516451eChimeric Antigen Receptor (CAR) TherapyChimeric Antigen Receptor (CAR) Therapy
{"3791": {"Id":3791,"MPAttachmentLetter":"A","Title":"ICD 10 codes","MPPolicyAttachmentInternalSourceId":6561,"PolicyAttachmentPageName":"c52d4929-1636-4076-b07d-a4a95bdbcd52"},}
7d3057f3-c09c-492e-8583-c5300b165742.aspx
  
3978ChiropracticServicesMA10.004hRehabilitation Services (10)MA10.004hMA10.0047d3057f3-c09c-492e-8583-c5300b165742Chiropractic ServicesChiropractic Services
{"3979": {"Id":3979,"MPAttachmentLetter":"A","Title":"Medically neessary ICD-10 diagnosis codes","MPPolicyAttachmentInternalSourceId":6877,"PolicyAttachmentPageName":"2fddedd7-0de5-4a26-83a9-310b2f845333"},}
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1368Circulating Tumor Cell (CTC) AssayPathology and Laboratory (06)MA06.030MA06.030F371FB2E48AFB33885257DBE00723399Circulating Tumor Cell (CTC) AssayCirculating Tumor Cell (CTC) Assay
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3958CoagulationFactorsMA08.004tPharmacy (08)MA08.004tMA08.004560ab61f-50a9-4fb5-9b2f-45445ab7a909Coagulation Factors Coagulation Factors
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4206Cobalamin(VitaminB12),FolicAcid,andHomocysteineTestingMA06.032aPathology and Laboratory (06)MA06.032aMA06.03208299b3d-e691-4b8a-b760-476b6013cdcfCobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingCobalamin (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"},}
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3962CochlearImplantationMA11.039eSurgery (11)MA11.039eMA11.0390c6e1f8b-9eb7-4fcf-9e55-88f408e4d4cbCochlear ImplantationCochlear Implantation
eb7a5b5b-9d54-474b-9874-57a8dce573fc.aspx
  
4297Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo™)MA08.128Pharmacy (08)MA08.128MA08.128eb7a5b5b-9d54-474b-9874-57a8dce573fcCollagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)
e33148b1-aa3c-4791-a297-b5f05efc14bc.aspx
  
4244CommodeChairsMA05.036bDME (05)MA05.036bMA05.036e33148b1-aa3c-4791-a297-b5f05efc14bcCommode ChairsCommode Chairs
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3614ComplementaryandIntegrativeHealthServicesMA12.001dMiscellaneous (12)MA12.001dMA12.001a62fd0fa-8e7b-4ed1-bb67-fd235c1159f0Complementary and Integrative Health ServicesComplementary and Integrative Health Services
74c1970e-fa1e-40e5-91ce-bd5dd3e8a6f5.aspx
  
3617CompleteDecongestiveTherapy(CDT)MA07.042Medicine (07)MA07.042MA07.04274c1970e-fa1e-40e5-91ce-bd5dd3e8a6f5Complete Decongestive Therapy (CDT)Complete Decongestive Therapy (CDT)
df7d7068-6c32-45da-b37f-2e979978b0d5.aspx
  
4251CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112Surgery (11)MA11.112MA11.112df7d7068-6c32-45da-b37f-2e979978b0d5Composite Tissue Allotransplantation of the Hand(s) and FaceComposite Tissue Allotransplantation of the Hand(s) and Face
f3dad6d9-4a32-4140-a210-b5b592b5812d.aspx
  
4388CompressionGarmentsMA05.045bDME (05)MA05.045bMA05.045f3dad6d9-4a32-4140-a210-b5b592b5812dCompression GarmentsCompression Garments
5280f42d-aefd-4364-b335-f20bb8471cff.aspx
  
4261Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014aRadiology (09)MA09.014aMA09.0145280f42d-aefd-4364-b335-f20bb8471cffComputer-Aided Detection (CAD) System for Use with Chest RadiographsComputer-Aided Detection (CAD) System for Use with Chest Radiographs
ceec4bd5-f2ac-4512-b0e7-b6b2f8aea4b6.aspx
  
4215Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088cSurgery (11)MA11.088cMA11.088ceec4bd5-f2ac-4512-b0e7-b6b2f8aea4b6Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic ProcedureComputer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
50f137b2-f09b-4bba-bf10-c689ad659402.aspx
  
4229ConsultationServicesMA00.049bAdministrative (00)MA00.049bMA00.04950f137b2-f09b-4bba-bf10-c689ad659402Consultation ServicesConsultation Services
a0fd6b96-f1ad-4331-a935-876dfe23a6dd.aspx
  
4445ContinuousGlucoseMonitorsandHomeBloodGlucoseMonitorsandSuppliesMA00.002kAdministrative (00)MA00.002kMA00.002a0fd6b96-f1ad-4331-a935-876dfe23a6ddContinuous Glucose Monitors and Home Blood Glucose Monitors and SuppliesContinuous Glucose Monitors and Home Blood Glucose Monitors and Supplies
{"4446": {"Id":4446,"MPAttachmentLetter":"A","Title":"ICD10: Short-Term Interstitial CGMS","MPPolicyAttachmentInternalSourceId":7184,"PolicyAttachmentPageName":"2deffc76-b612-4947-9bd9-a29e4a29f8d5"},"4447": {"Id":4447,"MPAttachmentLetter":"B","Title":"ICD10: Long-Term Interstitial CGMS (Non-Implantable)","MPPolicyAttachmentInternalSourceId":7185,"PolicyAttachmentPageName":"6489dd5f-014a-4bdb-8caa-78b41066dca9"},"4448": {"Id":4448,"MPAttachmentLetter":"C","Title":"ICD10: Home Blood Glucose Monitors and Supplies","MPPolicyAttachmentInternalSourceId":7186,"PolicyAttachmentPageName":"45f80977-b75b-44cd-9f4f-36d02b808e85"},"4449": {"Id":4449,"MPAttachmentLetter":"D","Title":"Implantable Continuous Glucose Monitors (I-CGM)","MPPolicyAttachmentInternalSourceId":7306,"PolicyAttachmentPageName":"70b2ddc6-692e-4ca4-ab79-43773961135d"},}
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4293ContrastAgentsUsedinConjunctionwithEchocardiographyMA09.004cRadiology (09)MA09.004cMA09.004d647b737-a9b2-45c6-8d24-5a6b333db1e7Contrast Agents Used in Conjunction with EchocardiographyContrast Agents Used in Conjunction with Echocardiography
0d262908-e6ab-4ad9-a017-96491fb35ed8.aspx
  
3636CornealPachymetryUsingUltrasoundMA07.046gMedicine (07)MA07.046gMA07.0460d262908-e6ab-4ad9-a017-96491fb35ed8Corneal Pachymetry Using UltrasoundCorneal 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"},}
6db2e8ed-e67a-4ecf-aebd-400834738d29.aspx
  
4217CosmeticProceduresMA12.009aMiscellaneous (12)MA12.009aMA12.0096db2e8ed-e67a-4ecf-aebd-400834738d29Cosmetic ProceduresCosmetic Procedures
69c3f8a1-1044-489c-869e-7e78dbb55b06.aspx
  
3048CoverageofMedicalDevicesMA05.040bDME (05)MA05.040bMA05.04069c3f8a1-1044-489c-869e-7e78dbb55b06Coverage of Medical DevicesCoverage of Medical Devices
14ef6470-44f4-4099-881a-21521d12fec8.aspx
  
3935CranialElectrotherapyStimulationMA05.066cDME (05)MA05.066cMA05.06614ef6470-44f4-4099-881a-21521d12fec8Cranial Electrotherapy StimulationCranial Electrotherapy Stimulation
bd8724e2-053c-46e0-ad5a-4e5dbf9cf587.aspx
  
4169CriteriaforReimbursementofEmergencyRoomServicesMA00.044cAdministrative (00)MA00.044cMA00.044bd8724e2-053c-46e0-ad5a-4e5dbf9cf587Criteria for Reimbursement of Emergency Room ServicesCriteria for Reimbursement of Emergency Room Services
9034c0d4-d181-4395-aca9-6863f186539d.aspx
  
4224crizanlizumab-tmca(Adakveo®)MA08.109aPharmacy (08)MA08.109aMA08.1099034c0d4-d181-4395-aca9-6863f186539dcrizanlizumab-tmca (Adakveo®)crizanlizumab-tmca (Adakveo®)
4262ba16-e187-42a1-a358-5309ce6b6ea5.aspx
  
3623CryosurgicalAblationoftheProstateGlandMA11.022aSurgery (11)MA11.022aMA11.0224262ba16-e187-42a1-a358-5309ce6b6ea5Cryosurgical Ablation of the Prostate GlandCryosurgical Ablation of the Prostate Gland
fc8bc0fe-8bb5-4590-830c-71eb68cd8fce.aspx
  
3746Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro®)MA08.079jPharmacy (08)MA08.079jMA08.079fc8bc0fe-8bb5-4590-830c-71eb68cd8fceDaratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)
ee92c759-ee9f-4de2-8688-6082eef33136.aspx
  
4493DayRehabilitationMA10.005bRehabilitation Services (10)MA10.005bMA10.005ee92c759-ee9f-4de2-8688-6082eef33136Day RehabilitationDay Rehabilitation
8aa69314-d990-40ec-a294-8971cc5c5e5b.aspx
  
4278DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014gSurgery (11)MA11.014gMA11.0148aa69314-d990-40ec-a294-8971cc5c5e5bDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
{"4279": {"Id":4279,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":7205,"PolicyAttachmentPageName":"1957de27-3b5a-409f-b455-3f1b04cc7e46"},"4280": {"Id":4280,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":7206,"PolicyAttachmentPageName":"94ee1983-7988-4fe6-a254-86aa041df790"},"4281": {"Id":4281,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":7207,"PolicyAttachmentPageName":"efc99947-4c38-4bd5-8a59-f023e5132f48"},"4282": {"Id":4282,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":7208,"PolicyAttachmentPageName":"22f0eb11-922b-4f0a-8a0b-c3b947ee5213"},"4283": {"Id":4283,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":7209,"PolicyAttachmentPageName":"16a5b6ea-586f-4f36-b28f-7c8b503ded37"},}
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4358DeepBrainStimulation(DBS)MA11.005fSurgery (11)MA11.005fMA11.0056f2033a3-bd4d-455e-9fb9-866627c45d2fDeep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)
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3522Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)MA08.052jPharmacy (08)MA08.052jMA08.052116bf5f6-59fe-4c5b-b271-9a90bf62beb6Denosumab (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"},}
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4139DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099cSurgery (11)MA11.099cMA11.0990254b636-2a8f-4b02-a7ca-0ea8002e8852Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
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4236DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032eAdministrative (00)MA00.032eMA00.032feaa2fd7-6fab-4ba8-8f44-0a0c428ccaa0Direct Access to Obstetrics/Gynecology (OB/GYN) ServicesDirect Access to Obstetrics/Gynecology (OB/GYN) Services
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3575Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021bPharmacy (08)MA08.021bMA08.021062b48a0-26a9-4077-805d-713072908f88Dofetilide (Tikosyn®) Use in the Inpatient SettingDofetilide (Tikosyn®) Use in the Inpatient Setting
18ff969a-7c89-4261-acdf-6c16773efc05.aspx
  
4310Dostarlimab-gxly(Jemperli)MA08.136dPharmacy (08)MA08.136dMA08.13618ff969a-7c89-4261-acdf-6c16773efc05Dostarlimab-gxly (Jemperli)Dostarlimab-gxly (Jemperli)
9b4d3cea-ae30-4134-98bd-9481da9fc035.aspx
  
3916Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041bMedicine (07)MA07.041bMA07.0419b4d3cea-ae30-4134-98bd-9481da9fc035Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic MalignanciesDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
4106fc5f-592e-4c4c-b9cb-a19406747053.aspx
  
4416DurableMedicalEquipment(DME)MA05.044nDME (05)MA05.044nMA05.0444106fc5f-592e-4c4c-b9cb-a19406747053Durable Medical Equipment (DME)Durable Medical Equipment (DME)
{"4417": {"Id":4417,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":7375,"PolicyAttachmentPageName":"56e4f4f0-d13a-482f-8eaa-9534c380e45c"},"4418": {"Id":4418,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":7376,"PolicyAttachmentPageName":"0199d55c-0045-4707-a381-ceee6af374e6"},"4419": {"Id":4419,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":7377,"PolicyAttachmentPageName":"92c5d35e-a291-429c-97bf-156f7bc30dc5"},}
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4015DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028eDME (05)MA05.028eMA05.0281b12ffb5-60aa-4123-895e-6165136f7204Durable Medical Equipment (DME) Not Subject to a Rental to Purchase MaximumDurable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
2c99c5d8-b866-4945-9fed-9fbc3712a42c.aspx
  
4113Durvalumab(Imfinzi®)MA08.123bPharmacy (08)MA08.123bMA08.1232c99c5d8-b866-4945-9fed-9fbc3712a42cDurvalumab (Imfinzi®)Durvalumab (Imfinzi®)
{"4114": {"Id":4114,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":6592,"PolicyAttachmentPageName":"bf714cae-91e4-4520-bd99-4856938f8f7a"},}
75362d2f-b4f7-4f18-90c0-e39dc57aaea7.aspx
  
4321Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)MA08.044hPharmacy (08)MA08.044hMA08.04475362d2f-b4f7-4f18-90c0-e39dc57aaea7Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)
93ee35b6-d0d3-4c1a-b0e0-152e9dd153e8.aspx
  
3578Edaravone(Radicava®)MA08.092aPharmacy (08)MA08.092aMA08.09293ee35b6-d0d3-4c1a-b0e0-152e9dd153e8Edaravone (Radicava®)Edaravone (Radicava®)
2e1307f8-6d9b-42c0-bcb3-f8a1d8130e7a.aspx
  
4441Efgartigimod-alfa(VyvgartTM)MA08.142aPharmacy (08)MA08.142aMA08.1422e1307f8-6d9b-42c0-bcb3-f8a1d8130e7aEfgartigimod-alfa (VyvgartTM)Efgartigimod-alfa (VyvgartTM)
b1ce6a6e-dd13-40a1-bfda-991f36ee8d46.aspx
  
4365Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082jPharmacy (08)MA08.082jMA08.082b1ce6a6e-dd13-40a1-bfda-991f36ee8d46Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related BiosimilarsEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars
{"4366": {"Id":4366,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":7289,"PolicyAttachmentPageName":"073d1324-e0f7-4423-8859-0c20e57e2ae1"},}
4d2edd4d-cda6-4f0a-90ca-019dfd361a62.aspx
  
4287ElectricalStimulationandElectromagneticStimulationfortheTreatmentofWoundsMA07.013dMedicine (07)MA07.013dMA07.0134d2edd4d-cda6-4f0a-90ca-019dfd361a62Electrical Stimulation and Electromagnetic Stimulation for the Treatment of WoundsElectrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
{"4288": {"Id":4288,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":7197,"PolicyAttachmentPageName":"682701e8-a236-4e4c-b4cc-69923e3999b7"},}
78280621-f992-4f8a-9825-368ec185cde4.aspx
  
3937ElectroconvulsiveTherapy(ECT)MA14.001Behavioral Health (14)MA14.001MA14.00178280621-f992-4f8a-9825-368ec185cde4Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)
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