MA PPO

The Centers for Medicare and Medicaid Services (CMS) Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions. The database also includes several other types of National Coverage policy related documents, including National Coverage Analyses (NCAs), Coding Analyses for Labs (CALs), Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) proceedings, Technical Assessments (TAs), and Medicare coverage guidance documents.

The MCD is located at https://www.cms.gov/medicare-coverage-database , one of the top links on the CMS website homepage.​​​​​​​​​

  
  
  
  
  
  
  
  
  
  
MPattachmentdataPub
85257D39006E7945852584BE00618356.aspx
  
29Always Bundled Procedure CodesAdministrative (00)MA00.026gMA00.02685257D39006E7945852584BE00618356Always Bundled Procedure CodesAlways Bundled Procedure Codes
{"1776":{"Id":1776,"MPAttachmentLetter":"A","Title":"CPT Codes and HCPCS Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584BE0061835A"},}
85257D39006E7945852582BA004934E6.aspx
  
34Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility CampusAdministrative (00)MA00.037hMA00.03785257D39006E7945852582BA004934E6Billing 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
{"1784":{"Id":1784,"MPAttachmentLetter":"A","Title":"CPT/HCPCS Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852582BA004934EC"},}
B62FA99106A1AEC1852581E9006281CE.aspx
  
18Cast and Splint Applications and Associated Supplies Provided in the Office SettingAdministrative (00)MA00.012bMA00.012B62FA99106A1AEC1852581E9006281CECast and Splint Applications and Associated Supplies Provided in the Office SettingCast and Splint Applications and Associated Supplies Provided in the Office Setting
{"1681":{"Id":1681,"MPAttachmentLetter":"A","Title":"No Title","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"A2DFF3878C4FCBD3852581E9006281DF"},}
8DFCA2ECFC6B5415852582DC00509E93.aspx
  
40Consultation ServicesMA00.049MA00.0498DFCA2ECFC6B5415852582DC00509E93Consultation ServicesConsultation Services
85257D39006E79458525851B005C2382.aspx
  
65Contrast Agents Used in Conjunction with EchocardiographyRadiology (09)MA09.004bMA09.00485257D39006E79458525851B005C2382Contrast Agents Used in Conjunction with EchocardiographyContrast Agents Used in Conjunction with Echocardiography
85257D39006E7945852584FD00658A7A.aspx
  
38Criteria for Reimbursement of Emergency Room ServicesAdministrative (00)MA00.044bMA00.04485257D39006E7945852584FD00658A7ACriteria for Reimbursement of Emergency Room ServicesCriteria for Reimbursement of Emergency Room Services
85257D39006E794585258360004DFC78.aspx
  
62Durable Medical Equipment (DME) Not Subject to a Rental to Purchase MaximumDME (05)MA05.028dMA05.02885257D39006E794585258360004DFC78Durable Medical Equipment (DME) Not Subject to a Rental to Purchase MaximumDurable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
BC141503B9A36679852583740052BE4A.aspx
  
36Facility Reporting of Observation ServicesAdministrative (00)MA00.040aMA00.040BC141503B9A36679852583740052BE4AFacility Reporting of Observation ServicesFacility Reporting of Observation Services
85257D39006E79458525841D004AA188.aspx
  
66High Osmolar Contrast AgentsRadiology (09)MA09.005aMA09.00585257D39006E79458525841D004AA188High Osmolar Contrast AgentsHigh Osmolar Contrast Agents
85257D39006E79458525843B0044336B.aspx
  
39Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)Administrative (00)MA00.045dMA00.04585257D39006E79458525843B0044336BIncident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)
85257D39006E79458525847100594308.aspx
  
27Inpatient Hospital ReadmissionAdministrative (00)MA00.023aMA00.02385257D39006E79458525847100594308Inpatient Hospital ReadmissionInpatient Hospital Readmission
85257D39006E794585258514005A66E5.aspx
  
64Instrument-Based Vision ScreeningMedicine (07)MA07.048aMA07.04885257D39006E794585258514005A66E5Instrument-Based Vision ScreeningInstrument-Based Vision Screening
85257D39006E79458525847100593A59.aspx
  
26Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other SubstancesAdministrative (00)MA00.022MA00.02285257D39006E79458525847100593A59Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other SubstancesIntravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances
85257D39006E79458525841E0056253E.aspx
  
67Low Osmolar Contrast AgentsRadiology (09)MA09.008aMA09.00885257D39006E79458525841E0056253ELow Osmolar Contrast AgentsLow Osmolar Contrast Agents
85257D39006E79458525841E00562B1A.aspx
  
69Magnetic Resonance Imaging (MRI) Contrast AgentsRadiology (09)MA09.010bMA09.01085257D39006E79458525841E00562B1AMagnetic Resonance Imaging (MRI) Contrast AgentsMagnetic Resonance Imaging (MRI) Contrast Agents
85257D39006E79458525840000486245.aspx
  
55Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative PeriodClinical Logic (03)MA03.009dMA03.00985257D39006E79458525840000486245Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative PeriodModifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
85257D39006E7945852584D6004E86B3.aspx
  
49Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other ServiceClinical Logic (03)MA03.003gMA03.00385257D39006E7945852584D6004E86B3Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other ServiceModifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
{"1781":{"Id":1781,"MPAttachmentLetter":"A","Title":"E&M codes appended with modifier 25 should be reimbursed at 50 percent of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure.","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584D6004E86CB"},"1782":{"Id":1782,"MPAttachmentLetter":"B","Title":"Problem-focused E&M codes appended with modifier 25 should be reimbursed at 50 percent of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a preven","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584D6004E86DC"},}
85257D39006E7945852585960050D150.aspx
  
48Modifier 50: Bilateral ProcedureClinical Logic (03)MA03.002eMA03.00285257D39006E7945852585960050D150Modifier 50: Bilateral ProcedureModifier 50: Bilateral Procedure
85257D39006E7945852583F900649418.aspx
  
59Modifier 52  Reduced ServicesClinical Logic (03)MA03.014aMA03.01485257D39006E7945852583F900649418Modifier 52  Reduced ServicesModifier 52 Reduced Services
85257D39006E7945852583CF0048AD21.aspx
  
61Modifier 53 Discontinued ProcedureMA03.018aMA03.01885257D39006E7945852583CF0048AD21Modifier 53 Discontinued ProcedureModifier 53 Discontinued Procedure
85257D39006E7945852583F90064A3CF.aspx
  
56Modifier 57  Decision for SurgeryClinical Logic (03)MA03.010dMA03.01085257D39006E7945852583F90064A3CFModifier 57  Decision for SurgeryModifier 57 Decision for Surgery
85257D39006E7945852585960050DA8A.aspx
  
17Modifier 62: Two SurgeonsAdministrative (00)MA00.011fMA00.01185257D39006E7945852585960050DA8AModifier 62: Two SurgeonsModifier 62: Two Surgeons
85257D39006E7945852585960050C9EB.aspx
  
20Modifier 66: Surgical TeamMA00.014eMA00.01485257D39006E7945852585960050C9EBModifier 66: Surgical TeamModifier 66: Surgical Team
{"1856":{"Id":1856,"MPAttachmentLetter":"A","Title":"Team Surgery Review Form","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585960050C9F2"},"1857":{"Id":1857,"MPAttachmentLetter":"B","Title":"Eligible Indicators 1 and 2 Procedure Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852585960050C9FA"},}
85257D39006E7945852584790052FFAE.aspx
  
47Modifier 76: Repeat Procedure or Service by Same Physican or Qualified Health Professionalma03.001ama03.00185257D39006E7945852584790052FFAEModifier 76: Repeat Procedure or Service by Same Physican or Qualified Health ProfessionalModifier 76: Repeat Procedure or Service by Same Physican or Qualified Health Professional
85257D39006E79458525847E0061CB14.aspx
  
53Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care ProfessionalMA03.007aMA03.00785257D39006E79458525847E0061CB14Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care ProfessionalModifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional
85257D39006E79458525848F0042DBA7.aspx
  
54Modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative PeriodClinical Logic (03)MA03.008bMA03.00885257D39006E79458525848F0042DBA7Modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative PeriodModifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period
85257D39006E79458525848F0042E3A5.aspx
  
58Modifier 79  Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative PeriodClinical Logic (03)MA03.012cMA03.01285257D39006E79458525848F0042E3A5Modifier 79  Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative PeriodModifier 79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
85257D39006E79458525854B00567D32.aspx
  
57Modifiers 26 (Professional Component) and TC (Technical Component)Clinical Logic (03)MA03.011eMA03.01185257D39006E79458525854B00567D32Modifiers 26 (Professional Component) and TC (Technical Component)Modifiers 26 (Professional Component) and TC (Technical Component)
85257D39006E7945852584E400525A38.aspx
  
23Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASAdministrative (00)MA00.015dMA00.01585257D39006E7945852584E400525A38Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
85257D39006E79458525848F0042EE64.aspx
  
60Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)Clinical Logic (03)MA03.017bMA03.01785257D39006E79458525848F0042EE64Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)
85257D39006E794585258489006077DA.aspx
  
52Modifiers XE, XS, XP, XU, and 59Clinical Logic (03)MA03.005bMA03.00585257D39006E794585258489006077DAModifiers XE, XS, XP, XU, and 59Modifiers XE, XS, XP, XU, and 59
85257D39006E79458525848900607139.aspx
  
43Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic ServicesAnesthesia (01)MA01.005dMA01.00585257D39006E79458525848900607139Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic ServicesMultiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services
{"1766":{"Id":1766,"MPAttachmentLetter":"A","Title":"Multiple Reduction Diagnostic Services","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E79458525848900607170"},}
A5AD9538B36B0D9A85258466004509F0.aspx
  
41Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy ServicesMA00.050MA00.050A5AD9538B36B0D9A85258466004509F0Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy ServicesMultiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services
{"1713":{"Id":1713,"MPAttachmentLetter":"A","Title":"Multiple Reduction Always Therapy Procedure Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"E08B4F6D7B0E162785258466004509FB"},}
8B06FE21A3E2306B8525853B006E4424.aspx
  
70Multiple Surgery Payment ReductionSurgery (11)MA11.032fMA11.0328B06FE21A3E2306B8525853B006E4424Multiple Surgery Payment ReductionMultiple Surgery Payment Reduction
{"1790":{"Id":1790,"MPAttachmentLetter":"B","Title":"HCPCS Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"A280D3FC17E8523E8525853B006E4430"},"1791":{"Id":1791,"MPAttachmentLetter":"A2","Title":"CPT Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"02D44CD5CEC9DE558525853B006E4441"},"1792":{"Id":1792,"MPAttachmentLetter":"A1","Title":"CPT Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"54C6A14C5BD5FFDE8525853B006E445F"},}
85257D39006E79458525841D004A822C.aspx
  
37National Correct Coding Initiative (NCCI) Code Pair EditsAdministrative (00)MA00.041MA00.04185257D39006E79458525841D004A822CNational Correct Coding Initiative (NCCI) Code Pair EditsNational Correct Coding Initiative (NCCI) Code Pair Edits
4A9E6A730665DE088525856C007555A7.aspx
  
76PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesAdministrative (00)MA00.010zMA00.0104A9E6A730665DE088525856C007555A7PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
{"1807":{"Id":1807,"MPAttachmentLetter":"A1","Title":"DME Network Rules and Limited Circumstances","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"C9E7B42FACFFDAD88525856C007555B5"},"1808":{"Id":1808,"MPAttachmentLetter":"A2","Title":"DME Network Rules and Limited Circumstances cont'd.","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"1CF7BA47D2890E028525856C007555C5"},"1809":{"Id":1809,"MPAttachmentLetter":"A3","Title":"DME Network Rules and Limited Circumstances","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"0E50650DDCFAB1D98525856C007555CE"},"1810":{"Id":1810,"MPAttachmentLetter":"B1","Title":"Laboratory Network Rules and Limited Circumstances","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"624A8282E1C55A848525856C007555D6"},"1811":{"Id":1811,"MPAttachmentLetter":"B2","Title":"Laboratory Network Rules and Limited Circumstances","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"A34766299D1E505D8525856C007555E1"},"1812":{"Id":1812,"MPAttachmentLetter":"B3","Title":"Laboratory Network Rules and Limited Circumstances cont'd.","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"4D7AC97A31EAB9C08525856C007555EA"},"1813":{"Id":1813,"MPAttachmentLetter":"C1","Title":"Radiology Network Rules and Limited Circumstances","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"0CF09ECE4B1A6E098525856C007555F2"},"1814":{"Id":1814,"MPAttachmentLetter":"C2","Title":"No Title","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"FFF32834F8657B178525856C007555FA"},"1815":{"Id":1815,"MPAttachmentLetter":"D","Title":"Physical Medicine & Rehabilitation Network Rules and Limited Circumstances","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"80378E0E69E228118525856C00755602"},}
85257D39006E794585258489006085D0.aspx
  
24Radiologic Guidance of a ProcedureAdministrative (00)MA00.019fMA00.01985257D39006E794585258489006085D0Radiologic Guidance of a ProcedureRadiologic Guidance of a Procedure
{"1777":{"Id":1777,"MPAttachmentLetter":"A","Title":"Radiologic Guidance and Supervision and Interpretation Procedure Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E794585258489006085D7"},}
67705FDEC08C535F852585880062ACA2.aspx
  
45Reimbursement for Components of Comprehensive Laboratory PanelsMA01.006aMA01.00667705FDEC08C535F852585880062ACA2Reimbursement for Components of Comprehensive Laboratory PanelsReimbursement for Components of Comprehensive Laboratory Panels
{"1827":{"Id":1827,"MPAttachmentLetter":"A","Title":"CPT Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"EEF7B1B6F23D48E8852585880062ACAF"},}
85257D39006E79458525847100594AEC.aspx
  
68Reimbursement for Radiopharmaceutical Agents for Professional ProvidersRadiology (09)MA09.009jMA09.00985257D39006E79458525847100594AECReimbursement for Radiopharmaceutical Agents for Professional ProvidersReimbursement for Radiopharmaceutical Agents for Professional Providers
85257D39006E794585257DE00073FD8C.aspx
  
63Reimbursement for the Administration of ImmunizationsMedicine (07)MA07.019aMA07.01985257D39006E794585257DE00073FD8CReimbursement for the Administration of ImmunizationsReimbursement for the Administration of Immunizations
0E615B4A9F37B7F28525855100613D7B.aspx
  
75Reporting and Documentation Requirements for Anesthesia ServicesMA00.009gMA00.0090E615B4A9F37B7F28525855100613D7BReporting and Documentation Requirements for Anesthesia ServicesReporting and Documentation Requirements for Anesthesia Services
85257D39006E7945852582F000467D68.aspx
  
28Reporting Requirements for Drugs and BiologicsAdministrative (00)MA00.024bMA00.02485257D39006E7945852582F000467D68Reporting Requirements for Drugs and BiologicsReporting Requirements for Drugs and Biologics
85257D39006E79458525846B006CB7EC.aspx
  
74Use of a Robotic-Assisted Surgical Systemma11.057ama11.05785257D39006E79458525846B006CB7ECUse of a Robotic-Assisted Surgical SystemUse of a Robotic-Assisted Surgical System
DBB10BFAEBC9F3C385258275004FF8A6.aspx
  
31X-rays Associated with Fractures in the Office SettingAdministrative (00)MA00.031dMA00.031DBB10BFAEBC9F3C385258275004FF8A6X-rays Associated with Fractures in the Office SettingX-rays Associated with Fractures in the Office Setting
{"1683":{"Id":1683,"MPAttachmentLetter":"A","Title":"Codes eligible for reimbursement when billed by Hand Surgeons, Orthopedic Surgeons, or Sports Medicine Specialists","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"16177F583FC4A41685258275004FF972"},"1684":{"Id":1684,"MPAttachmentLetter":"B","Title":"Codes eligible for reimbursement when billed by Podiatrists","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"614E1F051BE33B0085258275004FFA3C"},}