|  | | 1956 | Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028e | Pharmacy (08) | MA08.028e | MA08.028 | e6ab9a34-6c77-4168-b73e-e42a6a23b38f | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"1957": {"Id":1957,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":4836,"PolicyAttachmentPageName":"f8fe6bdc-30ad-47b8-a27f-01f1cdeffc2f"},} | |
| | | 2507 | AbortionMA11.010a | Surgery (11) | MA11.010a | MA11.010 | 5e7d70e9-cd59-4945-8fd8-e5552ecdbe7f | Abortion | Abortion | | |
| | | 2615 | AcupunctureMA12.004b | Miscellaneous (12) | MA12.004b | MA12.004 | 5ed85e0b-9cd1-4e89-9257-01f59ad720f1 | Acupuncture | Acupuncture | {"2616": {"Id":2616,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":5412,"PolicyAttachmentPageName":"61086ead-80c0-4588-b615-6c859629e3a9"},} | |
| | | 2689 | AcuteCareFacilityInpatientTransfersMA12.003a | Miscellaneous (12) | MA12.003a | MA12.003 | 534525a5-76f0-4bce-9bd9-d6dcff647b59 | Acute Care Facility Inpatient Transfers | Acute Care Facility Inpatient Transfers | | |
| | | 2306 | Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066d | Pharmacy (08) | MA08.066d | MA08.066 | 53c4e67b-3cda-4ec6-8248-67773a3ce433 | Ado-Trastuzumab Emtansine (Kadcyla®) | Ado-Trastuzumab Emtansine (Kadcyla®) | {"2307": {"Id":2307,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":4968,"PolicyAttachmentPageName":"007b8aa2-9b71-4ef1-b91e-6774ea67dbce"},} | |
| | | 1645 | Agalsidase beta (Fabrazyme®) | Pharmacy (08) | MA08.033b | MA08.033 | 85257D39006E7945852585430046609C | Agalsidase beta (Fabrazyme®) | Agalsidase beta (Fabrazyme®) | | |
| | | 2758 | AirAmbulanceServicesMA12.007a | Miscellaneous (12) | MA12.007a | MA12.007 | 8e39da98-8d07-4c8a-bef5-02fa5b6a5006 | Air Ambulance Services | Air Ambulance Services | | |
| | | 2768 | Alemtuzumab(Lemtrada®)MA08.015d | Pharmacy (08) | MA08.015d | MA08.015 | 90901d4f-1362-4821-9241-f9bed7689f50 | Alemtuzumab (Lemtrada®) | Alemtuzumab (Lemtrada®) | | |
| | | 1646 | Alglucosidase alfa (e.g., Lumizyme®) | Pharmacy (08) | MA08.036c | MA08.036 | 85257D39006E794585258543004566E0 | Alglucosidase alfa (e.g., Lumizyme®) | Alglucosidase alfa (e.g., Lumizyme®) | | |
| | | 2592 | AllergyImmunotherapyMA07.055d | Medicine (07) | MA07.055d | MA07.055 | 719b74d6-420c-4235-bd9c-701076317da1 | Allergy Immunotherapy | Allergy Immunotherapy | | |
| | | 2305 | Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050b | Pharmacy (08) | MA08.050b | MA08.050 | 3f61cbc3-b488-474e-9b87-7af08a0d7a37 | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | | |
| | | 2841 | AlwaysBundledProcedureCodesMA00.026k | Administrative (00) | MA00.026k | MA00.026 | d24ffd11-8851-4978-8c3d-40cf7b70d55e | Always Bundled Procedure Codes | Always Bundled Procedure Codes | {"2842": {"Id":2842,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (MPFSD Indicator B)","MPPolicyAttachmentInternalSourceId":5649,"PolicyAttachmentPageName":"cce192db-8313-4ae3-b45e-71df96e4135d"},"2843": {"Id":2843,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":5650,"PolicyAttachmentPageName":"57faf641-e364-4c58-8056-2df3bef9caf7"},"2844": {"Id":2844,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":5651,"PolicyAttachmentPageName":"a703d9ab-4aa0-4380-b7b1-0f7afb0d456f"},} | |
| | | 2460 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005c | Medicine (07) | MA07.005c | MA07.005 | 301346f4-5db6-4773-ade7-a8c8bddfe5fe | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | | |
| | | 2791 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026g | Medicine (07) | MA07.026g | MA07.026 | 2d06ce3e-d6d6-4e4a-9d5f-9d819e78862d | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | | |
| | | 2524 | Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010f | DME (05) | MA05.010f | MA05.010 | 323e74cd-c91b-477a-9f9a-790d2bc1dbc7 | Ankle-Foot/Knee-Ankle-Foot Orthoses | Ankle-Foot/Knee-Ankle-Foot Orthoses | {"2525": {"Id":2525,"MPAttachmentLetter":"A","Title":"HCPCS CODES FOR ANKLE-FOOT/ KNEE-ANKLE FOOT ORTHOSIS","MPPolicyAttachmentInternalSourceId":5397,"PolicyAttachmentPageName":"e5c855aa-09ff-43c6-8d25-61ea9d110409"},} | |
| | | 2223 | AnorectalManometry,Electromyography(EMG)ofAnorectalorUrethralSphincters;BiofeedbackTrainingforPerinealMusclesandAnorectalorUrethralSphinctersMA07.018b | Medicine (07) | MA07.018b | MA07.018 | 9f02b1b1-b4ae-4fb9-ba57-7b2967d1d6c2 | 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 | | |
| | | 2098 | ApplicationandRemovalofTattoosMA11.072 | Surgery (11) | MA11.072 | MA11.072 | 3639d8b3-9067-4cd7-9c4c-e376655e9ed3 | Application and Removal of Tattoos | Application and Removal of Tattoos | | |
| | | 2867 | Aprepitant(Cinvanti™),FosaprepitantDimeglumine(Emend®),Granisetron(Sustol®),andRolapitant(Varubi®)MA08.091c | Pharmacy (08) | MA08.091c | MA08.091 | 134bbb7e-e877-4644-bf15-46a142364cd2 | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®) | {"2868": {"Id":2868,"MPAttachmentLetter":"A","Title":"Risk of Emesis Without Prophylaxis: Intravenous and Oral Antineoplastic Agents","MPPolicyAttachmentInternalSourceId":5661,"PolicyAttachmentPageName":"718fd20f-ee5c-4f95-8b31-7e30d1326067"},} | |
| | | 2737 | AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105g | Surgery (11) | MA11.105g | MA11.105 | 8b4414c0-deff-4fd5-aa8d-95a96a99ae28 | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | {"2738": {"Id":2738,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5522,"PolicyAttachmentPageName":"d1d9ab23-91fa-460f-aa8f-adc36e0b6e84"},} | |
| | | 2273 | ArtificialHeartsandVentricularAssistDevices(VADs)MA11.011d | Surgery (11) | MA11.011d | MA11.011 | a4ae04b3-2afd-47d8-af6c-350cfb59df7f | Artificial Hearts and Ventricular Assist Devices (VADs) | Artificial Hearts and Ventricular Assist Devices (VADs) | | |
| | | 2361 | ArtificialIntervertebralLumbarDiscInsertionMA11.114 | Surgery (11) | MA11.114 | MA11.114 | ab7ba4a7-7b7e-477a-9b36-8be46c7597c1 | Artificial Intervertebral Lumbar Disc Insertion | Artificial Intervertebral Lumbar Disc Insertion | | |
| | | 2420 | AsparaginaseErwiniaChrysanthemi(Erwinaze®)MA08.085c | Pharmacy (08) | MA08.085c | MA08.085 | 167f3869-f6da-433d-9ab8-35366eec6588 | Asparaginase Erwinia Chrysanthemi (Erwinaze®) | Asparaginase Erwinia Chrysanthemi (Erwinaze®) | | |
| | | 1935 | Atezolizumab(Tecentriq®)MA08.127 | Pharmacy (08) | MA08.127 | MA08.127 | f4e0210e-b48a-4acf-bac3-8264b197062d | Atezolizumab (Tecentriq®) | Atezolizumab (Tecentriq®) | {"1936": {"Id":1936,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":4730,"PolicyAttachmentPageName":"f86f9b92-feec-4d82-bc81-7fc3f03eb9ef"},} | |
| | | 1879 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | DME (05) | MA05.005d | MA05.005 | 46045ED869F1832F852585AB0056C456 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"1867": {"Id":1867,"MPAttachmentLetter":"A","Title":"ICD-10 codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"5801A106F8EA95A1852585AB0056C464"},"1868": {"Id":1868,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"BFE142D6DE3A8525852585AB0056C46C"},} | |
| | | 2747 | AutonomicNervousSystemTestingMA07.027d | Medicine (07) | MA07.027d | MA07.027 | 76255c86-29e4-4040-ae57-1aef3cc8055f | Autonomic Nervous System Testing | Autonomic Nervous System Testing | | |
| | | 1921 | Avelumab(Bavencio®)MA08.122 | Pharmacy (08) | MA08.122 | MA08.122 | f91a2c3b-4f6b-4c15-b58c-6d05bcd97376 | Avelumab (Bavencio®) | Avelumab (Bavencio®) | {"1922": {"Id":1922,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":4675,"PolicyAttachmentPageName":"765f7154-9f56-4ca8-bd28-3b9c1d7df492"},} | |
| | | 2144 | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisMA11.100e | Surgery (11) | MA11.100e | MA11.100 | da677fd2-4630-47ac-af75-7526e365af35 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | | |
| | | 2613 | belantamabmafodotin-blmf(Blenrep)MA08.119b | Pharmacy (08) | MA08.119b | MA08.119 | 190a4a96-ec61-4357-837d-aaec160f4469 | belantamab mafodotin-blmf (Blenrep) | belantamab mafodotin-blmf (Blenrep) | | |
| | | 2494 | Belimumab(Benlysta®)forIntravenousUseMA08.057c | Pharmacy (08) | MA08.057c | MA08.057 | 0406eaa8-0ae9-4fa6-8803-025b9cfefbf2 | Belimumab (Benlysta®) for Intravenous Use | Belimumab (Benlysta®) for Intravenous Use | | |
| | | 2421 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072g | Pharmacy (08) | MA08.072g | MA08.072 | ced91d45-f963-4361-a204-a200fc6782bb | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"2422": {"Id":2422,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":5038,"PolicyAttachmentPageName":"54124135-9d23-4807-8bed-a767ac01f5b9"},} | |
| | | 2343 | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037j | Administrative (00) | MA00.037j | MA00.037 | c3346ad1-b72f-4800-9cb4-abec12bcb1ec | 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 | {"2344": {"Id":2344,"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":5192,"PolicyAttachmentPageName":"b47ce025-9171-45e2-adc8-cc63cf0c3d6f"},} | |
| | | 2107 | BiofeedbackTherapyMA07.010a | Medicine (07) | MA07.010a | MA07.010 | c8e9390f-47a4-4253-ac7c-d1678698c4fa | Biofeedback Therapy | Biofeedback Therapy | | |
| | | 2745 | BioimpedancefortheDetectionofLymphedemaMA07.052 | Medicine (07) | MA07.052 | MA07.052 | c1e6aafa-0100-443d-9127-3883ac43bb26 | Bioimpedance for the Detection of Lymphedema | Bioimpedance for the Detection of Lymphedema | | |
| | | 2417 | Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/CanthopexyMA11.047d | Surgery (11) | MA11.047d | MA11.047 | 81caf8fe-115d-4de8-b7d6-6eeeb38650ad | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | {"2418": {"Id":2418,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":5007,"PolicyAttachmentPageName":"a24bd6c5-96b9-49b3-ab0d-a36c41d645b1"},} | |
| | | 2707 | Blinatumomab(Blincyto®)MA08.058d | Pharmacy (08) | MA08.058d | MA08.058 | 2ee48daf-823a-407f-9a59-ee7b1644b7e5 | Blinatumomab (Blincyto®) | Blinatumomab (Blincyto®) | | |
| | | 2149 | Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049c | Surgery (11) | MA11.049c | MA11.049 | a82f627b-608e-46e6-8a8d-739c2bcd90f4 | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | | |
| | | 2584 | Bortezomib(BortezomibforInjection,Velcade®)MA08.037g | Pharmacy (08) | MA08.037g | MA08.037 | dd7b7c4d-7b78-402b-85dd-c547c40d1959 | Bortezomib (Bortezomib for Injection, Velcade®) | Bortezomib (Bortezomib for Injection, Velcade®) | | |
| | | 2610 | BotulinumToxinAgentsMA08.017f | Pharmacy (08) | MA08.017f | MA08.017 | 0593ec5d-f9c2-4ed5-bc83-5f36d09570ee | Botulinum Toxin Agents | Botulinum Toxin Agents | {"2611": {"Id":2611,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":5157,"PolicyAttachmentPageName":"a15e896e-9020-4a8a-b25c-687c2aeda3e7"},} | |
| | | 2463 | BrentuximabVedotin(Adcetris®)MA08.068e | Pharmacy (08) | MA08.068e | MA08.068 | 2dbb1a6c-5a4d-4740-ab89-669165aa125e | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | {"2464": {"Id":2464,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":5097,"PolicyAttachmentPageName":"5c0fa49d-3441-43ec-b1aa-a19c733a9201"},} | |
| | | 1363 | Bronchial Thermoplasty | Surgery (11) | MA11.006b | MA11.006 | 85257D39006E7945852585A400669A60 | Bronchial Thermoplasty | Bronchial Thermoplasty | | |
| | | 2493 | Burosumab-twza(Crysvita®)MA08.099b | Pharmacy (08) | MA08.099b | MA08.099 | 5d2c8f79-65d8-4f87-958e-20593b9da6d7 | Burosumab-twza (Crysvita®) | Burosumab-twza (Crysvita®) | | |
| | | 2449 | Canakinumab(Ilaris®)MA08.101a | Pharmacy (08) | MA08.101a | MA08.101 | da9e0793-604f-4c92-8e6c-21d765aac574 | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | | |
| | | 2474 | CanesandCrutchesMA05.052b | DME (05) | MA05.052b | MA05.052 | e7b87e7b-d3ea-4868-9135-b40a85b09ac6 | Canes and Crutches | Canes and Crutches | | |
| | | 2750 | CapsuleEndoscopyMA07.022c | Medicine (07) | MA07.022c | MA07.022 | 4242db3b-8710-49e1-9411-5b4bea68d707 | Capsule Endoscopy | Capsule Endoscopy | | |
| | | 2158 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002b | Rehabilitation Services (10) | MA10.002b | MA10.002 | 51e3d603-6f82-4751-8ea5-f1f85418b58c | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"2159": {"Id":2159,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":4997,"PolicyAttachmentPageName":"6d739da0-31b5-49d0-ae21-af978b5be9c5"},} | |
| | | 2314 | CareManagementandCarePlanningServicesMA00.006h | Administrative (00) | MA00.006h | MA00.006 | dce37063-3216-4d24-942a-4765161f8650 | Care Management and Care Planning Services | Care Management and Care Planning Services | | |
| | | 2101 | Carfilzomib(Kyprolis™)MA08.062e | Pharmacy (08) | MA08.062e | MA08.062 | e395dee3-755a-471c-b8f1-ddc066123e9e | Carfilzomib (Kyprolis™) | Carfilzomib (Kyprolis™) | | |
| | | 2236 | CastandSplintApplicationsandAssociatedSuppliesMA00.012c | Administrative (00) | MA00.012c | MA00.012 | 7a7e50a2-46a1-4673-b9d9-59a2fce39403 | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"2237": {"Id":2237,"MPAttachmentLetter":"A","Title":"Procedures Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":4985,"PolicyAttachmentPageName":"0a068e16-bb74-4ccb-9a5b-27b1dc464f75"},} | |
| | | 2664 | CataractSurgeryMA11.054c | Surgery (11) | MA11.054c | MA11.054 | 9600c19c-6fc5-4a4d-a3f0-28229f1d24ac | Cataract Surgery | Cataract Surgery | {"2665": {"Id":2665,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":5478,"PolicyAttachmentPageName":"ca21cbcc-7d65-4bd0-aa7a-b84bd6c67607"},} | |
| | | 2112 | CatheterAblationofCardiacArrhythmiasMA11.060c | Surgery (11) | MA11.060c | MA11.060 | 3caf3ad6-1b9a-42aa-97ec-1a5e31058230 | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | | |
| | | 1880 | Cemiplimab-rwlc (LIBTAYO®) | | MA08.124 | MA08.124 | 85257D39006E79458525857B007B8F60 | Cemiplimab-rwlc (LIBTAYO®) | Cemiplimab-rwlc (LIBTAYO®) | | |
| | | 2629 | Cerliponasealfa(Brineura®)MA08.089c | Pharmacy (08) | MA08.089c | MA08.089 | 819bf893-34cb-4721-bfb5-b8fbc37d603e | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | | |
| | | 2096 | CervicalTractionDevicesforIn-homeUseMA05.009a | DME (05) | MA05.009a | MA05.009 | d5768947-b18e-4bd3-a798-3b5a7af86d2c | Cervical Traction Devices for In-home Use | Cervical Traction Devices for In-home Use | | |
| | | 1507 | Cetuximab (Erbitux®) | Pharmacy (08) | MA08.031d | MA08.031 | 85257D39006E79458525846C00639663 | Cetuximab (Erbitux®) | Cetuximab (Erbitux®) | {"1762":{"Id":1762,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525846C0063966E"},"1763":{"Id":1763,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525846C00639677"},} | |
| | | 2115 | ChemicalPeelsMA11.103a | Surgery (11) | MA11.103a | MA11.103 | f37d8c75-abe0-4d37-b0c0-c18d46ab4c17 | Chemical Peels | Chemical Peels | | |
| | | 2793 | ChimericAntigenReceptor(CAR)TherapyMA08.093h | Pharmacy (08) | MA08.093h | MA08.093 | e7f91eb7-f1fd-47d9-9ddc-09af573261e6 | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | {"2794": {"Id":2794,"MPAttachmentLetter":"A","Title":"ICD 10 codes","MPPolicyAttachmentInternalSourceId":5618,"PolicyAttachmentPageName":"768826d6-5719-4024-9cf6-d88134f7e806"},} | |
| | | 2692 | ChiropracticServicesMA10.004g | Rehabilitation Services (10) | MA10.004g | MA10.004 | 44422659-35df-4c55-92df-d37362e80dce | Chiropractic Services | Chiropractic Services | {"2693": {"Id":2693,"MPAttachmentLetter":"A","Title":"Medically neessary ICD-10 diagnosis codes","MPPolicyAttachmentInternalSourceId":5518,"PolicyAttachmentPageName":"e2c6377a-eccf-4ce0-93b9-e85e2d45885c"},} | |
| | | 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 | | |
| | | 2176 | CoagulationFactorsMA08.004r | Pharmacy (08) | MA08.004r | MA08.004 | f8924323-e7d0-413d-a657-ace27100d002 | Coagulation Factors | Coagulation Factors | | |
| | | 1361 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | | MA06.032 | MA06.032 | 85257D39006E7945852585A400689511 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | {"1859":{"Id":1859,"MPAttachmentLetter":"A","Title":"ICD 10 CODES FOR MEDICALLY NECESSARY COBALAMIN (VITAMIN B12), FOLIC ACID, AND/OR HOMOCYSTEINE TESTING (CPT CODES 82607, 82746, AND 83090)","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585A400689538"},} | |
| | | 2505 | CochlearImplantationMA11.039d | Surgery (11) | MA11.039d | MA11.039 | 2ff992d2-ca4a-42b9-b321-e387ed4804fd | Cochlear Implantation | Cochlear Implantation | | |
| | | 2138 | Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo™)MA08.128 | Pharmacy (08) | MA08.128 | MA08.128 | 19b9a826-f613-4a37-9ef2-3b874f2f1b5a | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™) | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™) | | |
| | | 2476 | CommodeChairsMA05.036b | DME (05) | MA05.036b | MA05.036 | e541d72d-63cc-41ee-8d00-eef69df90a9f | Commode Chairs | Commode Chairs | | |
| | | 1668 | Complementary and Integrative Health Services | Miscellaneous (12) | MA12.001d | MA12.001 | 85257D39006E7945852585040068A7CD | Complementary and Integrative Health Services | Complementary and Integrative Health Services | | |
| | | 2752 | CompleteDecongestiveTherapy(CDT)MA07.042 | Medicine (07) | MA07.042 | MA07.042 | af3a51ad-e178-4ab8-87d6-c5f616db4abe | Complete Decongestive Therapy (CDT) | Complete Decongestive Therapy (CDT) | | |
| | | 2659 | CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112 | Surgery (11) | MA11.112 | MA11.112 | c751b663-969e-44e9-9ed3-333584162b51 | Composite Tissue Allotransplantation of the Hand(s) and Face | Composite Tissue Allotransplantation of the Hand(s) and Face | | |
| | | 2637 | CompressionGarmentsMA05.045a | DME (05) | MA05.045a | MA05.045 | ab1071fd-1c46-4266-a71c-6dd8cea5c750 | Compression Garments | Compression Garments | | |
| | | 1599 | Computer Aided Detection (CAD) System for Use with Chest Radiographs | Radiology (09) | MA09.014a | MA09.014 | 85257D39006E7945852584F2004CAC60 | Computer Aided Detection (CAD) System for Use with Chest Radiographs | Computer Aided Detection (CAD) System for Use with Chest Radiographs | | |
| | | 2640 | Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088c | Surgery (11) | MA11.088c | MA11.088 | 7eccc322-fc2c-4c32-97f5-d2792e48497b | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | | |
| | | 2041 | ConsultationServicesMA00.049 | Administrative (00) | MA00.049 | MA00.049 | 1a75604c-5542-4601-b256-9e702f9428ba | Consultation Services | Consultation Services | | |
| | | 2685 | ContinuousGlucoseMonitorsandArtificialPancreasDeviceSystems(APDS)MA00.002g | Administrative (00) | MA00.002g | MA00.002 | 7a3392ab-1edc-450a-bc31-0a85444fbcf2 | Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS) | Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS) | {"2686": {"Id":2686,"MPAttachmentLetter":"B","Title":"THERAPEUTIC LONG-TERM INTERSTITIAL CGMS","MPPolicyAttachmentInternalSourceId":5506,"PolicyAttachmentPageName":"49df4cfe-1b3a-4a7e-b698-511541e04e1f"},"2687": {"Id":2687,"MPAttachmentLetter":"A","Title":"ICD-10: Short term CGM","MPPolicyAttachmentInternalSourceId":5507,"PolicyAttachmentPageName":"2a2d10f3-5f53-45ae-bbe5-1f4a3b3b4872"},} | |
| | | 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 | | |
| | | 2104 | CornealPachymetryUsingUltrasoundMA07.046f | Medicine (07) | MA07.046f | MA07.046 | e0f65852-e550-4adc-a4f3-d102b58690c0 | Corneal Pachymetry Using Ultrasound | Corneal Pachymetry Using Ultrasound | {"2105": {"Id":2105,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes Eligible to be Reported for Corneal Pachymetry Using Ultrasound","MPPolicyAttachmentInternalSourceId":4970,"PolicyAttachmentPageName":"1444f578-cd43-4d9b-8efc-e7fdbabdfb63"},} | |
| | | 2751 | CosmeticProceduresMA12.009a | Miscellaneous (12) | MA12.009a | MA12.009 | 0853e101-4b8c-412e-a9e4-ebc95dc4ec4c | Cosmetic Procedures | Cosmetic Procedures | | |
| | | 1484 | Coverage of Medical Devices | DME (05) | MA05.040b | MA05.040 | 85257D39006E7945852583F90064AAD0 | Coverage of Medical Devices | Coverage of Medical Devices | | |
| | | 2075 | CranialElectrotherapyStimulationMA05.066a | DME (05) | MA05.066a | MA05.066 | 5d14dd79-3851-4eaf-bd7c-3896710bc679 | Cranial Electrotherapy Stimulation | Cranial Electrotherapy Stimulation | | |
| | | 1616 | Criteria for Reimbursement of Emergency Room Services | Administrative (00) | MA00.044b | MA00.044 | 85257D39006E7945852584FD00658A7A | Criteria for Reimbursement of Emergency Room Services | Criteria for Reimbursement of Emergency Room Services | | |
| | | 2614 | crizanlizumab-tmca(Adakveo®)MA08.109a | Pharmacy (08) | MA08.109a | MA08.109 | aa45bf6d-52fb-45cd-9290-1f0466d9eb3d | crizanlizumab-tmca (Adakveo®) | crizanlizumab-tmca (Adakveo®) | | |
| | | 2645 | CryosurgicalAblationoftheProstateGlandMA11.022a | Surgery (11) | MA11.022a | MA11.022 | f949b8ee-ae93-49e4-af37-675e06be8bd2 | Cryosurgical Ablation of the Prostate Gland | Cryosurgical Ablation of the Prostate Gland | | |
| | | 2709 | Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro®)MA08.079i | Pharmacy (08) | MA08.079i | MA08.079 | eeda51c3-f345-4c9c-b1e8-4383e943ae09 | Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®) | Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®) | | |
| | | 2769 | DayRehabilitationMA10.005b | Rehabilitation Services (10) | MA10.005b | MA10.005 | ebab4b51-cc41-4866-9d3e-f134b810965b | Day Rehabilitation | Day Rehabilitation | | |
| | | 2485 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014f | Surgery (11) | MA11.014f | MA11.014 | 16ca656e-5df1-4607-87cf-343264986af5 | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"2486": {"Id":2486,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":5301,"PolicyAttachmentPageName":"0f26fb3b-4b4f-438f-baaf-4887a7a09cf5"},"2487": {"Id":2487,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":5302,"PolicyAttachmentPageName":"03701af1-49b3-4ef5-9514-ff16d02d95d1"},"2488": {"Id":2488,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":5303,"PolicyAttachmentPageName":"5e8475c6-da70-448e-af8e-bb27fc837a48"},"2489": {"Id":2489,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":5304,"PolicyAttachmentPageName":"4f57eb6a-c04e-48c1-a7a7-e9f8362be969"},"2490": {"Id":2490,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":5305,"PolicyAttachmentPageName":"26476cbd-bbca-4a96-b1c3-e9e92225ecb0"},} | |
| | | 2079 | DeepBrainStimulation(DBS)MA11.005d | Surgery (11) | MA11.005d | MA11.005 | 16ffa733-0972-4703-be0f-1baa1a71f1f5 | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | | |
| | | 2627 | Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)MA08.052i | Pharmacy (08) | MA08.052i | MA08.052 | 04571c73-0e06-47e3-9709-e9ecdfa492d1 | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | {"2628": {"Id":2628,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":5351,"PolicyAttachmentPageName":"a69416c2-5469-4c42-b7c4-ac0f1de7400d"},} | |
| | | 2334 | DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032c | Administrative (00) | MA00.032c | MA00.032 | 855c3dd7-e21c-4c80-966f-b8c6a15a3472 | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | {"2335": {"Id":2335,"MPAttachmentLetter":"A","Title":"Procedure Code for Direct Access OB/GYN for Family Planning","MPPolicyAttachmentInternalSourceId":5194,"PolicyAttachmentPageName":"5f3e1a47-9b97-475d-a095-45b97f6c7876"},} | |
| | | 2651 | Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021b | Pharmacy (08) | MA08.021b | MA08.021 | fb045038-630a-438d-b076-241198fe9b0c | Dofetilide (Tikosyn®) Use in the Inpatient Setting | Dofetilide (Tikosyn®) Use in the Inpatient Setting | | |
| | | 2849 | Dostarlimab-gxly(Jemperli)MA08.136 | Pharmacy (08) | MA08.136 | MA08.136 | 9006d15d-d0ce-41a5-af7b-2aaaf80e7f78 | Dostarlimab-gxly (Jemperli) | Dostarlimab-gxly (Jemperli) | | |
| | | 2093 | Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041b | Medicine (07) | MA07.041b | MA07.041 | d23692bf-87f2-46e4-9ee8-4c39765b6b8d | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | | |
| | | 2552 | DurableMedicalEquipment(DME)MA05.044j | DME (05) | MA05.044j | MA05.044 | 596a60fd-ea68-4604-8262-7e7a662837a8 | Durable Medical Equipment (DME) | Durable Medical Equipment (DME) | {"2553": {"Id":2553,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":5444,"PolicyAttachmentPageName":"f7083114-f877-4261-a43b-01a976c4847b"},"2554": {"Id":2554,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":5445,"PolicyAttachmentPageName":"86a0554d-9174-4cfe-a70b-e6ff57c756a5"},"2555": {"Id":2555,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":5446,"PolicyAttachmentPageName":"4f5a6c9f-6370-4d60-abc1-bfc7b9116c5f"},} | |
| | | 2423 | DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028e | DME (05) | MA05.028e | MA05.028 | 81644841-0f55-4dc1-9476-5ab8d631fd3a | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | | |
| | | 1923 | Durvalumab(Imfinzi™)MA08.123 | Pharmacy (08) | MA08.123 | MA08.123 | 2cc301d3-5baf-4ab6-a6a5-21ce1991f10d | Durvalumab (Imfinzi™) | Durvalumab (Imfinzi™) | {"1924": {"Id":1924,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":4686,"PolicyAttachmentPageName":"2c353d16-201e-4684-9657-003c3bef9330"},} | |
| | | 2656 | Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)MA08.044f | Pharmacy (08) | MA08.044f | MA08.044 | 8f91f1e4-e60a-4d6e-917b-a08d665c22bd | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) | | |
| | | 2652 | Edaravone(Radicava®)MA08.092a | Pharmacy (08) | MA08.092a | MA08.092 | 3e6b4d1a-b289-45f9-938b-9b8c37e853d4 | Edaravone (Radicava®) | Edaravone (Radicava®) | | |
| | | 2454 | ElectricalContinenceAidMA05.059 | DME (05) | MA05.059 | MA05.059 | d0ed73a0-1d77-4f22-9d58-a33008362521 | Electrical Continence Aid | Electrical Continence Aid | | |
| | | 2734 | ElectricalStimulationandElectromagneticStimulationfortheTreatmentofWoundsMA07.013d | Medicine (07) | MA07.013d | MA07.013 | 15c67d90-5ff8-4e28-badd-8cf8cfdd168a | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | {"2735": {"Id":2735,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":5523,"PolicyAttachmentPageName":"e0ba3acc-6059-42ec-9aaa-04bb4c0c5298"},} | |
| | | 2180 | Electromyography(EMG)Studies:NeedleEMG,SurfaceEMG(SEMG)MA07.050g | Medicine (07) | MA07.050g | MA07.050 | 2b34f47b-170d-4497-a27b-e2473db10dfd | Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG) | Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG) | {"2181": {"Id":2181,"MPAttachmentLetter":"G","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5053,"PolicyAttachmentPageName":"726854b6-9990-4be5-b5ba-67cc672d6de3"},"2182": {"Id":2182,"MPAttachmentLetter":"F","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5054,"PolicyAttachmentPageName":"bfc3b8ab-79b3-4253-91d8-ec5865d2e9b7"},"2183": {"Id":2183,"MPAttachmentLetter":"D","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5055,"PolicyAttachmentPageName":"c8e3f9f7-61db-44eb-9f24-76677912c805"},"2184": {"Id":2184,"MPAttachmentLetter":"C","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5056,"PolicyAttachmentPageName":"b5e97c0f-1d18-4a2e-9019-2d7fffa0d991"},"2185": {"Id":2185,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic Studies","MPPolicyAttachmentInternalSourceId":5057,"PolicyAttachmentPageName":"5fdaac7d-0d77-4f9d-aab5-24285ca077aa"},"2186": {"Id":2186,"MPAttachmentLetter":"B","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5058,"PolicyAttachmentPageName":"3b049e48-b578-4525-82a7-62726c63c5ff"},"2187": {"Id":2187,"MPAttachmentLetter":"I","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5059,"PolicyAttachmentPageName":"31c08e58-bc44-4176-8d94-73a9bb4f606e"},"2188": {"Id":2188,"MPAttachmentLetter":"H","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5060,"PolicyAttachmentPageName":"b435fccd-0aaa-493b-8981-d238f7516ae2"},"2189": {"Id":2189,"MPAttachmentLetter":"K","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5061,"PolicyAttachmentPageName":"2ca859a1-a341-4354-bf28-a9db789272e3"},"2190": {"Id":2190,"MPAttachmentLetter":"E","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5062,"PolicyAttachmentPageName":"95377478-0472-4075-8201-a63c067ccf58"},"2191": {"Id":2191,"MPAttachmentLetter":"J","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5063,"PolicyAttachmentPageName":"6e14e80f-8e3b-46dd-a081-21d429929585"},} | |
| | | 1931 | ElectronBeamComputedTomography(EBCT)forScreeningEvaluationsMA09.011a | Radiology (09) | MA09.011a | MA09.011 | 7db73249-b6ca-4bca-bc82-51af7fac9622 | Electron Beam Computed Tomography (EBCT) for Screening Evaluations | Electron Beam Computed Tomography (EBCT) for Screening Evaluations | | |
| | | 2630 | Emapalumab-lzsg(Gamifant®)MA08.104b | Pharmacy (08) | MA08.104b | MA08.104 | 59432da8-ece6-47a2-b673-19a3b614d8f0 | Emapalumab-lzsg (Gamifant®) | Emapalumab-lzsg (Gamifant®) | | |
| | | 2666 | EndometrialAblationMA11.065d | Surgery (11) | MA11.065d | MA11.065 | 6ad99673-c741-41dc-b143-c1bd5cb7b82f | Endometrial Ablation | Endometrial Ablation | | |
