A0021 |
Outside state ambulance serv |
A0080 |
Noninterest escort in non er |
A0090 |
Interest escort in non er |
A0100 |
Nonemergency transport taxi |
A0110 |
Nonemergency transport bus |
A0120 |
Noner transport mini-bus |
A0130 |
Noner transport wheelch van |
A0140 |
Nonemergency transport air |
A0160 |
Noner transport case worker |
A0170 |
Transport parking fees/tolls |
A0180 |
Noner transport lodgng recip |
A0190 |
Noner transport meals recip |
A0200 |
Noner transport lodgng escrt |
A0210 |
Noner transport meals escort |
A0225 |
Neonatal emergency transport |
A0380 |
Basic life support mileage |
A0382 |
Basic support routine suppls |
A0384 |
Bls defibrillation supplies |
A0390 |
Advanced life support mileag |
A0392 |
Als defibrillation supplies |
A0394 |
Als iv drug therapy supplies |
A0396 |
Als esophageal intub suppls |
A0398 |
Als routine disposble suppls |
A0420 |
Ambulance waiting 1/2 hr |
A0422 |
Ambulance 02 life sustaining |
A0424 |
Extra ambulance attendant |
A0425 |
Ground mileage |
A0426 |
Als 1 |
A0427 |
Als1-emergency |
A0428 |
Bls |
A0429 |
Bls-emergency |
A0430 |
Fixed wing air transport |
A0431 |
Rotary wing air transport |
A0432 |
Pi volunteer ambulance co |
A0433 |
Als 2 |
A0434 |
Specialty care transport |
A0435 |
Fixed wing air mileage |
A0436 |
Rotary wing air mileage |
A0888 |
Noncovered ambulance mileage |
A0998 |
Ambulance response/treatment |
A0999 |
Unlisted ambulance service |
A4206 |
1 cc sterile syringe&needle |
A4207 |
2 cc sterile syringe&needle |
A4208 |
3 cc sterile syringe&needle |
A4209 |
5+ cc sterile syringe&needle |
A4210 |
Nonneedle injection device |
A4211 |
Supp for self-adm injections |
A4212 |
Non coring needle or stylet |
A4213 |
20+ cc syringe only |
A4215 |
Sterile needle |
A4216 |
Sterile water/saline, 10 ml |
A4217 |
Sterile water/saline, 500 ml |
A4218 |
Sterile saline or water |
A4220 |
Infusion pump refill kit |
A4221 |
Supp non-insulin inf cath/wk |
A4222 |
Infusion supplies with pump |
A4223 |
Infusion supplies w/o pump |
A4224 |
Supply insulin inf cath/wk |
A4225 |
Sup/ext insulin inf pump syr |
A4226 |
Weekly supply maint cgs pump |
A4230 |
Infus insulin pump non needl |
A4231 |
Infusion insulin pump needle |
A4232 |
Syringe w/needle insulin 3cc |
A4233 |
Alkalin batt for glucose mon |
A4234 |
J-cell batt for glucose mon |
A4235 |
Lithium batt for glucose mon |
A4236 |
Silvr oxide batt glucose mon |
A4244 |
Alcohol or peroxide per pint |
A4245 |
Alcohol wipes per box |
A4246 |
Betadine/phisohex solution |
A4247 |
Betadine/iodine swabs/wipes |
A4248 |
Chlorhexidine antisept |
A4250 |
Urine reagent strips/tablets |
A4252 |
Blood ketone test or strip |
A4253 |
Blood glucose/reagent strips |
A4255 |
Glucose monitor platforms |
A4256 |
Calibrator solution/chips |
A4257 |
Replace lensshield cartridge |
A4258 |
Lancet device each |
A4259 |
Lancets per box |
A4261 |
Cervical cap contraceptive |
A4262 |
Temporary tear duct plug |
A4263 |
Permanent tear duct plug |
A4264 |
Intratubal occlusion device |
A4265 |
Paraffin |
A4266 |
Diaphragm |
A4267 |
Male condom |
A4268 |
Female condom |
A4269 |
Spermicide |
A4270 |
Disposable endoscope sheath |
A4280 |
Brst prsths adhsv attchmnt |
A4281 |
Replacement breastpump tube |
A4282 |
Replacement breastpump adpt |
A4283 |
Replacement breastpump cap |
A4284 |
Replcmnt breast pump shield |
A4285 |
Replcmnt breast pump bottle |
A4286 |
Replcmnt breastpump lok ring |
A4290 |
Sacral nerve stim test lead |
A4300 |
Cath impl vasc access portal |
A4301 |
Implantable access syst perc |
A4305 |
Drug delivery system >=50 ml |
A4306 |
Drug delivery system <=50 ml |
A4310 |
Insert tray w/o bag/cath |
A4311 |
Catheter w/o bag 2-way latex |
A4312 |
Cath w/o bag 2-way silicone |
A4313 |
Catheter w/bag 3-way |
A4314 |
Cath w/drainage 2-way latex |
A4315 |
Cath w/drainage 2-way silcne |
A4316 |
Cath w/drainage 3-way |
A4320 |
Irrigation tray |
A4321 |
Cath therapeutic irrig agent |
A4322 |
Irrigation syringe |
A4326 |
Male external catheter |
A4327 |
Fem urinary collect dev cup |
A4328 |
Fem urinary collect pouch |
A4330 |
Stool collection pouch |
A4331 |
Extension drainage tubing |
A4332 |
Lube sterile packet |
A4333 |
Urinary cath anchor device |
A4334 |
Urinary cath leg strap |
A4335 |
Incontinence supply |
A4336 |
Urethral insert |
A4337 |
Incontinent rectal insert |
A4338 |
Indwelling catheter latex |
A4340 |
Indwelling catheter special |
A4344 |
Cath indw foley 2 way silicn |
A4346 |
Cath indw foley 3 way |
A4349 |
Disposable male external cat |
A4351 |
Straight tip urine catheter |
A4352 |
Coude tip urinary catheter |
A4353 |
Intermittent urinary cath |
A4354 |
Cath insertion tray w/bag |
A4355 |
Bladder irrigation tubing |
A4356 |
Ext ureth clmp or compr dvc |
A4357 |
Bedside drainage bag |
A4358 |
Urinary leg or abdomen bag |
A4360 |
Disposable ext urethral dev |
A4361 |
Ostomy face plate |
A4362 |
Solid skin barrier |
A4363 |
Ostomy clamp, replacement |
A4364 |
Adhesive, liquid or equal |
A4366 |
Ostomy vent |
A4367 |
Ostomy belt |
A4368 |
Ostomy filter |
A4369 |
Skin barrier liquid per oz |
A4371 |
Skin barrier powder per oz |
A4372 |
Skin barrier solid 4x4 equiv |
A4373 |
Skin barrier with flange |
A4375 |
Drainable plastic pch w fcpl |
A4376 |
Drainable rubber pch w fcplt |
A4377 |
Drainable plstic pch w/o fp |
A4378 |
Drainable rubber pch w/o fp |
A4379 |
Urinary plastic pouch w fcpl |
A4380 |
Urinary rubber pouch w fcplt |
A4381 |
Urinary plastic pouch w/o fp |
A4382 |
Urinary hvy plstc pch w/o fp |
A4383 |
Urinary rubber pouch w/o fp |
A4384 |
Ostomy faceplt/silicone ring |
A4385 |
Ost skn barrier sld ext wear |
A4387 |
Ost clsd pouch w att st barr |
A4388 |
Drainable pch w ex wear barr |
A4389 |
Drainable pch w st wear barr |
A4390 |
Drainable pch ex wear convex |
A4391 |
Urinary pouch w ex wear barr |
A4392 |
Urinary pouch w st wear barr |
A4393 |
Urine pch w ex wear bar conv |
A4394 |
Ostomy pouch liq deodorant |
A4395 |
Ostomy pouch solid deodorant |
A4396 |
Peristomal hernia supprt blt |
A4397 |
Irrigation supply sleeve |
A4398 |
Ostomy irrigation bag |
A4399 |
Ostomy irrig cone/cath w brs |
A4400 |
Ostomy irrigation set |
A4402 |
Lubricant per ounce |
A4404 |
Ostomy ring each |
A4405 |
Nonpectin based ostomy paste |
A4406 |
Pectin based ostomy paste |
A4407 |
Ext wear ost skn barr <=4sq"" |
A4408 |
Ext wear ost skn barr >4sq"" |
A4409 |
Ost skn barr convex <=4 sq i |
A4410 |
Ost skn barr extnd >4 sq |
A4411 |
Ost skn barr extnd =4sq |
A4412 |
Ost pouch drain high output |
A4413 |
2 pc drainable ost pouch |
A4414 |
Ost sknbar w/o conv<=4 sq in |
A4415 |
Ost skn barr w/o conv >4 sqi |
A4416 |
Ost pch clsd w barrier/filtr |
A4417 |
Ost pch w bar/bltinconv/fltr |
A4418 |
Ost pch clsd w/o bar w filtr |
A4419 |
Ost pch for bar w flange/flt |
A4420 |
Ost pch clsd for bar w lk fl |
A4421 |
Ostomy supply misc |
A4422 |
Ost pouch absorbent material |
A4423 |
Ost pch for bar w lk fl/fltr |
A4424 |
Ost pch drain w bar & filter |
A4425 |
Ost pch drain for barrier fl |
A4426 |
Ost pch drain 2 piece system |
A4427 |
Ost pch drain/barr lk flng/f |
A4428 |
Urine ost pouch w faucet/tap |
A4429 |
Urine ost pouch w bltinconv |
A4430 |
Ost urine pch w b/bltin conv |
A4431 |
Ost pch urine w barrier/tapv |
A4432 |
Os pch urine w bar/fange/tap |
A4433 |
Urine ost pch bar w lock fln |
A4434 |
Ost pch urine w lock flng/ft |
A4435 |
1pc ost pch drain hgh output |
A4450 |
Non-waterproof tape |
A4452 |
Waterproof tape |
A4455 |
Adhesive remover per ounce |
A4456 |
Adhesive remover, wipes |
A4458 |
Reusable enema bag |
A4459 |
Manual pump enema, reusable |
A4461 |
Surgicl dress hold non-reuse |
A4463 |
Surgical dress holder reuse |
A4465 |
Non-elastic extremity binder |
A4467 |
Belt strap sleev grmnt cover |
A4470 |
Gravlee jet washer |
A4480 |
Vabra aspirator |
A4481 |
Tracheostoma filter |
A4483 |
Moisture exchanger |
A4490 |
Above knee surgical stocking |
A4495 |
Thigh length surg stocking |
A4500 |
Below knee surgical stocking |
A4510 |
Full length surg stocking |
A4520 |
Incontinence garment anytype |
A4550 |
Surgical trays |
A4553 |
Nondisp underpads, all sizes |
A4554 |
Disposable underpads |
A4555 |
Ca tx e-stim electr/transduc |
A4556 |
Electrodes, pair |
A4557 |
Lead wires, pair |
A4558 |
Conductive gel or paste |
A4559 |
Coupling gel or paste |
A4561 |
Pessary rubber, any type |
A4562 |
Pessary, non rubber,any type |
A4563 |
Vag inser rectal control sys |
A4565 |
Slings |
A4566 |
Should sling/vest/abrestrain |
A4570 |
Splint |
A4575 |
Hyperbaric o2 chamber disps |
A4580 |
Cast supplies (plaster) |
A4590 |
Special casting material |
A4595 |
Tens suppl 2 lead per month |
A4600 |
Sleeve, inter limb comp dev |
A4601 |
Lith ion non prosth recharge |
A4602 |
Replace lithium battery 1.5v |
A4604 |
Tubing with heating element |
A4605 |
Trach suction cath close sys |
A4606 |
Oxygen probe used w oximeter |
A4608 |
Transtracheal oxygen cath |
A4611 |
Heavy duty battery |
A4612 |
Battery cables |
A4613 |
Battery charger |
A4614 |
Hand-held pefr meter |
A4615 |
Cannula nasal |
A4616 |
Tubing (oxygen) per foot |
A4617 |
Mouth piece |
A4618 |
Breathing circuits |
A4619 |
Face tent |
A4620 |
Variable concentration mask |
A4623 |
Tracheostomy inner cannula |
A4624 |
Tracheal suction tube |
A4625 |
Trach care kit for new trach |
A4626 |
Tracheostomy cleaning brush |
A4627 |
Spacer bag/reservoir |
A4628 |
Oropharyngeal suction cath |
A4629 |
Tracheostomy care kit |
A4630 |
Repl bat t.e.n.s. own by pt |
A4633 |
Uvl replacement bulb |
A4634 |
Replacement bulb th lightbox |
A4635 |
Underarm crutch pad |
A4636 |
Handgrip for cane etc |
A4637 |
Repl tip cane/crutch/walker |
A4638 |
Repl batt pulse gen sys |
A4639 |
Infrared ht sys replcmnt pad |
A4640 |
Alternating pressure pad |
A4641 |
Radiopharm dx agent noc |
A4642 |
In111 satumomab |
A4648 |
Implantable tissue marker |
A4649 |
Surgical supplies |
A4650 |
Implant radiation dosimeter |
A4651 |
Calibrated microcap tube |
A4652 |
Microcapillary tube sealant |
A4653 |
Pd catheter anchor belt |
A4657 |
Syringe w/wo needle |
A4660 |
Sphyg/bp app w cuff and stet |
A4663 |
Dialysis blood pressure cuff |
A4670 |
Automatic bp monitor, dial |
A4671 |
Disposable cycler set |
A4672 |
Drainage ext line, dialysis |
A4673 |
Ext line w easy lock connect |
A4674 |
Chem/antisept solution, 8oz |
A4680 |
Activated carbon filter, ea |
A4690 |
Dialyzer, each |
A4706 |
Bicarbonate conc sol per gal |
A4707 |
Bicarbonate conc pow per pac |
A4708 |
Acetate conc sol per gallon |
A4709 |
Acid conc sol per gallon |
A4714 |
Treated water per gallon |
A4719 |
"y set"" tubing" |
A4720 |
Dialysat sol fld vol > 249cc |
A4721 |
Dialysat sol fld vol > 999cc |
A4722 |
Dialys sol fld vol > 1999cc |
A4723 |
Dialys sol fld vol > 2999cc |
A4724 |
Dialys sol fld vol > 3999cc |
A4725 |
Dialys sol fld vol > 4999cc |
A4726 |
Dialys sol fld vol > 5999cc |
A4728 |
Dialysate solution, non-dex |
A4730 |
Fistula cannulation set, ea |
A4736 |
Topical anesthetic, per gram |
A4737 |
Inj anesthetic per 10 ml |
A4740 |
Shunt accessory |
A4750 |
Art or venous blood tubing |
A4755 |
Comb art/venous blood tubing |
A4760 |
Dialysate sol test kit, each |
A4765 |
Dialysate conc pow per pack |
A4766 |
Dialysate conc sol add 10 ml |
A4770 |
Blood collection tube/vacuum |
A4771 |
Serum clotting time tube |
A4772 |
Blood glucose test strips |
A4773 |
Occult blood test strips |
A4774 |
Ammonia test strips |
A4802 |
Protamine sulfate per 50 mg |
A4860 |
Disposable catheter tips |
A4870 |
Plumb/elec wk hm hemo equip |
A4890 |
Repair/maint cont hemo equip |
A4911 |
Drain bag/bottle |
A4913 |
Misc dialysis supplies noc |
A4918 |
Venous pressure clamp |
A4927 |
Non-sterile gloves |
A4928 |
Surgical mask |
A4929 |
Tourniquet for dialysis, ea |
A4930 |
Sterile, gloves per pair |
A4931 |
Reusable oral thermometer |
A4932 |
Reusable rectal thermometer |
A5051 |
Pouch clsd w barr attached |
A5052 |
Clsd ostomy pouch w/o barr |
A5053 |
Clsd ostomy pouch faceplate |
A5054 |
Clsd ostomy pouch w/flange |
A5055 |
Stoma cap |
A5056 |
1 pc ost pouch w filter |
A5057 |
1 pc ost pou w built-in conv |
A5061 |
Pouch drainable w barrier at |
A5062 |
Drnble ostomy pouch w/o barr |
A5063 |
Drain ostomy pouch w/flange |
A5071 |
Urinary pouch w/barrier |
A5072 |
Urinary pouch w/o barrier |
A5073 |
Urinary pouch on barr w/flng |
A5081 |
Stoma plug or seal, any type |
A5082 |
Continent stoma catheter |
A5083 |
Stoma absorptive cover |
A5093 |
Ostomy accessory convex inse |
A5102 |
Bedside drain btl w/wo tube |
A5105 |
Urinary suspensory |
A5112 |
Urinary leg bag |
A5113 |
Latex leg strap |
A5114 |
Foam/fabric leg strap |
A5120 |
Skin barrier, wipe or swab |
A5121 |
Solid skin barrier 6x6 |
A5122 |
Solid skin barrier 8x8 |
A5126 |
Disk/foam pad +or- adhesive |
A5131 |
Appliance cleaner |
A5200 |
Percutaneous catheter anchor |
A5500 |
Diab shoe for density insert |
A5501 |
Diabetic custom molded shoe |
A5503 |
Diabetic shoe w/roller/rockr |
A5504 |
Diabetic shoe with wedge |
A5505 |
Diab shoe w/metatarsal bar |
A5506 |
Diabetic shoe w/off set heel |
A5507 |
Modification diabetic shoe |
A5508 |
Diabetic deluxe shoe |
A5510 |
Compression form shoe insert |
A5512 |
Multi den insert direct form |
A5513 |
Multi den insert custom mold |
A5514 |
Mult den insert dir carv/cam |
A6000 |
Wound warming wound cover |
A6010 |
Collagen based wound filler |
A6011 |
Collagen gel/paste wound fil |
A6021 |
Collagen dressing <=16 sq in |
A6022 |
Collagen drsg>16<=48 sq in |
A6023 |
Collagen dressing >48 sq in |
A6024 |
Collagen dsg wound filler |
A6025 |
Silicone gel sheet, each |
A6154 |
Wound pouch each |
A6196 |
Alginate dressing <=16 sq in |
A6197 |
Alginate drsg >16 <=48 sq in |
A6198 |
Alginate dressing > 48 sq in |
A6199 |
Alginate drsg wound filler |
A6203 |
Composite drsg <= 16 sq in |
A6204 |
Composite drsg >16<=48 sq in |
A6205 |
Composite drsg > 48 sq in |
A6206 |
Contact layer <= 16 sq in |
A6207 |
Contact layer >16<= 48 sq in |
A6208 |
Contact layer > 48 sq in |
A6209 |
Foam drsg <=16 sq in w/o bdr |
A6210 |
Foam drg >16<=48 sq in w/o b |
A6211 |
Foam drg > 48 sq in w/o brdr |
A6212 |
Foam drg <=16 sq in w/border |
A6213 |
Foam drg >16<=48 sq in w/bdr |
A6214 |
Foam drg > 48 sq in w/border |
A6215 |
Foam dressing wound filler |
A6216 |
Non-sterile gauze<=16 sq in |
A6217 |
Non-sterile gauze>16<=48 sq |
A6218 |
Non-sterile gauze > 48 sq in |
A6219 |
Gauze <= 16 sq in w/border |
A6220 |
Gauze >16 <=48 sq in w/bordr |
A6221 |
Gauze > 48 sq in w/border |
A6222 |
Gauze <=16 in no w/sal w/o b |
A6223 |
Gauze >16<=48 no w/sal w/o b |
A6224 |
Gauze > 48 in no w/sal w/o b |
A6228 |
Gauze <= 16 sq in water/sal |
A6229 |
Gauze >16<=48 sq in watr/sal |
A6230 |
Gauze > 48 sq in water/salne |
A6231 |
Hydrogel dsg<=16 sq in |
A6232 |
Hydrogel dsg>16<=48 sq in |
A6233 |
Hydrogel dressing >48 sq in |
A6234 |
Hydrocolld drg <=16 w/o bdr |
A6235 |
Hydrocolld drg >16<=48 w/o b |
A6236 |
Hydrocolld drg > 48 in w/o b |
A6237 |
Hydrocolld drg <=16 in w/bdr |
A6238 |
Hydrocolld drg >16<=48 w/bdr |
A6239 |
Hydrocolld drg > 48 in w/bdr |
A6240 |
Hydrocolld drg filler paste |
A6241 |
Hydrocolloid drg filler dry |
A6242 |
Hydrogel drg <=16 in w/o bdr |
A6243 |
Hydrogel drg >16<=48 w/o bdr |
A6244 |
Hydrogel drg >48 in w/o bdr |
A6245 |
Hydrogel drg <= 16 in w/bdr |
A6246 |
Hydrogel drg >16<=48 in w/b |
A6247 |
Hydrogel drg > 48 sq in w/b |
A6248 |
Hydrogel drsg gel filler |
A6250 |
Skin seal protect moisturizr |
A6251 |
Absorpt drg <=16 sq in w/o b |
A6252 |
Absorpt drg >16 <=48 w/o bdr |
A6253 |
Absorpt drg > 48 sq in w/o b |
A6254 |
Absorpt drg <=16 sq in w/bdr |
A6255 |
Absorpt drg >16<=48 in w/bdr |
A6256 |
Absorpt drg > 48 sq in w/bdr |
A6257 |
Transparent film <= 16 sq in |
A6258 |
Transparent film >16<=48 in |
A6259 |
Transparent film > 48 sq in |
A6260 |
Wound cleanser any type/size |
A6261 |
Wound filler gel/paste /oz |
A6262 |
Wound filler dry form / gram |
A6266 |
Impreg gauze no h20/sal/yard |
A6402 |
Sterile gauze <= 16 sq in |
A6403 |
Sterile gauze>16 <= 48 sq in |
A6404 |
Sterile gauze > 48 sq in |
A6407 |
Packing strips, non-impreg |
A6410 |
Sterile eye pad |
A6411 |
Non-sterile eye pad |
A6412 |
Occlusive eye patch |
A6413 |
Adhesive bandage, first-aid |
A6441 |
Pad band w>=3" <5""/yd" |
A6442 |
Conform band n/s w<3"/yd" |
A6443 |
Conform band n/s w>=3"<5""/yd" |
A6444 |
Conform band n/s w>=5"/yd" |
A6445 |
Conform band s w <3"/yd" |
A6446 |
Conform band s w>=3" <5""/yd" |
A6447 |
Conform band s w >=5"/yd" |
A6448 |
Lt compres band <3"/yd" |
A6449 |
Lt compres band >=3" <5""/yd" |
A6450 |
Lt compres band >=5"/yd" |
A6451 |
Mod compres band w>=3"<5""/yd" |
A6452 |
High compres band w>=3"<5""yd" |
A6453 |
Self-adher band w <3"/yd" |
A6454 |
Self-adher band w>=3" <5""/yd" |
A6455 |
Self-adher band >=5"/yd" |
A6456 |
Zinc paste band w >=3"<5""/yd" |
A6457 |
Tubular dressing |
A6460 |
Synthetic drsg <= 16 sq in |
A6461 |
Synthetic drsg >16<=48 sq in |
A6501 |
Compres burngarment bodysuit |
A6502 |
Compres burngarment chinstrp |
A6503 |
Compres burngarment facehood |
A6504 |
Cmprsburngarment glove-wrist |
A6505 |
Cmprsburngarment glove-elbow |
A6506 |
Cmprsburngrmnt glove-axilla |
A6507 |
Cmprs burngarment foot-knee |
A6508 |
Cmprs burngarment foot-thigh |
A6509 |
Compres burn garment jacket |
A6510 |
Compres burn garment leotard |
A6511 |
Compres burn garment panty |
A6512 |
Compres burn garment, noc |
A6513 |
Compress burn mask face/neck |
A6530 |
Compression stocking bk18-30 |
A6531 |
Compression stocking bk30-40 |
A6532 |
Compression stocking bk40-50 |
A6533 |
Gc stocking thighlngth 18-30 |
A6534 |
Gc stocking thighlngth 30-40 |
A6535 |
Gc stocking thighlngth 40-50 |
A6536 |
Gc stocking full lngth 18-30 |
A6537 |
Gc stocking full lngth 30-40 |
A6538 |
Gc stocking full lngth 40-50 |
A6539 |
Gc stocking waistlngth 18-30 |
A6540 |
Gc stocking waistlngth 30-40 |
A6541 |
Gc stocking waistlngth 40-50 |
A6544 |
Gc stocking garter belt |
A6545 |
Grad comp non-elastic bk |
A6549 |
G compression stocking |
A6550 |
Neg pres wound ther drsg set |
A7000 |
Disposable canister for pump |
A7001 |
Nondisposable pump canister |
A7002 |
Tubing used w suction pump |
A7003 |
Nebulizer administration set |
A7004 |
Disposable nebulizer sml vol |
A7005 |
Nondisposable nebulizer set |
A7006 |
Filtered nebulizer admin set |
A7007 |
Lg vol nebulizer disposable |
A7008 |
Disposable nebulizer prefill |
A7009 |
Nebulizer reservoir bottle |
A7010 |
Disposable corrugated tubing |
A7012 |
Nebulizer water collec devic |
A7013 |
Disposable compressor filter |
A7014 |
Compressor nondispos filter |
A7015 |
Aerosol mask used w nebulize |
A7016 |
Nebulizer dome & mouthpiece |
A7017 |
Nebulizer not used w oxygen |
A7018 |
Water distilled w/nebulizer |
A7020 |
Interface, cough stim device |
A7025 |
Replace chest compress vest |
A7026 |
Replace chst cmprss sys hose |
A7027 |
Combination oral/nasal mask |
A7028 |
Repl oral cushion combo mask |
A7029 |
Repl nasal pillow comb mask |
A7030 |
Cpap full face mask |
A7031 |
Replacement facemask interfa |
A7032 |
Replacement nasal cushion |
A7033 |
Replacement nasal pillows |
A7034 |
Nasal application device |
A7035 |
Pos airway press headgear |
A7036 |
Pos airway press chinstrap |
A7037 |
Pos airway pressure tubing |
A7038 |
Pos airway pressure filter |
A7039 |
Filter, non disposable w pap |
A7040 |
One way chest drain valve |
A7041 |
Water seal drain container |
A7044 |
Pap oral interface |
A7045 |
Repl exhalation port for pap |
A7046 |
Repl water chamber, pap dev |
A7047 |
Resp suction oral interface |
A7048 |
Vacuum drain bottle/tube kit |
A7501 |
Tracheostoma valve w diaphra |
A7502 |
Replacement diaphragm/fplate |
A7503 |
Hmes filter holder or cap |
A7504 |
Tracheostoma hmes filter |
A7505 |
Hmes or trach valve housing |
A7506 |
Hmes/trachvalve adhesivedisk |
A7507 |
Integrated filter & holder |
A7508 |
Housing & integrated adhesiv |
A7509 |
Heat & moisture exchange sys |
A7520 |
Trach/laryn tube non-cuffed |
A7521 |
Trach/laryn tube cuffed |
A7522 |
Trach/laryn tube stainless |
A7523 |
Tracheostomy shower protect |
A7524 |
Tracheostoma stent/stud/bttn |
A7525 |
Tracheostomy mask |
A7526 |
Tracheostomy tube collar |
A7527 |
Trach/laryn tube plug/stop |
A8000 |
Soft protect helmet prefab |
A8001 |
Hard protect helmet prefab |
A8002 |
Soft protect helmet custom |
A8003 |
Hard protect helmet custom |
A8004 |
Repl soft interface, helmet |
A9150 |
Misc/exper non-prescript dru |
A9152 |
Single vitamin nos |
A9153 |
Multi-vitamin nos |
A9155 |
Artificial saliva |
A9180 |
Lice treatment, topical |
A9270 |
Non-covered item or service |
A9272 |
Disp wound suct, drsg/access |
A9273 |
Hot/cold botle/cap/col/wrap |
A9274 |
Ext amb insulin delivery sys |
A9275 |
Disp home glucose monitor |
A9276 |
Disposable sensor, cgm sys |
A9277 |
External transmitter, cgm |
A9278 |
External receiver, cgm sys |
A9279 |
Monitoring feature/devicenoc |
A9280 |
Alert device, noc |
A9281 |
Reaching/grabbing device |
A9282 |
Wig any type |
A9283 |
Foot press off load supp dev |
A9284 |
Non-electronic spirometer |
A9285 |
Inversion eversion cor devic |
A9286 |
Any hygienic item, device |
A9300 |
Exercise equipment |
A9500 |
Tc99m sestamibi |
A9501 |
Technetium tc-99m teboroxime |
A9502 |
Tc99m tetrofosmin |
A9503 |
Tc99m medronate |
A9504 |
Tc99m apcitide |
A9505 |
Tl201 thallium |
A9507 |
In111 capromab |
A9508 |
I131 iodobenguate, dx |
A9509 |
Iodine i-123 sod iodide mil |
A9510 |
Tc99m disofenin |
A9512 |
Tc99m pertechnetate |
A9513 |
Lutetium lu 177 dotatat ther |
A9515 |
Choline c-11 |
A9516 |
Iodine i-123 sod iodide mic |
A9517 |
I131 iodide cap, rx |
A9520 |
Tc99 tilmanocept diag 0.5mci |
A9521 |
Tc99m exametazime |
A9524 |
I131 serum albumin, dx |
A9526 |
Nitrogen n-13 ammonia |
A9527 |
Iodine i-125 sodium iodide |
A9528 |
Iodine i-131 iodide cap, dx |
A9529 |
I131 iodide sol, dx |
A9530 |
I131 iodide sol, rx |
A9531 |
I131 max 100uci |
A9532 |
I125 serum albumin, dx |
A9536 |
Tc99m depreotide |
A9537 |
Tc99m mebrofenin |
A9538 |
Tc99m pyrophosphate |
A9539 |
Tc99m pentetate |
A9540 |
Tc99m maa |
A9541 |
Tc99m sulfur colloid |
A9542 |
In111 ibritumomab, dx |
A9543 |
Y90 ibritumomab, rx |
A9546 |
Co57/58 |
A9547 |
In111 oxyquinoline |
A9548 |
In111 pentetate |
A9550 |
Tc99m gluceptate |
A9551 |
Tc99m succimer |
A9552 |
F18 fdg |
A9553 |
Cr51 chromate |
A9554 |
I125 iothalamate, dx |
A9555 |
Rb82 rubidium |
A9556 |
Ga67 gallium |
A9557 |
Tc99m bicisate |
A9558 |
Xe133 xenon 10mci |
A9559 |
Co57 cyano |
A9560 |
Tc99m labeled rbc |
A9561 |
Tc99m oxidronate |
A9562 |
Tc99m mertiatide |
A9563 |
P32 na phosphate |
A9564 |
P32 chromic phosphate |
A9566 |
Tc99m fanolesomab |
A9567 |
Technetium tc-99m aerosol |
A9568 |
Technetium tc99m arcitumomab |
A9569 |
Technetium tc-99m auto wbc |
A9570 |
Indium in-111 auto wbc |
A9571 |
Indium in-111 auto platelet |
A9572 |
Indium in-111 pentetreotide |
A9575 |
Inj gadoterate meglumi 0.1ml |
A9576 |
Inj prohance multipack |
A9577 |
Inj multihance |
A9578 |
Inj multihance multipack |
A9579 |
Gad-base mr contrast nos,1ml |
A9580 |
Sodium fluoride f-18 |
A9581 |
Gadoxetate disodium inj |
A9582 |
Iodine i-123 iobenguane |
A9583 |
Gadofosveset trisodium inj |
A9584 |
Iodine i-123 ioflupane |
A9585 |
Gadobutrol injection |
A9586 |
Florbetapir f18 |
A9587 |
Gallium ga-68 |
A9588 |
Fluciclovine f-18 |
A9589 |
Insti hexaminolevulinate hcl |
A9590 |
Iodine i-131 iobenguane 1mci |
A9597 |
Pet, dx, for tumor id, noc |
A9598 |
Pet dx for non-tumor id, noc |
A9600 |
Sr89 strontium |
A9604 |
Sm 153 lexidronam |
A9606 |
Radium ra223 dichloride ther |
A9698 |
Non-rad contrast materialnoc |
A9699 |
Radiopharm rx agent noc |
A9700 |
Echocardiography contrast |
A9900 |
Supply/accessory/service |
A9901 |
Delivery/set up/dispensing |
A9999 |
Dme supply or accessory, nos |