A0000–A9999: Transportation Services, Including Ambulance Medical and Surgical Supplies

HCPC SEQNUM RECID LONG DESCRIPTION SHORT DESCRIPTION
A0021 0010 3 Ambulance service, outside state per mile, transport (medicaid only) Outside state ambulance serv
A0080 0010 3 Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest Noninterest escort in non er
A0090 0010 3 Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest Interest escort in non er
A0100 0010 3 Non-emergency transportation; taxi Nonemergency transport taxi
A0110 0010 3 Non-emergency transportation and bus, intra or inter state carrier Nonemergency transport bus
A0120 0010 3 Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems Noner transport mini-bus
A0130 0010 3 Non-emergency transportation: wheelchair van Noner transport wheelch van
A0140 0010 3 Non-emergency transportation and air travel (private or commercial) intra or inter state Nonemergency transport air
A0160 0010 3 Non-emergency transportation: per mile - case worker or social worker Noner transport case worker
A0170 0010 3 Transportation ancillary: parking fees, tolls, other Transport parking fees/tolls
A0180 0010 3 Non-emergency transportation: ancillary: lodging-recipient Noner transport lodgng recip
A0190 0010 3 Non-emergency transportation: ancillary: meals-recipient Noner transport meals recip
A0200 0010 3 Non-emergency transportation: ancillary: lodging escort Noner transport lodgng escrt
A0210 0010 3 Non-emergency transportation: ancillary: meals-escort Noner transport meals escort
A0225 0010 3 Ambulance service, neonatal transport, base rate, emergency transport, one way Neonatal emergency transport
A0380 0010 3 Bls mileage (per mile) Basic life support mileage
A0382 0010 3 Bls routine disposable supplies Basic support routine suppls
A0384 0010 3 Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances) Bls defibrillation supplies
A0390 0010 3 Als mileage (per mile) Advanced life support mileag
A0392 0010 3 Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances) Als defibrillation supplies
A0394 0010 3 Als specialized service disposable supplies; iv drug therapy Als iv drug therapy supplies
A0396 0010 3 Als specialized service disposable supplies; esophageal intubation Als esophageal intub suppls
A0398 0010 3 Als routine disposable supplies Als routine disposble suppls
A0420 0010 3 Ambulance waiting time (als or bls), one half (1/2) hour increments Ambulance waiting 1/2 hr
A0422 0010 3 Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation Ambulance 02 life sustaining
A0424 0010 3 Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review) Extra ambulance attendant
A0425 0010 3 Ground mileage, per statute mile Ground mileage
A0426 0010 3 Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) Als 1
A0427 0010 3 Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) Als1-emergency
A0428 0010 3 Ambulance service, basic life support, non-emergency transport, (bls) Bls
A0429 0010 3 Ambulance service, basic life support, emergency transport (bls-emergency) Bls-emergency
A0430 0010 3 Ambulance service, conventional air services, transport, one way (fixed wing) Fixed wing air transport
A0431 0010 3 Ambulance service, conventional air services, transport, one way (rotary wing) Rotary wing air transport
A0432 0010 3 Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers Pi volunteer ambulance co
A0433 0010 3 Advanced life support, level 2 (als 2) Als 2
A0434 0010 3 Specialty care transport (sct) Specialty care transport
A0435 0010 3 Fixed wing air mileage, per statute mile Fixed wing air mileage
A0436 0010 3 Rotary wing air mileage, per statute mile Rotary wing air mileage
A0888 0010 3 Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) Noncovered ambulance mileage
A0998 0010 3 Ambulance response and treatment, no transport Ambulance response/treatment
A0999 0010 3 Unlisted ambulance service Unlisted ambulance service
A4206 0010 3 Syringe with needle, sterile, 1 cc or less, each 1 cc sterile syringe&needle
A4207 0010 3 Syringe with needle, sterile 2 cc, each 2 cc sterile syringe&needle
A4208 0010 3 Syringe with needle, sterile 3 cc, each 3 cc sterile syringe&needle
A4209 0010 3 Syringe with needle, sterile 5 cc or greater, each 5+ cc sterile syringe&needle
A4210 0010 3 Needle-free injection device, each Nonneedle injection device
A4211 0010 3 Supplies for self-administered injections Supp for self-adm injections
A4212 0010 3 Non-coring needle or stylet with or without catheter Non coring needle or stylet
A4213 0010 3 Syringe, sterile, 20 cc or greater, each 20+ cc syringe only
A4215 0010 3 Needle, sterile, any size, each Sterile needle
A4216 0010 3 Sterile water, saline and/or dextrose, diluent/flush, 10 ml Sterile water/saline, 10 ml
A4217 0010 3 Sterile water/saline, 500 ml Sterile water/saline, 500 ml
A4218 0010 3 Sterile saline or water, metered dose dispenser, 10 ml Sterile saline or water
A4220 0010 3 Refill kit for implantable infusion pump Infusion pump refill kit
A4221 0010 3 Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) Supp non-insulin inf cath/wk
A4222 0010 3 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) Infusion supplies with pump
A4223 0010 3 Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) Infusion supplies w/o pump
A4224 0010 3 Supplies for maintenance of insulin infusion catheter, per week Supply insulin inf cath/wk
A4225 0010 3 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each Sup/ext insulin inf pump syr
A4226 0010 3 Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week Weekly supply maint cgs pump
A4230 0010 3 Infusion set for external insulin pump, non needle cannula type Infus insulin pump non needl
A4231 0010 3 Infusion set for external insulin pump, needle type Infusion insulin pump needle
A4232 0010 3 Syringe with needle for external insulin pump, sterile, 3 cc Syringe w/needle insulin 3cc
A4233 0010 3 Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each Alkalin batt for glucose mon
A4234 0010 3 Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each J-cell batt for glucose mon
A4235 0010 3 Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each Lithium batt for glucose mon
A4236 0010 3 Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each Silvr oxide batt glucose mon
A4244 0010 3 Alcohol or peroxide, per pint Alcohol or peroxide per pint
A4245 0010 3 Alcohol wipes, per box Alcohol wipes per box
A4246 0010 3 Betadine or phisohex solution, per pint Betadine/phisohex solution
A4247 0010 3 Betadine or iodine swabs/wipes, per box Betadine/iodine swabs/wipes
A4248 0010 3 Chlorhexidine containing antiseptic, 1 ml Chlorhexidine antisept
A4250 0010 3 Urine test or reagent strips or tablets (100 tablets or strips) Urine reagent strips/tablets
A4252 0010 3 Blood ketone test or reagent strip, each Blood ketone test or strip
A4253 0010 3 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips Blood glucose/reagent strips
A4255 0010 3 Platforms for home blood glucose monitor, 50 per box Glucose monitor platforms
A4256 0010 3 Normal, low and high calibrator solution / chips Calibrator solution/chips
A4257 0010 3 Replacement lens shield cartridge for use with laser skin piercing device, each Replace lensshield cartridge
A4258 0010 3 Spring-powered device for lancet, each Lancet device each
A4259 0010 3 Lancets, per box of 100 Lancets per box
A4261 0010 3 Cervical cap for contraceptive use Cervical cap contraceptive
A4262 0010 3 Temporary, absorbable lacrimal duct implant, each Temporary tear duct plug
A4263 0010 3 Permanent, long term, non-dissolvable lacrimal duct implant, each Permanent tear duct plug
A4264 0010 3 Permanent implantable contraceptive intratubal occlusion device(s) and delivery system Intratubal occlusion device
A4265 0010 3 Paraffin, per pound Paraffin
A4266 0010 3 Diaphragm for contraceptive use Diaphragm
A4267 0010 3 Contraceptive supply, condom, male, each Male condom
A4268 0010 3 Contraceptive supply, condom, female, each Female condom
A4269 0010 3 Contraceptive supply, spermicide (e.g., foam, gel), each Spermicide
A4270 0010 3 Disposable endoscope sheath, each Disposable endoscope sheath
A4280 0010 3 Adhesive skin support attachment for use with external breast prosthesis, each Brst prsths adhsv attchmnt
A4281 0010 3 Tubing for breast pump, replacement Replacement breastpump tube
A4282 0010 3 Adapter for breast pump, replacement Replacement breastpump adpt
A4283 0010 3 Cap for breast pump bottle, replacement Replacement breastpump cap
A4284 0010 3 Breast shield and splash protector for use with breast pump, replacement Replcmnt breast pump shield
A4285 0010 3 Polycarbonate bottle for use with breast pump, replacement Replcmnt breast pump bottle
A4286 0010 3 Locking ring for breast pump, replacement Replcmnt breastpump lok ring
A4290 0010 3 Sacral nerve stimulation test lead, each Sacral nerve stim test lead
A4300 0010 3 Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access Cath impl vasc access portal
A4301 0010 3 Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) Implantable access syst perc
A4305 0010 3 Disposable drug delivery system, flow rate of 50 ml or greater per hour Drug delivery system >=50 ml
A4306 0010 3 Disposable drug delivery system, flow rate of less than 50 ml per hour Drug delivery system <=50 ml
A4310 0010 3 Insertion tray without drainage bag and without catheter (accessories only) Insert tray w/o bag/cath
A4311 0010 3 Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) Catheter w/o bag 2-way latex
A4312 0010 3 Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone Cath w/o bag 2-way silicone
A4313 0010 3 Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation Catheter w/bag 3-way
A4314 0010 3 Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) Cath w/drainage 2-way latex
A4315 0010 3 Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone Cath w/drainage 2-way silcne
A4316 0010 3 Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation Cath w/drainage 3-way
A4320 0010 3 Irrigation tray with bulb or piston syringe, any purpose Irrigation tray
A4321 0010 3 Therapeutic agent for urinary catheter irrigation Cath therapeutic irrig agent
A4322 0010 3 Irrigation syringe, bulb or piston, each Irrigation syringe
A4326 0010 3 Male external catheter with integral collection chamber, any type, each Male external catheter
A4327 0010 3 Female external urinary collection device; meatal cup, each Fem urinary collect dev cup
A4328 0010 3 Female external urinary collection device; pouch, each Fem urinary collect pouch
A4330 0010 3 Perianal fecal collection pouch with adhesive, each Stool collection pouch
A4331 0010 3 Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each Extension drainage tubing
A4332 0010 3 Lubricant, individual sterile packet, each Lube sterile packet
A4333 0010 3 Urinary catheter anchoring device, adhesive skin attachment, each Urinary cath anchor device
A4334 0010 3 Urinary catheter anchoring device, leg strap, each Urinary cath leg strap
A4335 0010 3 Incontinence supply; miscellaneous Incontinence supply
A4336 0010 3 Incontinence supply, urethral insert, any type, each Urethral insert
A4337 0010 3 Incontinence supply, rectal insert, any type, each Incontinent rectal insert
A4338 0010 3 Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each Indwelling catheter latex
A4340 0010 3 Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each Indwelling catheter special
A4344 0010 3 Indwelling catheter, foley type, two-way, all silicone, each Cath indw foley 2 way silicn
A4346 0010 3 Indwelling catheter; foley type, three way for continuous irrigation, each Cath indw foley 3 way
A4349 0010 3 Male external catheter, with or without adhesive, disposable, each Disposable male external cat
A4351 0010 3 Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each Straight tip urine catheter
A4352 0010 3 Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each Coude tip urinary catheter
A4353 0010 3 Intermittent urinary catheter, with insertion supplies Intermittent urinary cath
A4354 0010 3 Insertion tray with drainage bag but without catheter Cath insertion tray w/bag
A4355 0010 3 Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each Bladder irrigation tubing
A4356 0010 3 External urethral clamp or compression device (not to be used for catheter clamp), each Ext ureth clmp or compr dvc
A4357 0010 3 Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each Bedside drainage bag
A4358 0010 3 Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each Urinary leg or abdomen bag
A4360 0010 3 Disposable external urethral clamp or compression device, with pad and/or pouch, each Disposable ext urethral dev
A4361 0010 3 Ostomy faceplate, each Ostomy face plate
A4362 0010 3 Skin barrier; solid, 4 x 4 or equivalent; each Solid skin barrier
A4363 0010 3 Ostomy clamp, any type, replacement only, each Ostomy clamp, replacement
A4364 0010 3 Adhesive, liquid or equal, any type, per oz Adhesive, liquid or equal
A4366 0010 3 Ostomy vent, any type, each Ostomy vent
A4367 0010 3 Ostomy belt, each Ostomy belt
A4368 0010 3 Ostomy filter, any type, each Ostomy filter
A4369 0010 3 Ostomy skin barrier, liquid (spray, brush, etc.), per oz Skin barrier liquid per oz
A4371 0010 3 Ostomy skin barrier, powder, per oz Skin barrier powder per oz
A4372 0010 3 Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each Skin barrier solid 4x4 equiv
A4373 0010 3 Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each Skin barrier with flange
A4375 0010 3 Ostomy pouch, drainable, with faceplate attached, plastic, each Drainable plastic pch w fcpl
A4376 0010 3 Ostomy pouch, drainable, with faceplate attached, rubber, each Drainable rubber pch w fcplt
A4377 0010 3 Ostomy pouch, drainable, for use on faceplate, plastic, each Drainable plstic pch w/o fp
A4378 0010 3 Ostomy pouch, drainable, for use on faceplate, rubber, each Drainable rubber pch w/o fp
A4379 0010 3 Ostomy pouch, urinary, with faceplate attached, plastic, each Urinary plastic pouch w fcpl
A4380 0010 3 Ostomy pouch, urinary, with faceplate attached, rubber, each Urinary rubber pouch w fcplt
A4381 0010 3 Ostomy pouch, urinary, for use on faceplate, plastic, each Urinary plastic pouch w/o fp
A4382 0010 3 Ostomy pouch, urinary, for use on faceplate, heavy plastic, each Urinary hvy plstc pch w/o fp
A4383 0010 3 Ostomy pouch, urinary, for use on faceplate, rubber, each Urinary rubber pouch w/o fp
A4384 0010 3 Ostomy faceplate equivalent, silicone ring, each Ostomy faceplt/silicone ring
A4385 0010 3 Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each Ost skn barrier sld ext wear
A4387 0010 3 Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each Ost clsd pouch w att st barr
A4388 0010 3 Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each Drainable pch w ex wear barr
A4389 0010 3 Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each Drainable pch w st wear barr
A4390 0010 3 Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each Drainable pch ex wear convex
A4391 0010 3 Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each Urinary pouch w ex wear barr
A4392 0010 3 Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each Urinary pouch w st wear barr
A4393 0010 3 Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each Urine pch w ex wear bar conv
A4394 0010 3 Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce Ostomy pouch liq deodorant
A4395 0010 3 Ostomy deodorant for use in ostomy pouch, solid, per tablet Ostomy pouch solid deodorant
A4396 0010 3 Ostomy belt with peristomal hernia support Peristomal hernia supprt blt
A4397 0010 3 Irrigation supply; sleeve, each Irrigation supply sleeve
A4398 0010 3 Ostomy irrigation supply; bag, each Ostomy irrigation bag
A4399 0010 3 Ostomy irrigation supply; cone/catheter, with or without brush Ostomy irrig cone/cath w brs
A4400 0010 3 Ostomy irrigation set Ostomy irrigation set
A4402 0010 3 Lubricant, per ounce Lubricant per ounce
A4404 0010 3 Ostomy ring, each Ostomy ring each
A4405 0010 3 Ostomy skin barrier, non-pectin based, paste, per ounce Nonpectin based ostomy paste
A4406 0010 3 Ostomy skin barrier, pectin-based, paste, per ounce Pectin based ostomy paste
A4407 0010 3 Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each Ext wear ost skn barr <=4sq”
A4408 0010 3 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each Ext wear ost skn barr >4sq”
A4409 0010 3 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each Ost skn barr convex <=4 sq i
A4410 0010 3 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each Ost skn barr extnd >4 sq
A4411 0010 3 Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each Ost skn barr extnd =4sq
A4412 0010 3 Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each Ost pouch drain high output
A4413 0010 3 Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each 2 pc drainable ost pouch
A4414 0010 3 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each Ost sknbar w/o conv<=4 sq in
A4415 0010 3 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each Ost skn barr w/o conv >4 sqi
A4416 0010 3 Ostomy pouch, closed, with barrier attached, with filter (1 piece), each Ost pch clsd w barrier/filtr
A4417 0010 3 Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each Ost pch w bar/bltinconv/fltr
A4418 0010 3 Ostomy pouch, closed; without barrier attached, with filter (1 piece), each Ost pch clsd w/o bar w filtr
A4419 0010 3 Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each Ost pch for bar w flange/flt
A4420 0010 3 Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each Ost pch clsd for bar w lk fl
A4421 0010 3 Ostomy supply; miscellaneous Ostomy supply misc
A4422 0010 3 Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each Ost pouch absorbent material
A4423 0010 3 Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each Ost pch for bar w lk fl/fltr
A4424 0010 3 Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each Ost pch drain w bar & filter
A4425 0010 3 Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each Ost pch drain for barrier fl
A4426 0010 3 Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each Ost pch drain 2 piece system
A4427 0010 3 Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each Ost pch drain/barr lk flng/f
A4428 0010 3 Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each Urine ost pouch w faucet/tap
A4429 0010 3 Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each Urine ost pouch w bltinconv
A4430 0010 3 Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each Ost urine pch w b/bltin conv
A4431 0010 3 Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each Ost pch urine w barrier/tapv
A4432 0010 3 Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each Os pch urine w bar/fange/tap
A4433 0010 3 Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each Urine ost pch bar w lock fln
A4434 0010 3 Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each Ost pch urine w lock flng/ft
A4435 0010 3 Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each 1pc ost pch drain hgh output
A4450 0010 3 Tape, non-waterproof, per 18 square inches Non-waterproof tape
A4452 0010 3 Tape, waterproof, per 18 square inches Waterproof tape
A4455 0010 3 Adhesive remover or solvent (for tape, cement or other adhesive), per ounce Adhesive remover per ounce
A4456 0010 3 Adhesive remover, wipes, any type, each Adhesive remover, wipes
A4458 0010 3 Enema bag with tubing, reusable Reusable enema bag
A4459 0010 3 Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type Manual pump enema, reusable
A4461 0010 3 Surgical dressing holder, non-reusable, each Surgicl dress hold non-reuse
A4463 0010 3 Surgical dressing holder, reusable, each Surgical dress holder reuse
A4465 0010 3 Non-elastic binder for extremity Non-elastic extremity binder
A4466 0010 3 Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each Elastic garment/covering
A4467 0010 3 Belt, strap, sleeve, garment, or covering, any type Belt strap sleev grmnt cover
A4470 0010 3 Gravlee jet washer Gravlee jet washer
A4480 0010 3 Vabra aspirator Vabra aspirator
A4481 0010 3 Tracheostoma filter, any type, any size, each Tracheostoma filter
A4483 0010 3 Moisture exchanger, disposable, for use with invasive mechanical ventilation Moisture exchanger
A4490 0010 3 Surgical stockings above knee length, each Above knee surgical stocking
A4495 0010 3 Surgical stockings thigh length, each Thigh length surg stocking
A4500 0010 3 Surgical stockings below knee length, each Below knee surgical stocking
A4510 0010 3 Surgical stockings full length, each Full length surg stocking
A4520 0010 3 Incontinence garment, any type, (e.g., brief, diaper), each Incontinence garment anytype
A4550 0010 3 Surgical trays Surgical trays
A4553 0010 3 Non-disposable underpads, all sizes Nondisp underpads, all sizes
A4554 0010 3 Disposable underpads, all sizes Disposable underpads
A4555 0010 3 Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only Ca tx e-stim electr/transduc
A4556 0010 3 Electrodes, (e.g., apnea monitor), per pair Electrodes, pair
A4557 0010 3 Lead wires, (e.g., apnea monitor), per pair Lead wires, pair
A4558 0010 3 Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz Conductive gel or paste
A4559 0010 3 Coupling gel or paste, for use with ultrasound device, per oz Coupling gel or paste
A4561 0010 3 Pessary, rubber, any type Pessary rubber, any type
A4562 0010 3 Pessary, non rubber, any type Pessary, non rubber,any type
A4563 0010 3 Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each Vag inser rectal control sys
A4565 0010 3 Slings Slings
A4566 0010 3 Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment Should sling/vest/abrestrain
A4570 0010 3 Splint Splint
A4575 0010 3 Topical hyperbaric oxygen chamber, disposable Hyperbaric o2 chamber disps
A4580 0010 3 Cast supplies (e.g., plaster) Cast supplies (plaster)
A4590 0010 3 Special casting material (e.g., fiberglass) Special casting material
A4595 0010 3 Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) Tens suppl 2 lead per month
A4600 0010 3 Sleeve for intermittent limb compression device, replacement only, each Sleeve, inter limb comp dev
A4601 0010 3 Lithium ion battery, rechargeable, for non-prosthetic use, replacement Lith ion non prosth recharge
A4602 0010 3 Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each Replace lithium battery 1.5v
A4604 0010 3 Tubing with integrated heating element for use with positive airway pressure device Tubing with heating element
A4605 0010 3 Tracheal suction catheter, closed system, each Trach suction cath close sys
A4606 0010 3 Oxygen probe for use with oximeter device, replacement Oxygen probe used w oximeter
A4608 0010 3 Transtracheal oxygen catheter, each Transtracheal oxygen cath
A4611 0010 3 Battery, heavy duty; replacement for patient owned ventilator Heavy duty battery
A4612 0010 3 Battery cables; replacement for patient-owned ventilator Battery cables
A4613 0010 3 Battery charger; replacement for patient-owned ventilator Battery charger
A4614 0010 3 Peak expiratory flow rate meter, hand held Hand-held pefr meter
A4615 0010 3 Cannula, nasal Cannula nasal
A4616 0010 3 Tubing (oxygen), per foot Tubing (oxygen) per foot
A4617 0010 3 Mouth piece Mouth piece
A4618 0010 3 Breathing circuits Breathing circuits
A4619 0010 3 Face tent Face tent
A4620 0010 3 Variable concentration mask Variable concentration mask
A4623 0010 3 Tracheostomy, inner cannula Tracheostomy inner cannula
A4624 0010 3 Tracheal suction catheter, any type other than closed system, each Tracheal suction tube
A4625 0010 3 Tracheostomy care kit for new tracheostomy Trach care kit for new trach
A4626 0010 3 Tracheostomy cleaning brush, each Tracheostomy cleaning brush
A4627 0010 3 Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler Spacer bag/reservoir
A4628 0010 3 Oropharyngeal suction catheter, each Oropharyngeal suction cath
A4629 0010 3 Tracheostomy care kit for established tracheostomy Tracheostomy care kit
A4630 0010 3 Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient Repl bat t.e.n.s. own by pt
A4633 0010 3 Replacement bulb/lamp for ultraviolet light therapy system, each Uvl replacement bulb
A4634 0010 3 Replacement bulb for therapeutic light box, tabletop model Replacement bulb th lightbox
A4635 0010 3 Underarm pad, crutch, replacement, each Underarm crutch pad
A4636 0010 3 Replacement, handgrip, cane, crutch, or walker, each Handgrip for cane etc
A4637 0010 3 Replacement, tip, cane, crutch, walker, each. Repl tip cane/crutch/walker
A4638 0010 3 Replacement battery for patient-owned ear pulse generator, each Repl batt pulse gen sys
A4639 0010 3 Replacement pad for infrared heating pad system, each Infrared ht sys replcmnt pad
A4640 0010 3 Replacement pad for use with medically necessary alternating pressure pad owned by patient Alternating pressure pad
A4641 0010 3 Radiopharmaceutical, diagnostic, not otherwise classified Radiopharm dx agent noc
A4642 0010 3 Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries In111 satumomab
A4648 0010 3 Tissue marker, implantable, any type, each Implantable tissue marker
A4649 0010 3 Surgical supply; miscellaneous Surgical supplies
A4650 0010 3 Implantable radiation dosimeter, each Implant radiation dosimeter
A4651 0010 3 Calibrated microcapillary tube, each Calibrated microcap tube
A4652 0010 3 Microcapillary tube sealant Microcapillary tube sealant
A4653 0010 3 Peritoneal dialysis catheter anchoring device, belt, each Pd catheter anchor belt
A4657 0010 3 Syringe, with or without needle, each Syringe w/wo needle
A4660 0010 3 Sphygmomanometer/blood pressure apparatus with cuff and stethoscope Sphyg/bp app w cuff and stet
A4663 0010 3 Blood pressure cuff only Dialysis blood pressure cuff
A4670 0010 3 Automatic blood pressure monitor Automatic bp monitor, dial
A4671 0010 3 Disposable cycler set used with cycler dialysis machine, each Disposable cycler set
A4672 0010 3 Drainage extension line, sterile, for dialysis, each Drainage ext line, dialysis
A4673 0010 3 Extension line with easy lock connectors, used with dialysis Ext line w easy lock connect
A4674 0010 3 Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz Chem/antisept solution, 8oz
A4680 0010 3 Activated carbon filter for hemodialysis, each Activated carbon filter, ea
A4690 0010 3 Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each Dialyzer, each
A4706 0010 3 Bicarbonate concentrate, solution, for hemodialysis, per gallon Bicarbonate conc sol per gal
A4707 0010 3 Bicarbonate concentrate, powder, for hemodialysis, per packet Bicarbonate conc pow per pac
A4708 0010 3 Acetate concentrate solution, for hemodialysis, per gallon Acetate conc sol per gallon
A4709 0010 3 Acid concentrate, solution, for hemodialysis, per gallon Acid conc sol per gallon
A4714 0010 3 Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon Treated water per gallon
A4719 0010 3 “y set” tubing for peritoneal dialysis “y set” tubing
A4720 0010 3 Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis Dialysat sol fld vol > 249cc
A4721 0010 3 Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis Dialysat sol fld vol > 999cc
A4722 0010 3 Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis Dialys sol fld vol > 1999cc
A4723 0010 3 Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis Dialys sol fld vol > 2999cc
A4724 0010 3 Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis Dialys sol fld vol > 3999cc
A4725 0010 3 Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis Dialys sol fld vol > 4999cc
A4726 0010 3 Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis Dialys sol fld vol > 5999cc
A4728 0010 3 Dialysate solution, non-dextrose containing, 500 ml Dialysate solution, non-dex
A4730 0010 3 Fistula cannulation set for hemodialysis, each Fistula cannulation set, ea
A4736 0010 3 Topical anesthetic, for dialysis, per gram Topical anesthetic, per gram
A4737 0010 3 Injectable anesthetic, for dialysis, per 10 ml Inj anesthetic per 10 ml
A4740 0010 3 Shunt accessory, for hemodialysis, any type, each Shunt accessory
A4750 0010 3 Blood tubing, arterial or venous, for hemodialysis, each Art or venous blood tubing
A4755 0010 3 Blood tubing, arterial and venous combined, for hemodialysis, each Comb art/venous blood tubing
A4760 0010 3 Dialysate solution test kit, for peritoneal dialysis, any type, each Dialysate sol test kit, each
A4765 0010 3 Dialysate concentrate, powder, additive for peritoneal dialysis, per packet Dialysate conc pow per pack
A4766 0010 3 Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml Dialysate conc sol add 10 ml
A4770 0010 3 Blood collection tube, vacuum, for dialysis, per 50 Blood collection tube/vacuum
A4771 0010 3 Serum clotting time tube, for dialysis, per 50 Serum clotting time tube
A4772 0010 3 Blood glucose test strips, for dialysis, per 50 Blood glucose test strips
A4773 0010 3 Occult blood test strips, for dialysis, per 50 Occult blood test strips
A4774 0010 3 Ammonia test strips, for dialysis, per 50 Ammonia test strips
A4802 0010 3 Protamine sulfate, for hemodialysis, per 50 mg Protamine sulfate per 50 mg
A4860 0010 3 Disposable catheter tips for peritoneal dialysis, per 10 Disposable catheter tips
A4870 0010 3 Plumbing and/or electrical work for home hemodialysis equipment Plumb/elec wk hm hemo equip
A4890 0010 3 Contracts, repair and maintenance, for hemodialysis equipment Repair/maint cont hemo equip
A4911 0010 3 Drain bag/bottle, for dialysis, each Drain bag/bottle
A4913 0010 3 Miscellaneous dialysis supplies, not otherwise specified Misc dialysis supplies noc
A4918 0010 3 Venous pressure clamp, for hemodialysis, each Venous pressure clamp
A4927 0010 3 Gloves, non-sterile, per 100 Non-sterile gloves
A4928 0010 3 Surgical mask, per 20 Surgical mask
A4929 0010 3 Tourniquet for dialysis, each Tourniquet for dialysis, ea
A4930 0010 3 Gloves, sterile, per pair Sterile, gloves per pair
A4931 0010 3 Oral thermometer, reusable, any type, each Reusable oral thermometer
A4932 0010 3 Rectal thermometer, reusable, any type, each Reusable rectal thermometer
A5051 0010 3 Ostomy pouch, closed; with barrier attached (1 piece), each Pouch clsd w barr attached
A5052 0010 3 Ostomy pouch, closed; without barrier attached (1 piece), each Clsd ostomy pouch w/o barr
A5053 0010 3 Ostomy pouch, closed; for use on faceplate, each Clsd ostomy pouch faceplate
A5054 0010 3 Ostomy pouch, closed; for use on barrier with flange (2 piece), each Clsd ostomy pouch w/flange
A5055 0010 3 Stoma cap Stoma cap
A5056 0010 3 Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each 1 pc ost pouch w filter
A5057 0010 3 Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each 1 pc ost pou w built-in conv
A5061 0010 3 Ostomy pouch, drainable; with barrier attached, (1 piece), each Pouch drainable w barrier at
A5062 0010 3 Ostomy pouch, drainable; without barrier attached (1 piece), each Drnble ostomy pouch w/o barr
A5063 0010 3 Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each Drain ostomy pouch w/flange
A5071 0010 3 Ostomy pouch, urinary; with barrier attached (1 piece), each Urinary pouch w/barrier
A5072 0010 3 Ostomy pouch, urinary; without barrier attached (1 piece), each Urinary pouch w/o barrier
A5073 0010 3 Ostomy pouch, urinary; for use on barrier with flange (2 piece), each Urinary pouch on barr w/flng
A5081 0010 3 Stoma plug or seal, any type Stoma plug or seal, any type
A5082 0010 3 Continent device; catheter for continent stoma Continent stoma catheter
A5083 0010 3 Continent device, stoma absorptive cover for continent stoma Stoma absorptive cover
A5093 0010 3 Ostomy accessory; convex insert Ostomy accessory convex inse
A5102 0010 3 Bedside drainage bottle with or without tubing, rigid or expandable, each Bedside drain btl w/wo tube
A5105 0010 3 Urinary suspensory with leg bag, with or without tube, each Urinary suspensory
A5112 0010 3 Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each Urinary leg bag
A5113 0010 3 Leg strap; latex, replacement only, per set Latex leg strap
A5114 0010 3 Leg strap; foam or fabric, replacement only, per set Foam/fabric leg strap
A5120 0010 3 Skin barrier, wipes or swabs, each Skin barrier, wipe or swab
A5121 0010 3 Skin barrier; solid, 6 x 6 or equivalent, each Solid skin barrier 6x6
A5122 0010 3 Skin barrier; solid, 8 x 8 or equivalent, each Solid skin barrier 8x8
A5126 0010 3 Adhesive or non-adhesive; disk or foam pad Disk/foam pad +or- adhesive
A5131 0010 3 Appliance cleaner, incontinence and ostomy appliances, per 16 oz. Appliance cleaner
A5200 0010 3 Percutaneous catheter/tube anchoring device, adhesive skin attachment Percutaneous catheter anchor
A5500 0010 3 For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe Diab shoe for density insert
A5501 0010 3 For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient’s foot (custom molded shoe), per shoe Diabetic custom molded shoe
A5503 0010 3 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe Diabetic shoe w/roller/rockr
A5504 0010 3 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe Diabetic shoe with wedge
A5505 0010 3 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe Diab shoe w/metatarsal bar
A5506 0010 3 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe Diabetic shoe w/off set heel
A5507 0010 3 For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe Modification diabetic shoe
A5508 0010 3 For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe Diabetic deluxe shoe
A5510 0010 3 For diabetics only, direct formed, compression molded to patient’s foot without external heat source, multiple-density insert(s) prefabricated, per shoe Compression form shoe insert
A5512 0010 3 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each Multi den insert direct form
A5513 0010 3 For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each Multi den insert custom mold
A5514 0010 3 For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each Mult den insert dir carv/cam
A6000 0010 3 Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card Wound warming wound cover
A6010 0010 3 Collagen based wound filler, dry form, sterile, per gram of collagen Collagen based wound filler
A6011 0010 3 Collagen based wound filler, gel/paste, per gram of collagen Collagen gel/paste wound fil
A6021 0010 3 Collagen dressing, sterile, size 16 sq. in. or less, each Collagen dressing <=16 sq in
A6022 0010 3 Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each Collagen drsg>16<=48 sq in
A6023 0010 3 Collagen dressing, sterile, size more than 48 sq. in., each Collagen dressing >48 sq in
A6024 0010 3 Collagen dressing wound filler, sterile, per 6 inches Collagen dsg wound filler
A6025 0010 3 Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each Silicone gel sheet, each
A6154 0010 3 Wound pouch, each Wound pouch each
A6196 0010 3 Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing Alginate dressing <=16 sq in
A6197 0010 3 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing Alginate drsg >16 <=48 sq in
A6198 0010 3 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing Alginate dressing > 48 sq in
A6199 0010 3 Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches Alginate drsg wound filler
A6203 0010 3 Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing Composite drsg <= 16 sq in
A6204 0010 3 Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing Composite drsg >16<=48 sq in
A6205 0010 3 Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing Composite drsg > 48 sq in
A6206 0010 3 Contact layer, sterile, 16 sq. in. or less, each dressing Contact layer <= 16 sq in
A6207 0010 3 Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing Contact layer >16<= 48 sq in
A6208 0010 3 Contact layer, sterile, more than 48 sq. in., each dressing Contact layer > 48 sq in
A6209 0010 3 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Foam drsg <=16 sq in w/o bdr
A6210 0010 3 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing Foam drg >16<=48 sq in w/o b
A6211 0010 3 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing Foam drg > 48 sq in w/o brdr
A6212 0010 3 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing Foam drg <=16 sq in w/border
A6213 0010 3 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing Foam drg >16<=48 sq in w/bdr
A6214 0010 3 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing Foam drg > 48 sq in w/border
A6215 0010 3 Foam dressing, wound filler, sterile, per gram Foam dressing wound filler
A6216 0010 3 Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Non-sterile gauze<=16 sq in
A6217 0010 3 Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing Non-sterile gauze>16<=48 sq
A6218 0010 3 Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing Non-sterile gauze > 48 sq in
A6219 0010 3 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing Gauze <= 16 sq in w/border
A6220 0010 3 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing Gauze >16 <=48 sq in w/bordr
A6221 0010 3 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing Gauze > 48 sq in w/border
A6222 0010 3 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Gauze <=16 in no w/sal w/o b
A6223 0010 3 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing Gauze >16<=48 no w/sal w/o b
A6224 0010 3 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing Gauze > 48 in no w/sal w/o b
A6228 0010 3 Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Gauze <= 16 sq in water/sal
A6229 0010 3 Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing Gauze >16<=48 sq in watr/sal
A6230 0010 3 Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing Gauze > 48 sq in water/salne
A6231 0010 3 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing Hydrogel dsg<=16 sq in
A6232 0010 3 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing Hydrogel dsg>16<=48 sq in
A6233 0010 3 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing Hydrogel dressing >48 sq in
A6234 0010 3 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Hydrocolld drg <=16 w/o bdr
A6235 0010 3 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing Hydrocolld drg >16<=48 w/o b
A6236 0010 3 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing Hydrocolld drg > 48 in w/o b
A6237 0010 3 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing Hydrocolld drg <=16 in w/bdr
A6238 0010 3 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing Hydrocolld drg >16<=48 w/bdr
A6239 0010 3 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing Hydrocolld drg > 48 in w/bdr
A6240 0010 3 Hydrocolloid dressing, wound filler, paste, sterile, per ounce Hydrocolld drg filler paste
A6241 0010 3 Hydrocolloid dressing, wound filler, dry form, sterile, per gram Hydrocolloid drg filler dry
A6242 0010 3 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Hydrogel drg <=16 in w/o bdr
A6243 0010 3 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing Hydrogel drg >16<=48 w/o bdr
A6244 0010 3 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing Hydrogel drg >48 in w/o bdr
A6245 0010 3 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing Hydrogel drg <= 16 in w/bdr
A6246 0010 3 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing Hydrogel drg >16<=48 in w/b
A6247 0010 3 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing Hydrogel drg > 48 sq in w/b
A6248 0010 3 Hydrogel dressing, wound filler, gel, per fluid ounce Hydrogel drsg gel filler
A6250 0010 3 Skin sealants, protectants, moisturizers, ointments, any type, any size Skin seal protect moisturizr
A6251 0010 3 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Absorpt drg <=16 sq in w/o b
A6252 0010 3 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing Absorpt drg >16 <=48 w/o bdr
A6253 0010 3 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing Absorpt drg > 48 sq in w/o b
A6254 0010 3 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing Absorpt drg <=16 sq in w/bdr
A6255 0010 3 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing Absorpt drg >16<=48 in w/bdr
A6256 0010 3 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing Absorpt drg > 48 sq in w/bdr
A6257 0010 3 Transparent film, sterile, 16 sq. in. or less, each dressing Transparent film <= 16 sq in
A6258 0010 3 Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing Transparent film >16<=48 in
A6259 0010 3 Transparent film, sterile, more than 48 sq. in., each dressing Transparent film > 48 sq in
A6260 0010 3 Wound cleansers, any type, any size Wound cleanser any type/size
A6261 0010 3 Wound filler, gel/paste, per fluid ounce, not otherwise specified Wound filler gel/paste /oz
A6262 0010 3 Wound filler, dry form, per gram, not otherwise specified Wound filler dry form / gram
A6266 0010 3 Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard Impreg gauze no h20/sal/yard
A6402 0010 3 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Sterile gauze <= 16 sq in
A6403 0010 3 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing Sterile gauze>16 <= 48 sq in
A6404 0010 3 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing Sterile gauze > 48 sq in
A6407 0010 3 Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard Packing strips, non-impreg
A6410 0010 3 Eye pad, sterile, each Sterile eye pad
A6411 0010 3 Eye pad, non-sterile, each Non-sterile eye pad
A6412 0010 3 Eye patch, occlusive, each Occlusive eye patch
A6413 0010 3 Adhesive bandage, first-aid type, any size, each Adhesive bandage, first-aid
A6441 0010 3 Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard Pad band w>=3” <5”/yd
A6442 0010 3 Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard Conform band n/s w<3”/yd
A6443 0010 3 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard Conform band n/s w>=3”<5”/yd
A6444 0010 3 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard Conform band n/s w>=5”/yd
A6445 0010 3 Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard Conform band s w <3”/yd
A6446 0010 3 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard Conform band s w>=3” <5”/yd
A6447 0010 3 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard Conform band s w >=5”/yd
A6448 0010 3 Light compression bandage, elastic, knitted/woven, width less than three inches, per yard Lt compres band <3”/yd
A6449 0010 3 Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard Lt compres band >=3” <5”/yd
A6450 0010 3 Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard Lt compres band >=5”/yd
A6451 0010 3 Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard Mod compres band w>=3”<5”/yd
A6452 0010 3 High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard High compres band w>=3”<5”yd
A6453 0010 3 Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard Self-adher band w <3”/yd
A6454 0010 3 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard Self-adher band w>=3” <5”/yd
A6455 0010 3 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard Self-adher band >=5”/yd
A6456 0010 3 Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard Zinc paste band w >=3”<5”/yd
A6457 0010 3 Tubular dressing with or without elastic, any width, per linear yard Tubular dressing
A6460 0010 3 Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing Synthetic drsg <= 16 sq in
A6461 0010 3 Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing Synthetic drsg >16<=48 sq in
A6501 0010 3 Compression burn garment, bodysuit (head to foot), custom fabricated Compres burngarment bodysuit
A6502 0010 3 Compression burn garment, chin strap, custom fabricated Compres burngarment chinstrp
A6503 0010 3 Compression burn garment, facial hood, custom fabricated Compres burngarment facehood
A6504 0010 3 Compression burn garment, glove to wrist, custom fabricated Cmprsburngarment glove-wrist
A6505 0010 3 Compression burn garment, glove to elbow, custom fabricated Cmprsburngarment glove-elbow
A6506 0010 3 Compression burn garment, glove to axilla, custom fabricated Cmprsburngrmnt glove-axilla
A6507 0010 3 Compression burn garment, foot to knee length, custom fabricated Cmprs burngarment foot-knee
A6508 0010 3 Compression burn garment, foot to thigh length, custom fabricated Cmprs burngarment foot-thigh
A6509 0010 3 Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated Compres burn garment jacket
A6510 0010 3 Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated Compres burn garment leotard
A6511 0010 3 Compression burn garment, lower trunk including leg openings (panty), custom fabricated Compres burn garment panty
A6512 0010 3 Compression burn garment, not otherwise classified Compres burn garment, noc
A6513 0010 3 Compression burn mask, face and/or neck, plastic or equal, custom fabricated Compress burn mask face/neck
A6530 0010 3 Gradient compression stocking, below knee, 18-30 mmhg, each Compression stocking bk18-30
A6531 0010 3 Gradient compression stocking, below knee, 30-40 mmhg, each Compression stocking bk30-40
A6532 0010 3 Gradient compression stocking, below knee, 40-50 mmhg, each Compression stocking bk40-50
A6533 0010 3 Gradient compression stocking, thigh length, 18-30 mmhg, each Gc stocking thighlngth 18-30
A6534 0010 3 Gradient compression stocking, thigh length, 30-40 mmhg, each Gc stocking thighlngth 30-40
A6535 0010 3 Gradient compression stocking, thigh length, 40-50 mmhg, each Gc stocking thighlngth 40-50
A6536 0010 3 Gradient compression stocking, full length/chap style, 18-30 mmhg, each Gc stocking full lngth 18-30
A6537 0010 3 Gradient compression stocking, full length/chap style, 30-40 mmhg, each Gc stocking full lngth 30-40
A6538 0010 3 Gradient compression stocking, full length/chap style, 40-50 mmhg, each Gc stocking full lngth 40-50
A6539 0010 3 Gradient compression stocking, waist length, 18-30 mmhg, each Gc stocking waistlngth 18-30
A6540 0010 3 Gradient compression stocking, waist length, 30-40 mmhg, each Gc stocking waistlngth 30-40
A6541 0010 3 Gradient compression stocking, waist length, 40-50 mmhg, each Gc stocking waistlngth 40-50
A6544 0010 3 Gradient compression stocking, garter belt Gc stocking garter belt
A6545 0010 3 Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each Grad comp non-elastic bk
A6549 0010 3 Gradient compression stocking/sleeve, not otherwise specified G compression stocking
A6550 0010 3 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories Neg pres wound ther drsg set
A7000 0010 3 Canister, disposable, used with suction pump, each Disposable canister for pump
A7001 0010 3 Canister, non-disposable, used with suction pump, each Nondisposable pump canister
A7002 0010 3 Tubing, used with suction pump, each Tubing used w suction pump
A7003 0010 3 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable Nebulizer administration set
A7004 0010 3 Small volume nonfiltered pneumatic nebulizer, disposable Disposable nebulizer sml vol
A7005 0010 3 Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable Nondisposable nebulizer set
A7006 0010 3 Administration set, with small volume filtered pneumatic nebulizer Filtered nebulizer admin set
A7007 0010 3 Large volume nebulizer, disposable, unfilled, used with aerosol compressor Lg vol nebulizer disposable
A7008 0010 3 Large volume nebulizer, disposable, prefilled, used with aerosol compressor Disposable nebulizer prefill
A7009 0010 3 Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer Nebulizer reservoir bottle
A7010 0010 3 Corrugated tubing, disposable, used with large volume nebulizer, 100 feet Disposable corrugated tubing
A7011 0010 3 Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet Nondispos corrugated tubing
A7012 0010 3 Water collection device, used with large volume nebulizer Nebulizer water collec devic
A7013 0010 3 Filter, disposable, used with aerosol compressor or ultrasonic generator Disposable compressor filter
A7014 0010 3 Filter, nondisposable, used with aerosol compressor or ultrasonic generator Compressor nondispos filter
A7015 0010 3 Aerosol mask, used with dme nebulizer Aerosol mask used w nebulize
A7016 0010 3 Dome and mouthpiece, used with small volume ultrasonic nebulizer Nebulizer dome & mouthpiece
A7017 0010 3 Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen Nebulizer not used w oxygen
A7018 0010 3 Water, distilled, used with large volume nebulizer, 1000 ml Water distilled w/nebulizer
A7020 0010 3 Interface for cough stimulating device, includes all components, replacement only Interface, cough stim device
A7025 0010 3 High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each Replace chest compress vest
A7026 0010 3 High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each Replace chst cmprss sys hose
A7027 0010 3 Combination oral/nasal mask, used with continuous positive airway pressure device, each Combination oral/nasal mask
A7028 0010 3 Oral cushion for combination oral/nasal mask, replacement only, each Repl oral cushion combo mask
A7029 0010 3 Nasal pillows for combination oral/nasal mask, replacement only, pair Repl nasal pillow comb mask
A7030 0010 3 Full face mask used with positive airway pressure device, each Cpap full face mask
A7031 0010 3 Face mask interface, replacement for full face mask, each Replacement facemask interfa
A7032 0010 3 Cushion for use on nasal mask interface, replacement only, each Replacement nasal cushion
A7033 0010 3 Pillow for use on nasal cannula type interface, replacement only, pair Replacement nasal pillows
A7034 0010 3 Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap Nasal application device
A7035 0010 3 Headgear used with positive airway pressure device Pos airway press headgear
A7036 0010 3 Chinstrap used with positive airway pressure device Pos airway press chinstrap
A7037 0010 3 Tubing used with positive airway pressure device Pos airway pressure tubing
A7038 0010 3 Filter, disposable, used with positive airway pressure device Pos airway pressure filter
A7039 0010 3 Filter, non disposable, used with positive airway pressure device Filter, non disposable w pap
A7040 0010 3 One way chest drain valve One way chest drain valve
A7041 0010 3 Water seal drainage container and tubing for use with implanted chest tube Water seal drain container
A7042 0010 3 Implanted pleural catheter, each Implanted pleural catheter
A7043 0010 3 Vacuum drainage bottle and tubing for use with implanted catheter Vacuum drainagebottle/tubing
A7044 0010 3 Oral interface used with positive airway pressure device, each Pap oral interface
A7045 0010 3 Exhalation port with or without swivel used with accessories for positive airway devices, replacement only Repl exhalation port for pap
A7046 0010 3 Water chamber for humidifier, used with positive airway pressure device, replacement, each Repl water chamber, pap dev
A7047 0010 3 Oral interface used with respiratory suction pump, each Resp suction oral interface
A7048 0010 3 Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each Vacuum drain bottle/tube kit
A7501 0010 3 Tracheostoma valve, including diaphragm, each Tracheostoma valve w diaphra
A7502 0010 3 Replacement diaphragm/faceplate for tracheostoma valve, each Replacement diaphragm/fplate
A7503 0010 3 Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each Hmes filter holder or cap
A7504 0010 3 Filter for use in a tracheostoma heat and moisture exchange system, each Tracheostoma hmes filter
A7505 0010 3 Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each Hmes or trach valve housing
A7506 0010 3 Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each Hmes/trachvalve adhesivedisk
A7507 0010 3 Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each Integrated filter & holder
A7508 0010 3 Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each Housing & integrated adhesiv
A7509 0010 3 Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each Heat & moisture exchange sys
A7520 0010 3 Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each Trach/laryn tube non-cuffed
A7521 0010 3 Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each Trach/laryn tube cuffed
A7522 0010 3 Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each Trach/laryn tube stainless
A7523 0010 3 Tracheostomy shower protector, each Tracheostomy shower protect
A7524 0010 3 Tracheostoma stent/stud/button, each Tracheostoma stent/stud/bttn
A7525 0010 3 Tracheostomy mask, each Tracheostomy mask
A7526 0010 3 Tracheostomy tube collar/holder, each Tracheostomy tube collar
A7527 0010 3 Tracheostomy/laryngectomy tube plug/stop, each Trach/laryn tube plug/stop
A8000 0010 3 Helmet, protective, soft, prefabricated, includes all components and accessories Soft protect helmet prefab
A8001 0010 3 Helmet, protective, hard, prefabricated, includes all components and accessories Hard protect helmet prefab
A8002 0010 3 Helmet, protective, soft, custom fabricated, includes all components and accessories Soft protect helmet custom
A8003 0010 3 Helmet, protective, hard, custom fabricated, includes all components and accessories Hard protect helmet custom
A8004 0010 3 Soft interface for helmet, replacement only Repl soft interface, helmet
A9150 0010 3 Non-prescription drugs Misc/exper non-prescript dru
A9152 0010 3 Single vitamin/mineral/trace element, oral, per dose, not otherwise specified Single vitamin nos
A9153 0010 3 Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified Multi-vitamin nos
A9155 0010 3 Artificial saliva, 30 ml Artificial saliva
A9180 0010 3 Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker Lice treatment, topical
A9270 0010 3 Non-covered item or service Non-covered item or service
A9272 0010 3 Wound suction, disposable, includes dressing, all accessories and components, any type, each Disp wound suct, drsg/access
A9273 0010 3 Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type Hot/cold botle/cap/col/wrap
A9274 0010 3 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories Ext amb insulin delivery sys
A9275 0010 3 Home glucose disposable monitor, includes test strips Disp home glucose monitor
A9276 0010 3 Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply Disposable sensor, cgm sys
A9277 0010 3 Transmitter; external, for use with interstitial continuous glucose monitoring system External transmitter, cgm
A9278 0010 3 Receiver (monitor); external, for use with interstitial continuous glucose monitoring system External receiver, cgm sys
A9279 0010 3 Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified Monitoring feature/devicenoc
A9280 0010 3 Alert or alarm device, not otherwise classified Alert device, noc
A9281 0010 3 Reaching/grabbing device, any type, any length, each Reaching/grabbing device
A9282 0010 3 Wig, any type, each Wig any type
A9283 0010 3 Foot pressure off loading/supportive device, any type, each Foot press off load supp dev
A9284 0010 3 Spirometer, non-electronic, includes all accessories Non-electronic spirometer
A9285 0010 3 Inversion/eversion correction device Inversion eversion cor devic
A9286 0010 3 Hygienic item or device, disposable or non-disposable, any type, each Any hygienic item, device
A9300 0010 3 Exercise equipment Exercise equipment
A9500 0010 3 Technetium tc-99m sestamibi, diagnostic, per study dose Tc99m sestamibi
A9501 0010 3 Technetium tc-99m teboroxime, diagnostic, per study dose Technetium tc-99m teboroxime
A9502 0010 3 Technetium tc-99m tetrofosmin, diagnostic, per study dose Tc99m tetrofosmin
A9503 0010 3 Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries Tc99m medronate
A9504 0010 3 Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries Tc99m apcitide
A9505 0010 3 Thallium tl-201 thallous chloride, diagnostic, per millicurie Tl201 thallium
A9507 0010 3 Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries In111 capromab
A9508 0010 3 Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie I131 iodobenguate, dx
A9509 0010 3 Iodine i-123 sodium iodide, diagnostic, per millicurie Iodine i-123 sod iodide mil
A9510 0010 3 Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries Tc99m disofenin
A9512 0010 3 Technetium tc-99m pertechnetate, diagnostic, per millicurie Tc99m pertechnetate
A9513 0010 3 Lutetium lu 177, dotatate, therapeutic, 1 millicurie Lutetium lu 177 dotatat ther
A9515 0010 3 Choline c-11, diagnostic, per study dose up to 20 millicuries Choline c-11
A9516 0010 3 Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries Iodine i-123 sod iodide mic
A9517 0010 3 Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie I131 iodide cap, rx
A9520 0010 3 Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries Tc99 tilmanocept diag 0.5mci
A9521 0010 3 Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries Tc99m exametazime
A9524 0010 3 Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries I131 serum albumin, dx
A9526 0010 3 Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries Nitrogen n-13 ammonia
A9527 0010 3 Iodine i-125, sodium iodide solution, therapeutic, per millicurie Iodine i-125 sodium iodide
A9528 0010 3 Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie Iodine i-131 iodide cap, dx
A9529 0010 3 Iodine i-131 sodium iodide solution, diagnostic, per millicurie I131 iodide sol, dx
A9530 0010 3 Iodine i-131 sodium iodide solution, therapeutic, per millicurie I131 iodide sol, rx
A9531 0010 3 Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) I131 max 100uci
A9532 0010 3 Iodine i-125 serum albumin, diagnostic, per 5 microcuries I125 serum albumin, dx
A9536 0010 3 Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries Tc99m depreotide
A9537 0010 3 Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries Tc99m mebrofenin
A9538 0010 3 Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries Tc99m pyrophosphate
A9539 0010 3 Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries Tc99m pentetate
A9540 0010 3 Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries Tc99m maa
A9541 0010 3 Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries Tc99m sulfur colloid
A9542 0010 3 Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries In111 ibritumomab, dx
A9543 0010 3 Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries Y90 ibritumomab, rx
A9544 0010 3 Iodine i-131 tositumomab, diagnostic, per study dose I131 tositumomab, dx
A9545 0010 3 Iodine i-131 tositumomab, therapeutic, per treatment dose I131 tositumomab, rx
A9546 0010 3 Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie Co57/58
A9547 0010 3 Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie In111 oxyquinoline
A9548 0010 3 Indium in-111 pentetate, diagnostic, per 0.5 millicurie In111 pentetate
A9550 0010 3 Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie Tc99m gluceptate
A9551 0010 3 Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries Tc99m succimer
A9552 0010 3 Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries F18 fdg
A9553 0010 3 Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries Cr51 chromate
A9554 0010 3 Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries I125 iothalamate, dx
A9555 0010 3 Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries Rb82 rubidium
A9556 0010 3 Gallium ga-67 citrate, diagnostic, per millicurie Ga67 gallium
A9557 0010 3 Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries Tc99m bicisate
A9558 0010 3 Xenon xe-133 gas, diagnostic, per 10 millicuries Xe133 xenon 10mci
A9559 0010 3 Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie Co57 cyano
A9560 0010 3 Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries Tc99m labeled rbc
A9561 0010 3 Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries Tc99m oxidronate
A9562 0010 3 Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries Tc99m mertiatide
A9563 0010 3 Sodium phosphate p-32, therapeutic, per millicurie P32 na phosphate
A9564 0010 3 Chromic phosphate p-32 suspension, therapeutic, per millicurie P32 chromic phosphate
A9566 0010 3 Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries Tc99m fanolesomab
A9567 0010 3 Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries Technetium tc-99m aerosol
A9568 0010 3 Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries Technetium tc99m arcitumomab
A9569 0010 3 Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose Technetium tc-99m auto wbc
A9570 0010 3 Indium in-111 labeled autologous white blood cells, diagnostic, per study dose Indium in-111 auto wbc
A9571 0010 3 Indium in-111 labeled autologous platelets, diagnostic, per study dose Indium in-111 auto platelet
A9572 0010 3 Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries Indium in-111 pentetreotide
A9575 0010 3 Injection, gadoterate meglumine, 0.1 ml Inj gadoterate meglumi 0.1ml
A9576 0010 3 Injection, gadoteridol, (prohance multipack), per ml Inj prohance multipack
A9577 0010 3 Injection, gadobenate dimeglumine (multihance), per ml Inj multihance
A9578 0010 3 Injection, gadobenate dimeglumine (multihance multipack), per ml Inj multihance multipack
A9579 0010 3 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml Gad-base mr contrast nos,1ml
A9580 0010 3 Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries Sodium fluoride f-18
A9581 0010 3 Injection, gadoxetate disodium, 1 ml Gadoxetate disodium inj
A9582 0010 3 Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries Iodine i-123 iobenguane
A9583 0010 3 Injection, gadofosveset trisodium, 1 ml Gadofosveset trisodium inj
A9584 0010 3 Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries Iodine i-123 ioflupane
A9585 0010 3 Injection, gadobutrol, 0.1 ml Gadobutrol injection
A9586 0010 3 Florbetapir f18, diagnostic, per study dose, up to 10 millicuries Florbetapir f18
A9587 0010 3 Gallium ga-68, dotatate, diagnostic, 0.1 millicurie Gallium ga-68
A9588 0010 3 Fluciclovine f-18, diagnostic, 1 millicurie Fluciclovine f-18
A9589 0010 3 Instillation, hexaminolevulinate hydrochloride, 100 mg Insti hexaminolevulinate hcl
A9590 0010 3 Iodine i-131, iobenguane, 1 millicurie Iodine i-131 iobenguane 1mci
A9597 0010 3 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified Pet, dx, for tumor id, noc
A9598 0010 3 Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified Pet dx for non-tumor id, noc
A9599 0010 3 Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified Radioph dx b amyloid pet nos
A9600 0010 3 Strontium sr-89 chloride, therapeutic, per millicurie Sr89 strontium
A9604 0010 3 Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries Sm 153 lexidronam
A9606 0010 3 Radium ra-223 dichloride, therapeutic, per microcurie Radium ra223 dichloride ther
A9698 0010 3 Non-radioactive contrast imaging material, not otherwise classified, per study Non-rad contrast materialnoc
A9699 0010 3 Radiopharmaceutical, therapeutic, not otherwise classified Radiopharm rx agent noc
A9700 0010 3 Supply of injectable contrast material for use in echocardiography, per study Echocardiography contrast
A9900 0010 3 Miscellaneous dme supply, accessory, and/or service component of another hcpcs code Supply/accessory/service
A9901 0010 3 Dme delivery, set up, and/or dispensing service component of another hcpcs code Delivery/set up/dispensing
A9999 0010 3 Miscellaneous dme supply or accessory, not otherwise specified Dme supply or accessory, nos