S0012 |
Butorphanol tartrate, nasal |
S0014 |
Tacrine hydrochloride, 10 mg |
S0017 |
Injection, aminocaproic acid |
S0020 |
Injection, bupivicaine hydro |
S0021 |
Injection, cefoperazone sod |
S0023 |
Injection, cimetidine hydroc |
S0028 |
Injection, famotidine, 20 mg |
S0030 |
Injection, metronidazole |
S0032 |
Injection, nafcillin sodium |
S0034 |
Injection, ofloxacin, 400 mg |
S0039 |
Injection, sulfamethoxazole |
S0040 |
Injection, ticarcillin disod |
S0073 |
Injection, aztreonam, 500 mg |
S0074 |
Injection, cefotetan disodiu |
S0077 |
Injection, clindamycin phosp |
S0078 |
Injection, fosphenytoin sodi |
S0080 |
Injection, pentamidine iseth |
S0081 |
Injection, piperacillin sodi |
S0088 |
Imatinib 100 mg |
S0090 |
Sildenafil citrate, 25 mg |
S0091 |
Granisetron 1mg |
S0092 |
Hydromorphone 250 mg |
S0093 |
Morphine 500 mg |
S0104 |
Zidovudine, oral, 100 mg |
S0106 |
Bupropion hcl sr 60 tablets |
S0108 |
Mercaptopurine 50 mg |
S0109 |
Methadone oral 5mg |
S0117 |
Tretinoin topical 5 g |
S0119 |
Ondansetron 4 mg |
S0122 |
Inj menotropins 75 iu |
S0126 |
Inj follitropin alfa 75 iu |
S0128 |
Inj follitropin beta 75 iu |
S0132 |
Inj ganirelix acetat 250 mcg |
S0136 |
Clozapine, 25 mg |
S0137 |
Didanosine, 25 mg |
S0138 |
Finasteride, 5 mg |
S0139 |
Minoxidil, 10 mg |
S0140 |
Saquinavir, 200 mg |
S0142 |
Colistimethate inh sol mg |
S0145 |
Peg interferon alfa-2a/180 |
S0148 |
Peg interferon alfa-2b/10 |
S0155 |
Epoprostenol dilutant |
S0156 |
Exemestane, 25 mg |
S0157 |
Becaplermin gel 1%, 0.5 gm |
S0160 |
Dextroamphetamine |
S0164 |
Injection pantroprazole |
S0166 |
Inj olanzapine 2.5mg |
S0169 |
Calcitrol |
S0170 |
Anastrozole 1 mg |
S0171 |
Bumetanide 0.5 mg |
S0172 |
Chlorambucil 2 mg |
S0174 |
Dolasetron 50 mg |
S0175 |
Flutamide 125 mg |
S0176 |
Hydroxyurea 500 mg |
S0177 |
Levamisole 50 mg |
S0178 |
Lomustine 10 mg |
S0179 |
Megestrol 20 mg |
S0182 |
Procarbazine, oral |
S0183 |
Prochlorperazine 5 mg |
S0187 |
Tamoxifen 10 mg |
S0189 |
Testosterone pellet 75 mg |
S0190 |
Mifepristone, oral, 200 mg |
S0191 |
Misoprostol, oral, 200 mcg |
S0194 |
Vitamin suppl 100 caps |
S0197 |
Prenatal vitamins 30 day |
S0199 |
Med abortion inc all ex drug |
S0201 |
Partial hospitalization serv |
S0207 |
Paramedicintercep nonhospals |
S0208 |
Paramed intrcept nonvol |
S0209 |
Wc van mileage per mi |
S0215 |
Nonemerg transp mileage |
S0220 |
Medical conference by physic |
S0221 |
Medical conference, 60 min |
S0250 |
Comp geriatr assmt team |
S0255 |
Hospice refer visit nonmd |
S0257 |
End of life counseling |
S0260 |
H&p for surgery |
S0265 |
Genetic counsel 15 mins |
S0270 |
Home std case rate 30 days |
S0271 |
Home hospice case 30 days |
S0272 |
Home episodic case 30 days |
S0273 |
Md home visit outside cap |
S0274 |
Nurse practr visit outs cap |
S0280 |
Medical home, initial plan |
S0281 |
Medical home, maintenance |
S0285 |
Cnslt before screen colonosc |
S0302 |
Completed epsdt |
S0310 |
Hospitalist visit |
S0311 |
Comp mgmt care coord adv ill |
S0315 |
Disease management program |
S0316 |
Follow-up/reassessment |
S0317 |
Disease mgmt per diem |
S0320 |
Rn telephone calls to dmp |
S0340 |
Lifestyle mod 1st stage |
S0341 |
Lifestyle mod 2 or 3 stage |
S0342 |
Lifestyle mod 4th stage |
S0353 |
Cancer treatmentplan initial |
S0354 |
Cancer treatment plan change |
S0390 |
Rout foot care per visit |
S0395 |
Impression casting ft |
S0400 |
Global eswl kidney |
S0500 |
Dispos cont lens |
S0504 |
Singl prscrp lens |
S0506 |
Bifoc prscp lens |
S0508 |
Trifoc prscrp lens |
S0510 |
Non-prscrp lens |
S0512 |
Daily cont lens |
S0514 |
Color cont lens |
S0515 |
Scleral lens liquid bandage |
S0516 |
Safety frames |
S0518 |
Sunglass frames |
S0580 |
Polycarb lens |
S0581 |
Nonstnd lens |
S0590 |
Misc integral lens serv |
S0592 |
Comp cont lens eval |
S0595 |
New lenses in pts old frame |
S0596 |
Phakic iol refractive error |
S0601 |
Screening proctoscopy |
S0610 |
Annual gynecological examina |
S0612 |
Annual gynecological examina |
S0613 |
Ann breast exam |
S0618 |
Audiometry for hearing aid |
S0620 |
Routine ophthalmological exa |
S0621 |
Routine ophthalmological exa |
S0622 |
Phys exam for college |
S0630 |
Removal of sutures |
S0800 |
Laser in situ keratomileusis |
S0810 |
Photorefractive keratectomy |
S0812 |
Phototherap keratect |
S1001 |
Deluxe item |
S1002 |
Custom item |
S1015 |
Iv tubing extension set |
S1016 |
Non-pvc intravenous administ |
S1030 |
Gluc monitor purchase |
S1031 |
Gluc monitor rental |
S1034 |
Art pancreas system |
S1035 |
Art pancreas inv disp sensor |
S1036 |
Art pancreas ext transmitter |
S1037 |
Art pancreas ext receiver |
S1040 |
Cranial remolding orthosis |
S2053 |
Transplantation of small int |
S2054 |
Transplantation of multivisc |
S2055 |
Harvesting of donor multivis |
S2060 |
Lobar lung transplantation |
S2061 |
Donor lobectomy (lung) |
S2065 |
Simult panc kidn trans |
S2066 |
Breast gap flap reconst |
S2067 |
including harvesting of the flap(s) |
S2068 |
Breast diep or siea flap |
S2070 |
Cysto laser tx ureteral calc |
S2079 |
Lap esophagomyotomy |
S2080 |
Laup |
S2083 |
Adjustment gastric band |
S2095 |
Transcath emboliz microspher |
S2102 |
Islet cell tissue transplant |
S2103 |
Adrenal tissue transplant |
S2107 |
Adoptive immunotherapy |
S2112 |
Knee arthroscp harv |
S2115 |
Periacetabular osteotomy |
S2117 |
Arthroereisis, subtalar |
S2118 |
Total hip resurfacing |
S2120 |
Low density lipoprotein(ldl) |
S2140 |
Cord blood harvesting |
S2142 |
Cord blood-derived stem-cell |
S2150 |
Bmt harv/transpl 28d pkg |
S2152 |
Solid organ transpl pkg |
S2202 |
Echosclerotherapy |
S2205 |
Minimally invasive direct co |
S2206 |
Minimally invasive direct co |
S2207 |
Minimally invasive direct co |
S2208 |
Minimally invasive direct co |
S2209 |
Minimally invasive direct co |
S2225 |
Myringotomy laser-assist |
S2230 |
Implant semi-imp hear |
S2235 |
Implant auditory brain imp |
S2260 |
Induced abortion 17-24 weeks |
S2265 |
Induced abortion 25-28 wks |
S2266 |
Induced abortion 29-31 wks |
S2267 |
Induced abortion 32 or more |
S2300 |
Arthroscopy, shoulder, surgi |
S2325 |
Hip core decompression |
S2340 |
Chemodenervation of abductor |
S2341 |
Chemodenerv adduct vocal |
S2342 |
Nasal endoscop po debrid |
S2348 |
Decompress disc rf lumbar |
S2350 |
Diskectomy, anterior, with d |
S2351 |
Diskectomy, anterior, with d |
S2400 |
Fetal surg congen hernia |
S2401 |
Fetal surg urin trac obstr |
S2402 |
Fetal surg cong cyst malf |
S2403 |
Fetal surg pulmon sequest |
S2404 |
Fetal surg myelomeningo |
S2405 |
Fetal surg sacrococ teratoma |
S2409 |
Fetal surg noc |
S2411 |
Fetoscop laser ther ttts |
S2900 |
Robotic surgical system |
S3000 |
Bilat dil retinal exam |
S3005 |
Eval self-assess depression |
S3600 |
Stat lab |
S3601 |
Stat lab home/nf |
S3620 |
Newborn metabolic screening |
S3630 |
Eosinophil blood count |
S3645 |
Hiv-1 antibody testing of or |
S3650 |
Saliva test, hormone level; |
S3652 |
Saliva test, hormone level; |
S3655 |
Antisperm antibodies test |
S3708 |
Gastrointestinal fat absorpt |
S3722 |
Dose optimization auc - 5fu |
S3800 |
Genetic testing als |
S3840 |
Dna analysis ret-oncogene |
S3841 |
Gene test retinoblastoma |
S3842 |
Gene test hippel-lindau |
S3844 |
Dna analysis deafness |
S3845 |
Gene test alpha-thalassemia |
S3846 |
Gene test beta-thalassemia |
S3849 |
Gene test niemann-pick |
S3850 |
Gene test sickle cell |
S3852 |
Dna analysis apoe alzheimer |
S3853 |
Gene test myo musclr dyst |
S3854 |
Gene profile panel breast |
S3861 |
Genetic test brugada |
S3865 |
Comp genet test hyp cardiomy |
S3866 |
Spec gene test hyp cardiomy |
S3870 |
Cgh test developmental delay |
S3900 |
Surface emg |
S3902 |
Ballistocardiogram |
S3904 |
Masters two step |
S4005 |
Interim labor facility globa |
S4011 |
Ivf package |
S4013 |
Compl gift case rate |
S4014 |
Compl zift case rate |
S4015 |
Complete ivf nos case rate |
S4016 |
Frozen ivf case rate |
S4017 |
Ivf canc a stim case rate |
S4018 |
F emb trns canc case rate |
S4020 |
Ivf canc a aspir case rate |
S4021 |
Ivf canc p aspir case rate |
S4022 |
Asst oocyte fert case rate |
S4023 |
Incompl donor egg case rate |
S4025 |
Donor serv ivf case rate |
S4026 |
Procure donor sperm |
S4027 |
Store prev froz embryos |
S4028 |
Microsurg epi sperm asp |
S4030 |
Sperm procure init visit |
S4031 |
Sperm procure subs visit |
S4035 |
Stimulated iui case rate |
S4037 |
Cryo embryo transf case rate |
S4040 |
Monit store cryo embryo 30 d |
S4042 |
Ovulation mgmt per cycle |
S4981 |
Insert levonorgestrel ius |
S4989 |
Contracept iud |
S4990 |
Nicotine patch legend |
S4991 |
Nicotine patch nonlegend |
S4993 |
Contraceptive pills for bc |
S4995 |
Smoking cessation gum |
S5000 |
Prescription drug, generic |
S5001 |
Prescription drug,brand name |
S5010 |
5% dextrose and 0.45% saline |
S5012 |
5% dextrose with potassium |
S5013 |
5%dextrose/0.45%saline1000ml |
S5014 |
D5w/0.45ns w kcl and mgs04 |
S5035 |
Hit routine device maint |
S5036 |
Hit device repair |
S5100 |
Adult daycare services 15min |
S5101 |
Adult day care per half day |
S5102 |
Adult day care per diem |
S5105 |
Centerbased day care perdiem |
S5108 |
Homecare train pt 15 min |
S5109 |
Homecare train pt session |
S5110 |
Family homecare training 15m |
S5111 |
Family homecare train/sessio |
S5115 |
Nonfamily homecare train/15m |
S5116 |
Nonfamily hc train/session |
S5120 |
Chore services per 15 min |
S5121 |
Chore services per diem |
S5125 |
Attendant care service /15m |
S5126 |
Attendant care service /diem |
S5130 |
Homaker service nos per 15m |
S5131 |
Homemaker service nos /diem |
S5135 |
Adult companioncare per 15m |
S5136 |
Adult companioncare per diem |
S5140 |
Adult foster care per diem |
S5141 |
Adult foster care per month |
S5145 |
Child fostercare th per diem |
S5146 |
Ther fostercare child /month |
S5150 |
Unskilled respite care /15m |
S5151 |
Unskilled respitecare /diem |
S5160 |
Emer response sys instal&tst |
S5161 |
Emer rspns sys serv permonth |
S5162 |
Emer rspns system purchase |
S5165 |
Home modifications per serv |
S5170 |
Homedelivered prepared meal |
S5175 |
Laundry serv,ext,prof,/order |
S5180 |
Hh respiratory thrpy in eval |
S5181 |
Hh respiratory thrpy nos/day |
S5185 |
Med reminder serv per month |
S5190 |
Wellness assessment by nonph |
S5199 |
Personal care item nos each |
S5497 |
Hit cath care noc |
S5498 |
Hit simple cath care |
S5501 |
Hit complex cath care |
S5502 |
Hit interim cath care |
S5517 |
Hit declotting kit |
S5518 |
Hit cath repair kit |
S5520 |
Hit picc insert kit |
S5521 |
Hit midline cath insert kit |
S5522 |
Hit picc insert no supp |
S5523 |
Hip midline cath insert kit |
S5550 |
Insulin rapid 5 u |
S5551 |
Insulin most rapid 5 u |
S5552 |
Insulin intermed 5 u |
S5553 |
Insulin long acting 5 u |
S5560 |
Insulin reuse pen 1.5 ml |
S5561 |
Insulin reuse pen 3 ml |
S5565 |
Insulin cartridge 150 u |
S5566 |
Insulin cartridge 300 u |
S5570 |
Insulin dispos pen 1.5 ml |
S5571 |
Insulin dispos pen 3 ml |
S8030 |
Tantalum ring application |
S8035 |
Magnetic source imaging |
S8037 |
Mrcp |
S8040 |
Topographic brain mapping |
S8042 |
Mri low field |
S8055 |
Us guidance fetal reduct |
S8080 |
Scintimammography |
S8085 |
Fluorine-18 fluorodeoxygluco |
S8092 |
Electron beam computed tomog |
S8096 |
Portable peak flow meter |
S8097 |
Asthma kit |
S8100 |
Spacer without mask |
S8101 |
Spacer with mask |
S8110 |
Peak expiratory flow rate (p |
S8120 |
O2 contents gas cubic ft |
S8121 |
O2 contents liquid lb |
S8130 |
Interferential stim 2 chan |
S8131 |
Interferential stim 4 chan |
S8185 |
Flutter device |
S8186 |
Swivel adaptor |
S8189 |
Trach supply noc |
S8210 |
Mucus trap |
S8265 |
Haberman feeder |
S8270 |
Enuresis alarm |
S8301 |
Infect control supplies nos |
S8415 |
Supplies for home delivery |
S8420 |
Custom gradient sleev/glov |
S8421 |
Ready gradient sleev/glov |
S8422 |
Custom grad sleeve med |
S8423 |
Custom grad sleeve heavy |
S8424 |
Ready gradient sleeve |
S8425 |
Custom grad glove med |
S8426 |
Custom grad glove heavy |
S8427 |
Ready gradient glove |
S8428 |
Ready gradient gauntlet |
S8429 |
Gradient pressure wrap |
S8430 |
Padding for comprssn bdg |
S8431 |
Compression bandage |
S8450 |
Splint digit |
S8451 |
Splint wrist or ankle |
S8452 |
Splint elbow |
S8460 |
Camisole post-mast |
S8490 |
100 insulin syringes |
S8930 |
Auricular electrostimulation |
S8940 |
Hippotherapy per session |
S8948 |
Low-level laser trmt 15 min |
S8950 |
Complex lymphedema therapy, |
S8990 |
Pt or manip for maint |
S8999 |
Resuscitation bag |
S9001 |
Home uterine monitor with or |
S9007 |
Ultrafiltration monitor |
S9024 |
Paranasal sinus ultrasound |
S9025 |
Omnicardiogram/cardiointegra |
S9034 |
Eswl for gallstones |
S9055 |
Procuren or other growth fac |
S9056 |
Coma stimulation per diem |
S9061 |
Medical supplies and equipme |
S9083 |
Urgent care center global |
S9088 |
Services provided in urgent |
S9090 |
Vertebral axial decompressio |
S9097 |
Home visit wound care |
S9098 |
Home phototherapy visit |
S9110 |
Telemonitoring/home per mnth |
S9117 |
Back school visit |
S9122 |
Home health aide or certifie |
S9123 |
Nursing care in home rn |
S9124 |
Nursing care, in the home; b |
S9125 |
Respite care, in the home, p |
S9126 |
Hospice care, in the home, p |
S9127 |
Social work visit, in the ho |
S9128 |
Speech therapy, in the home, |
S9129 |
Occupational therapy, in the |
S9131 |
Pt in the home per diem |
S9140 |
Diabetic management program, |
S9141 |
Diabetic management program, |
S9145 |
Insulin pump initiation |
S9150 |
Evaluation by ocularist |
S9152 |
Speech therapy, re-eval |
S9208 |
Home mgmt preterm labor |
S9209 |
Home mgmt pprom |
S9211 |
Home mgmt gest hypertension |
S9212 |
Hm postpar hyper per diem |
S9213 |
Hm preeclamp per diem |
S9214 |
Hm gest dm per diem |
S9325 |
Hit pain mgmt per diem |
S9326 |
Hit cont pain per diem |
S9327 |
Hit int pain per diem |
S9328 |
Hit pain imp pump diem |
S9329 |
Hit chemo per diem |
S9330 |
Hit cont chem diem |
S9331 |
Hit intermit chemo diem |
S9335 |
Ht hemodialysis diem |
S9336 |
Hit cont anticoag diem |
S9338 |
Hit immunotherapy diem |
S9339 |
Hit periton dialysis diem |
S9340 |
Hit enteral per diem |
S9341 |
Hit enteral grav diem |
S9342 |
Hit enteral pump diem |
S9343 |
Hit enteral bolus nurs |
S9345 |
Hit anti-hemophil diem |
S9346 |
Hit alpha-1-proteinas diem |
S9347 |
Hit longterm infusion diem |
S9348 |
Hit sympathomim diem |
S9349 |
Hit tocolysis diem |
S9351 |
Hit cont antiemetic diem |
S9353 |
Hit cont insulin diem |
S9355 |
Hit chelation diem |
S9357 |
Hit enzyme replace diem |
S9359 |
Hit anti-tnf per diem |
S9361 |
Hit diuretic infus diem |
S9363 |
Hit anti-spasmotic diem |
S9364 |
Hit tpn total diem |
S9365 |
Hit tpn 1 liter diem |
S9366 |
Hit tpn 2 liter diem |
S9367 |
Hit tpn 3 liter diem |
S9368 |
Hit tpn over 3l diem |
S9370 |
Ht inj antiemetic diem |
S9372 |
Ht inj anticoag diem |
S9373 |
Hit hydra total diem |
S9374 |
Hit hydra 1 liter diem |
S9375 |
Hit hydra 2 liter diem |
S9376 |
Hit hydra 3 liter diem |
S9377 |
Hit hydra over 3l diem |
S9379 |
Hit noc per diem |
S9381 |
Hit high risk/escort |
S9401 |
Anticoag clinic per session |
S9430 |
Pharmacy comp/disp serv |
S9433 |
Medical food oral 100% nutr |
S9434 |
Mod solid food suppl |
S9435 |
Medical foods for inborn err |
S9436 |
Lamaze class |
S9437 |
Childbirth refresher class |
S9438 |
Cesarean birth class |
S9439 |
Vbac class |
S9441 |
Asthma education |
S9442 |
Birthing class |
S9443 |
Lactation class |
S9444 |
Parenting class |
S9445 |
Pt education noc individ |
S9446 |
Pt education noc group |
S9447 |
Infant safety class |
S9449 |
Weight mgmt class |
S9451 |
Exercise class |
S9452 |
Nutrition class |
S9453 |
Smoking cessation class |
S9454 |
Stress mgmt class |
S9455 |
Diabetic management program, |
S9460 |
Diabetic management program, |
S9465 |
Diabetic management program, |
S9470 |
Nutritional counseling, diet |
S9472 |
Cardiac rehabilitation progr |
S9473 |
Pulmonary rehabilitation pro |
S9474 |
Enterostomal therapy by a re |
S9475 |
Ambulatory setting substance |
S9476 |
Vestibular rehab per diem |
S9480 |
Intensive outpatient psychia |
S9482 |
Family stabilization 15 min |
S9484 |
Crisis intervention per hour |
S9485 |
Crisis intervention mental h |
S9490 |
Hit corticosteroid/diem |
S9494 |
Hit antibiotic total diem |
S9497 |
Hit antibiotic q3h diem |
S9500 |
Hit antibiotic q24h diem |
S9501 |
Hit antibiotic q12h diem |
S9502 |
Hit antibiotic q8h diem |
S9503 |
Hit antibiotic q6h diem |
S9504 |
Hit antibiotic q4h diem |
S9529 |
Venipuncture home/snf |
S9537 |
Ht hem horm inj diem |
S9538 |
Hit blood products diem |
S9542 |
Ht inj noc per diem |
S9558 |
Ht inj growth horm diem |
S9559 |
Hit inj interferon diem |
S9560 |
Ht inj hormone diem |
S9562 |
Ht inj palivizumab diem |
S9590 |
Ht irrigation diem |
S9810 |
Ht pharm per hour |
S9900 |
Christian sci pract visit |
S9901 |
Christian sci nurse visit |
S9960 |
Air ambulanc nonemerg fixed |
S9961 |
Air ambulan nonemerg rotary |
S9970 |
Health club membership yr |
S9975 |
Transplant related per diem |
S9976 |
Lodging per diem |
S9977 |
Meals per diem |
S9981 |
Med record copy admin |
S9982 |
Med record copy per page |
S9986 |
Not medically necessary svc |
S9988 |
Serv part of phase i trial |
S9989 |
Services outside us |
S9990 |
Services provided as part of |
S9991 |
Services provided as part of |
S9992 |
Transportation costs to and |
S9994 |
Lodging costs (e.g. hotel ch |
S9996 |
Meals for clinical trial par |
S9999 |
Sales tax |