Type of Service (TOS) Indicator P: Lump Sum Purchase of DME, Prosthetics, Orthotics
Special Considerations/Exceptions
For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is P or 1,
- Use TOS P if the drug is administered through durable medical equipment (DME); or
- Use TOS 1 if the drug is administered in the office.
HCPCS codes | ||
| Code | Description | |
|---|---|---|
| A4216 | Sterile water, saline and/or dextrose, diluent/flush, 10 ml | |
| A4217 | Sterile water/saline, 500 ml | |
| A4218 | Sterile saline or water, metered dose dispenser, 10 ml | |
| A4220 | Refill kit for implantable infusion pump | |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) | |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | |
| A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) | |
| A4224 | Supplies for maintenance of insulin infusion catheter, per week | |
| A4225 | Supplies for external insulin infusion pump, syringe type cartridge, sterile, each | |
| A4230 | Infusion set for external insulin pump, non needle cannula type | |
| A4231 | Infusion set for external insulin pump, needle type | |
| A4232 | Syringe with needle for external insulin pump, sterile, 3 cc | |
| A4233 | Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each | |
| A4234 | Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each | |
| A4235 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each | |
| A4236 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each | |
| A4252 | Blood ketone test or reagent strip, each | |
| A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips | |
| A4254 | REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH | |
| A4255 | Platforms for home blood glucose monitor, 50 per box | |
| A4256 | Normal, low and high calibrator solution / chips | |
| A4257 | Replacement lens shield cartridge for use with laser skin piercing device, each | |
| A4258 | Spring-powered device for lancet, each | |
| A4259 | Lancets, per box of 100 | |
| A4280 | Adhesive skin support attachment for use with external breast prosthesis, each | |
| A4310 | Insertion tray without drainage bag and without catheter (accessories only) | |
| A4311 | Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) | |
| A4312 | Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone | |
| A4313 | Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation | |
| A4314 | Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) | |
| A4315 | Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone | |
| A4316 | Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation | |
| A4320 | Irrigation tray with bulb or piston syringe, any purpose | |
| A4321 | Therapeutic agent for urinary catheter irrigation | |
| A4322 | Irrigation syringe, bulb or piston, each | |
| A4324 | MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH | |
| A4325 | MALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH | |
| A4326 | Male external catheter with integral collection chamber, any type, each | |
| A4327 | Female external urinary collection device; meatal cup, each | |
| A4328 | Female external urinary collection device; pouch, each | |
| A4330 | Perianal fecal collection pouch with adhesive, each | |
| A4331 | Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each | |
| A4332 | Lubricant, individual sterile packet, each | |
| A4333 | Urinary catheter anchoring device, adhesive skin attachment, each | |
| A4334 | Urinary catheter anchoring device, leg strap, each | |
| A4335 | Incontinence supply; miscellaneous | |
| A4336 | Incontinence supply, urethral insert, any type, each | |
| A4337 | Incontinence supply, rectal insert, any type, each | |
| A4338 | Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each | |
| A4340 | Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each | |
| A4341 | Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each | |
| A4342 | Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each | |
| A4344 | Indwelling catheter, foley type, two-way, all silicone, each | |
| A4346 | Indwelling catheter; foley type, three way for continuous irrigation, each | |
| A4347 | MALE EXTERNAL CATHETER WITH OR WITHOUT ADHESIVE, WITH OR WITHOUT ANTI-REFLUX DEVICE; PER DOZEN | |
| A4348 | MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION COMPARTMENT, EXTENDED WEAR, EACH (E.G., 2 PER MONTH) | |
| A4349 | Male external catheter, with or without adhesive, disposable, each | |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each | |
| A4352 | Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each | |
| A4353 | Intermittent urinary catheter, with insertion supplies | |
| A4354 | Insertion tray with drainage bag but without catheter | |
| A4355 | Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each | |
| A4356 | External urethral clamp or compression device (not to be used for catheter clamp), each | |
| A4357 | Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each | |
| A4358 | Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each | |
| A4359 | URINARY SUSPENSORY WITHOUT LEG BAG, EACH | |
| A4361 | Ostomy faceplate, each | |
| A4362 | Skin barrier; solid, 4 x 4 or equivalent; each | |
| A4363 | Ostomy clamp, any type, replacement only, each | |
| A4364 | Adhesive, liquid or equal, any type, per oz | |
| A4365 | ADHESIVE REMOVER WIPES, ANY TYPE, PER 50 | |
| A4366 | Ostomy vent, any type, each | |
| A4367 | Ostomy belt, each | |
| A4368 | Ostomy filter, any type, each | |
| A4369 | Ostomy skin barrier, liquid (spray, brush, etc.), per oz | |
| A4371 | Ostomy skin barrier, powder, per oz | |
| A4372 | Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each | |
| A4373 | Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each | |
| A4375 | Ostomy pouch, drainable, with faceplate attached, plastic, each | |
| A4376 | Ostomy pouch, drainable, with faceplate attached, rubber, each | |
| A4377 | Ostomy pouch, drainable, for use on faceplate, plastic, each | |
| A4378 | Ostomy pouch, drainable, for use on faceplate, rubber, each | |
| A4379 | Ostomy pouch, urinary, with faceplate attached, plastic, each | |
| A4380 | Ostomy pouch, urinary, with faceplate attached, rubber, each | |
| A4381 | Ostomy pouch, urinary, for use on faceplate, plastic, each | |
| A4382 | Ostomy pouch, urinary, for use on faceplate, heavy plastic, each | |
| A4383 | Ostomy pouch, urinary, for use on faceplate, rubber, each | |
| A4384 | Ostomy faceplate equivalent, silicone ring, each | |
| A4385 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each | |
| A4387 | Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each | |
| A4388 | Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each | |
| A4389 | Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each | |
| A4390 | Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each | |
| A4391 | Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each | |
| A4392 | Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each | |
| A4393 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each | |
| A4394 | Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce | |
| A4395 | Ostomy deodorant for use in ostomy pouch, solid, per tablet | |
| A4396 | Ostomy belt with peristomal hernia support | |
| A4397 | Irrigation supply; sleeve, each | |
| A4398 | Ostomy irrigation supply; bag, each | |
| A4399 | Ostomy irrigation supply; cone/catheter, with or without brush | |
| A4400 | Ostomy irrigation set | |
| A4402 | Lubricant, per ounce | |
| A4404 | Ostomy ring, each | |
| A4405 | Ostomy skin barrier, non-pectin based, paste, per ounce | |
| A4406 | Ostomy skin barrier, pectin-based, paste, per ounce | |
| A4407 | Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each | |
| A4408 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each | |
| A4409 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each | |
| A4410 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each | |
| A4411 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each | |
| A4412 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each | |
| A4413 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each | |
| A4414 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each | |
| A4415 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each | |
| A4416 | Ostomy pouch, closed, with barrier attached, with filter (1 piece), each | |
| A4417 | Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each | |
| A4418 | Ostomy pouch, closed; without barrier attached, with filter (1 piece), each | |
| A4419 | Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each | |
| A4420 | Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each | |
| A4421 | Ostomy supply; miscellaneous | |
| A4422 | Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each | |
| A4423 | Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each | |
| A4424 | Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each | |
| A4425 | Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each | |
| A4426 | Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each | |
| A4427 | Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each | |
| A4428 | Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each | |
| A4429 | Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each | |
| A4430 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each | |
| A4431 | Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each | |
| A4432 | Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each | |
| A4433 | Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each | |
| A4434 | Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each | |
| A4435 | Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each | |
| A4450 | Tape, non-waterproof, per 18 square inches | |
| A4452 | Tape, waterproof, per 18 square inches | |
| A4454 | TAPE, ALL TYPES, ALL SIZES | |
| A4455 | Adhesive remover or solvent (for tape, cement or other adhesive), per ounce | |
| A4456 | Adhesive remover, wipes, any type, each | |
| A4470 | Gravlee jet washer | |
| A4480 | Vabra aspirator | |
| A4481 | Tracheostoma filter, any type, any size, each | |
| A4483 | Moisture exchanger, disposable, for use with invasive mechanical ventilation | |
| A4490 | Surgical stockings above knee length, each | |
| A4495 | Surgical stockings thigh length, each | |
| A4500 | Surgical stockings below knee length, each | |
| A4510 | Surgical stockings full length, each | |
| A4555 | Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only | |
| A4556 | Electrodes, (e.g., apnea monitor), per pair | |
| A4557 | Lead wires, (e.g., apnea monitor), per pair | |
| A4558 | Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz | |
| A4559 | Coupling gel or paste, for use with ultrasound device, per oz | |
| A4560 | Neuromuscular electrical stimulator (nmes), disposable, replacement only | |
| A4561 | Pessary, rubber, any type | |
| A4562 | Pessary, non rubber, any type | |
| A4563 | Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each | |
| A4565 | Slings | |
| A4570 | Splint | |
| A4595 | Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) | |
| A4596 | Cranial electrotherapy stimulation (ces) system supplies and accessories, per month | |
| A4600 | Sleeve for intermittent limb compression device, replacement only, each | |
| A4601 | Lithium ion battery, rechargeable, for non-prosthetic use, replacement | |
| A4602 | Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each | |
| A4604 | Tubing with integrated heating element for use with positive airway pressure device | |
| A4605 | Tracheal suction catheter, closed system, each | |
| A4608 | Transtracheal oxygen catheter, each | |
| A4609 | TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR LESS THAN 72 HOURS OF USE, EACH | |
| A4610 | TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR 72 OR MORE HOURS OF USE, EACH | |
| A4611 | Battery, heavy duty; replacement for patient owned ventilator | |
| A4612 | Battery cables; replacement for patient-owned ventilator | |
| A4613 | Battery charger; replacement for patient-owned ventilator | |
| 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 catheter, any type other than closed system, each | |
| A4625 | Tracheostomy care kit for new tracheostomy | |
| A4626 | Tracheostomy cleaning brush, each | |
| A4628 | Oral and/or oropharyngeal suction catheter, each | |
| A4629 | Tracheostomy care kit for established tracheostomy | |
| A4630 | Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient | |
| A4632 | REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH | |
| A4633 | Replacement bulb/lamp for ultraviolet light therapy system, each | |
| A4635 | Underarm pad, crutch, replacement, each | |
| A4636 | Replacement, handgrip, cane, crutch, or walker, each | |
| A4637 | Replacement, tip, cane, crutch, walker, each. | |
| A4638 | Replacement battery for patient-owned ear pulse generator, each | |
| A4639 | Replacement pad for infrared heating pad system, each | |
| A4640 | Replacement pad for use with medically necessary alternating pressure pad owned by patient | |
| A5051 | Ostomy pouch, closed; with barrier attached (1 piece), each | |
| A5052 | Ostomy pouch, closed; without barrier attached (1 piece), each | |
| A5053 | Ostomy pouch, closed; for use on faceplate, each | |
| A5054 | Ostomy pouch, closed; for use on barrier with flange (2 piece), each | |
| A5055 | Stoma cap | |
| A5056 | Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each | |
| A5057 | Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each | |
| A5061 | Ostomy pouch, drainable; with barrier attached, (1 piece), each | |
| A5062 | Ostomy pouch, drainable; without barrier attached (1 piece), each | |
| A5063 | Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each | |
| A5071 | Ostomy pouch, urinary; with barrier attached (1 piece), each | |
| A5072 | Ostomy pouch, urinary; without barrier attached (1 piece), each | |
| A5073 | Ostomy pouch, urinary; for use on barrier with flange (2 piece), each | |
| A5081 | Stoma plug or seal, any type | |
| A5082 | Continent device; catheter for continent stoma | |
| A5083 | Continent device, stoma absorptive cover for continent stoma | |
| A5093 | Ostomy accessory; convex insert | |
| A5102 | Bedside drainage bottle with or without tubing, rigid or expandable, each | |
| A5105 | Urinary suspensory with leg bag, with or without tube, each | |
| A5112 | Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each | |
| A5113 | Leg strap; latex, replacement only, per set | |
| A5114 | Leg strap; foam or fabric, replacement only, per set | |
| A5119 | SKIN BARRIER, WIPES OR SWABS, PER BOX 50 | |
| A5120 | Skin barrier, wipes or swabs, each | |
| A5121 | Skin barrier; solid, 6 x 6 or equivalent, each | |
| A5122 | Skin barrier; solid, 8 x 8 or equivalent, each | |
| A5126 | Adhesive or non-adhesive; disk or foam pad | |
| A5131 | Appliance cleaner, incontinence and ostomy appliances, per 16 oz. | |
| A5200 | Percutaneous catheter/tube anchoring device, adhesive skin attachment | |
| A6000 | Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card | |
| A6413 | Adhesive bandage, first-aid type, any size, each | |
| A6441 | Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard | |
| A6442 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard | |
| A6443 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard | |
| A6444 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard | |
| A6445 | Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard | |
| A6446 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard | |
| A6447 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard | |
| A6448 | Light compression bandage, elastic, knitted/woven, width less than three inches, per yard | |
| A6449 | Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | |
| A6450 | Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard | |
| A6451 | 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 | |
| A6452 | 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 | |
| A6453 | Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard | |
| A6454 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard | |
| A6455 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard | |
| A6456 | Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | |
| A6457 | Tubular dressing with or without elastic, any width, per linear yard | |
| A6460 | Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6461 | 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 | |
| A6501 | Compression burn garment, bodysuit (head to foot), custom fabricated | |
| A6502 | Compression burn garment, chin strap, custom fabricated | |
| A6503 | Compression burn garment, facial hood, custom fabricated | |
| A6504 | Compression burn garment, glove to wrist, custom fabricated | |
| A6505 | Compression burn garment, glove to elbow, custom fabricated | |
| A6506 | Compression burn garment, glove to axilla, custom fabricated | |
| A6507 | Compression burn garment, foot to knee length, custom fabricated | |
| A6508 | Compression burn garment, foot to thigh length, custom fabricated | |
| A6509 | Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated | |
| A6510 | Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated | |
| A6511 | Compression burn garment, lower trunk including leg openings (panty), custom fabricated | |
| A6512 | Compression burn garment, not otherwise classified | |
| A6513 | Compression burn mask, face and/or neck, plastic or equal, custom fabricated | |
| A6530 | Gradient compression stocking, below knee, 18-30 mmhg, each | |
| A6531 | Gradient compression stocking, below knee, 30-40 mmhg, each | |
| A6532 | Gradient compression stocking, below knee, 40-50 mmhg, each | |
| A6533 | Gradient compression stocking, thigh length, 18-30 mmhg, each | |
| A6534 | Gradient compression stocking, thigh length, 30-40 mmhg, each | |
| A6535 | Gradient compression stocking, thigh length, 40-50 mmhg, each | |
| A6536 | Gradient compression stocking, full length/chap style, 18-30 mmhg, each | |
| A6537 | Gradient compression stocking, full length/chap style, 30-40 mmhg, each | |
| A6538 | Gradient compression stocking, full length/chap style, 40-50 mmhg, each | |
| A6539 | Gradient compression stocking, waist length, 18-30 mmhg, each | |
| A6540 | Gradient compression stocking, waist length, 30-40 mmhg, each | |
| A6541 | Gradient compression stocking, waist length, 40-50 mmhg, each | |
| A6542 | GRADIENT COMPRESSION STOCKING, CUSTOM MADE | |
| A6543 | GRADIENT COMPRESSION STOCKING, LYMPHEDEMA | |
| A6544 | Gradient compression stocking, garter belt | |
| A6545 | Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each | |
| A6549 | Gradient compression stocking/sleeve, not otherwise specified | |
| A6550 | Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories | |
| A6551 | CANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE, EACH | |
| A7000 | Canister, disposable, used with suction pump, each | |
| A7001 | Canister, non-disposable, used with suction pump, each | |
| A7002 | Tubing, used with suction pump, each | |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | |
| A7004 | Small volume nonfiltered pneumatic nebulizer, disposable | |
| A7005 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable | |
| A7006 | Administration set, with small volume filtered pneumatic nebulizer | |
| A7007 | Large volume nebulizer, disposable, unfilled, used with aerosol compressor | |
| A7008 | Large volume nebulizer, disposable, prefilled, used with aerosol compressor | |
| A7009 | Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer | |
| A7010 | Corrugated tubing, disposable, used with large volume nebulizer, 100 feet | |
| A7011 | Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet | |
| A7012 | Water collection device, used with large volume nebulizer | |
| A7013 | Filter, disposable, used with aerosol compressor or ultrasonic generator | |
| A7014 | Filter, nondisposable, used with aerosol compressor or ultrasonic generator | |
| A7015 | Aerosol mask, used with dme nebulizer | |
| A7016 | Dome and mouthpiece, used with small volume ultrasonic nebulizer | |
| A7017 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen | |
| A7018 | Water, distilled, used with large volume nebulizer, 1000 ml | |
| A7020 | Interface for cough stimulating device, includes all components, replacement only | |
| A7025 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each | |
| A7026 | High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each | |
| A7027 | Combination oral/nasal mask, used with continuous positive airway pressure device, each | |
| A7028 | Oral cushion for combination oral/nasal mask, replacement only, each | |
| A7029 | Nasal pillows for combination oral/nasal mask, replacement only, pair | |
| A7030 | Full face mask used with positive airway pressure device, each | |
| A7031 | Face mask interface, replacement for full face mask, each | |
| A7032 | Cushion for use on nasal mask interface, replacement only, each | |
| A7033 | Pillow for use on nasal cannula type interface, replacement only, pair | |
| A7034 | Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap | |
| A7035 | Headgear used with positive airway pressure device | |
| A7036 | Chinstrap used with positive airway pressure device | |
| A7037 | Tubing used with positive airway pressure device | |
| A7038 | Filter, disposable, used with positive airway pressure device | |
| A7039 | Filter, non disposable, used with positive airway pressure device | |
| A7040 | One way chest drain valve | |
| A7041 | Water seal drainage container and tubing for use with implanted chest tube | |
| A7042 | Implanted pleural catheter, each | |
| A7043 | Vacuum drainage bottle and tubing for use with implanted catheter | |
| A7044 | Oral interface used with positive airway pressure device, each | |
| A7045 | Exhalation port with or without swivel used with accessories for positive airway devices, replacement only | |
| A7046 | Water chamber for humidifier, used with positive airway pressure device, replacement, each | |
| A7047 | Oral interface used with respiratory suction pump, each | |
| A7048 | Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each | |
| A7049 | Expiratory positive airway pressure intranasal resistance valve | |
| A7501 | Tracheostoma valve, including diaphragm, each | |
| A7502 | Replacement diaphragm/faceplate for tracheostoma valve, each | |
| A7503 | Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each | |
| A7504 | Filter for use in a tracheostoma heat and moisture exchange system, each | |
| A7505 | Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each | |
| A7506 | Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each | |
| A7507 | Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each | |
| A7508 | Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each | |
| A7509 | Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each | |
| A7520 | Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each | |
| A7521 | Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each | |
| A7522 | Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each | |
| A7523 | Tracheostomy shower protector, each | |
| A7524 | Tracheostoma stent/stud/button, each | |
| A7525 | Tracheostomy mask, each | |
| A7526 | Tracheostomy tube collar/holder, each | |
| A7527 | Tracheostomy/laryngectomy tube plug/stop, each | |
| A8000 | Helmet, protective, soft, prefabricated, includes all components and accessories | |
| A8001 | Helmet, protective, hard, prefabricated, includes all components and accessories | |
| A8002 | Helmet, protective, soft, custom fabricated, includes all components and accessories | |
| A8003 | Helmet, protective, hard, custom fabricated, includes all components and accessories | |
| A8004 | Soft interface for helmet, replacement only | |
| A9273 | Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type | |
| A9281 | Reaching/grabbing device, any type, any length, each | |
| A9284 | Spirometer, non-electronic, includes all accessories | |
| A9581 | Injection, gadoxetate disodium, 1 ml | |
| B9000 | Enteral nutrition infusion pump - without alarm | |
| B9002 | Enteral nutrition infusion pump, any type | |
| B9004 | Parenteral nutrition infusion pump, portable | |
| B9006 | Parenteral nutrition infusion pump, stationary | |
| C1178 | INJECTION, BUSULFAN, PER 6 MG | |
| C9121 | Injection, argatroban, per 5 mg | |
| E0100 | Cane, includes canes of all materials, adjustable or fixed, with tip | |
| E0105 | Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips | |
| E0110 | Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips | |
| E0111 | Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips | |
| E0112 | Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips | |
| E0113 | Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip | |
| E0114 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips | |
| E0116 | Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each | |
| E0117 | Crutch, underarm, articulating, spring assisted, each | |
| E0118 | Crutch substitute, lower leg platform, with or without wheels, each | |
| E0130 | Walker, rigid (pickup), adjustable or fixed height | |
| E0135 | Walker, folding (pickup), adjustable or fixed height | |
| E0140 | Walker, with trunk support, adjustable or fixed height, any type | |
| E0141 | Walker, rigid, wheeled, adjustable or fixed height | |
| E0143 | Walker, folding, wheeled, adjustable or fixed height | |
| E0144 | Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat | |
| E0147 | Walker, heavy duty, multiple braking system, variable wheel resistance | |
| E0148 | Walker, heavy duty, without wheels, rigid or folding, any type, each | |
| E0149 | Walker, heavy duty, wheeled, rigid or folding, any type | |
| E0153 | Platform attachment, forearm crutch, each | |
| E0154 | Platform attachment, walker, each | |
| E0155 | Wheel attachment, rigid pick-up walker, per pair | |
| E0156 | Seat attachment, walker | |
| E0157 | Crutch attachment, walker, each | |
| E0158 | Leg extensions for walker, per set of four (4) | |
| E0159 | Brake attachment for wheeled walker, replacement, each | |
| E0160 | Sitz type bath or equipment, portable, used with or without commode | |
| E0161 | Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s | |
| E0162 | Sitz bath chair | |
| E0163 | Commode chair, mobile or stationary, with fixed arms | |
| E0164 | COMMODE CHAIR, MOBILE, WITH FIXED ARMS | |
| E0167 | Pail or pan for use with commode chair, replacement only | |
| E0168 | Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each | |
| E0170 | Commode chair with integrated seat lift mechanism, electric, any type | |
| E0171 | Commode chair with integrated seat lift mechanism, non-electric, any type | |
| E0172 | Seat lift mechanism placed over or on top of toilet, any type | |
| E0175 | Foot rest, for use with commode chair, each | |
| E0176 | AIR PRESSURE PAD OR CUSHION, NONPOSITIONING | |
| E0177 | WATER PRESSURE PAD OR CUSHION, NONPOSITIONING | |
| E0178 | GEL OR GEL-LIKE PRESSURE PAD OR CUSHION, NONPOSITIONING | |
| E0179 | DRY PRESSURE PAD OR CUSHION, NONPOSITIONING | |
| E0184 | Dry pressure mattress | |
| E0185 | Gel or gel-like pressure pad for mattress, standard mattress length and width | |
| E0188 | Synthetic sheepskin pad | |
| E0189 | Lambswool sheepskin pad, any size | |
| E0191 | Heel or elbow protector, each | |
| E0192 | LOW PRESSURE AND POSITIONING EQUALIZATION PAD, FOR WHEELCHAIR | |
| E0197 | Air pressure pad for mattress, standard mattress length and width | |
| E0198 | Water pressure pad for mattress, standard mattress length and width | |
| E0199 | Dry pressure pad for mattress, standard mattress length and width | |
| E0200 | Heat lamp, without stand (table model), includes bulb, or infrared element | |
| E0205 | Heat lamp, with stand, includes bulb, or infrared element | |
| E0210 | Electric heat pad, standard | |
| E0215 | Electric heat pad, moist | |
| E0217 | Water circulating heat pad with pump | |
| E0218 | Fluid circulating cold pad with pump, any type | |
| E0220 | Hot water bottle | |
| E0221 | Infrared heating pad system | |
| E0225 | Hydrocollator unit, includes pads | |
| E0230 | Ice cap or collar | |
| E0232 | Warming card for use with the non contact wound warming device and non contact wound warming wound cover | |
| E0238 | Non-electric heat pad, moist | |
| E0239 | Hydrocollator unit, portable | |
| E0241 | Bath tub wall rail, each | |
| E0242 | Bath tub rail, floor base | |
| E0243 | Toilet rail, each | |
| E0244 | Raised toilet seat | |
| E0245 | Tub stool or bench | |
| E0246 | Transfer tub rail attachment | |
| E0247 | Transfer bench for tub or toilet with or without commode opening | |
| E0248 | Transfer bench, heavy duty, for tub or toilet with or without commode opening | |
| E0249 | Pad for water circulating heat unit, for replacement only | |
| E0271 | Mattress, innerspring | |
| E0272 | Mattress, foam rubber | |
| E0273 | Bed board | |
| E0274 | Over-bed table | |
| E0275 | Bed pan, standard, metal or plastic | |
| E0276 | Bed pan, fracture, metal or plastic | |
| E0280 | Bed cradle, any type | |
| E0300 | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure | |
| E0310 | Bed side rails, full length | |
| E0315 | Bed accessory: board, table, or support device, any type | |
| E0316 | Safety enclosure frame/canopy for use with hospital bed, any type | |
| E0325 | Urinal; male, jug-type, any material | |
| E0326 | Urinal; female, jug-type, any material | |
| E0370 | Air pressure elevator for heel | |
| E0371 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width | |
| E0372 | Powered air overlay for mattress, standard mattress length and width | |
| E0373 | Nonpowered advanced pressure reducing mattress | |
| E0433 | Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge | |
| E0441 | Stationary oxygen contents, gaseous, 1 month's supply = 1 unit | |
| E0442 | Stationary oxygen contents, liquid, 1 month's supply = 1 unit | |
| E0443 | Portable oxygen contents, gaseous, 1 month's supply = 1 unit | |
| E0444 | Portable oxygen contents, liquid, 1 month's supply = 1 unit | |
| E0457 | Chest shell (cuirass) | |
| E0481 | Intrapulmonary percussive ventilation system and related accessories | |
| E0484 | Oscillatory positive expiratory pressure device, non-electric, any type, each | |
| E0485 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment | |
| E0486 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment | |
| E0487 | Spirometer, electronic, includes all accessories | |
| E0555 | Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter | |
| E0560 | Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery | |
| E0561 | Humidifier, non-heated, used with positive airway pressure device | |
| E0562 | Humidifier, heated, used with positive airway pressure device | |
| E0571 | Aerosol compressor, battery powered, for use with small volume nebulizer | |
| E0572 | Aerosol compressor, adjustable pressure, light duty for intermittent use | |
| E0574 | Ultrasonic/electronic aerosol generator with small volume nebulizer | |
| E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter | |
| E0605 | Vaporizer, room type | |
| E0607 | Home blood glucose monitor | |
| E0610 | Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) | |
| E0615 | Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems | |
| E0620 | Skin piercing device for collection of capillary blood, laser, each | |
| E0621 | Sling or seat, patient lift, canvas or nylon | |
| E0625 | Patient lift, bathroom or toilet, not otherwise classified | |
| E0627 | Seat lift mechanism, electric, any type | |
| E0628 | Separate seat lift mechanism for use with patient owned furniture-electric | |
| E0629 | Seat lift mechanism, non-electric, any type | |
| E0637 | Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels | |
| E0638 | Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels | |
| E0641 | Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels | |
| E0642 | Standing frame/table system, mobile (dynamic stander), any size including pediatric | |
| E0650 | Pneumatic compressor, non-segmental home model | |
| E0651 | Pneumatic compressor, segmental home model without calibrated gradient pressure | |
| E0652 | Pneumatic compressor, segmental home model with calibrated gradient pressure | |
| E0655 | Non-segmental pneumatic appliance for use with pneumatic compressor, half arm | |
| E0656 | Segmental pneumatic appliance for use with pneumatic compressor, trunk | |
| E0657 | Segmental pneumatic appliance for use with pneumatic compressor, chest | |
| E0660 | Non-segmental pneumatic appliance for use with pneumatic compressor, full leg | |
| E0665 | Non-segmental pneumatic appliance for use with pneumatic compressor, full arm | |
| E0666 | Non-segmental pneumatic appliance for use with pneumatic compressor, half leg | |
| E0667 | Segmental pneumatic appliance for use with pneumatic compressor, full leg | |
| E0668 | Segmental pneumatic appliance for use with pneumatic compressor, full arm | |
| E0669 | Segmental pneumatic appliance for use with pneumatic compressor, half leg | |
| E0670 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk | |
| E0671 | Segmental gradient pressure pneumatic appliance, full leg | |
| E0672 | Segmental gradient pressure pneumatic appliance, full arm | |
| E0673 | Segmental gradient pressure pneumatic appliance, half leg | |
| E0676 | Intermittent limb compression device (includes all accessories), not otherwise specified | |
| E0677 | Non-pneumatic sequential compression garment, trunk | |
| E0691 | Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less | |
| E0692 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel | |
| E0693 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel | |
| E0694 | Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection | |
| E0700 | Safety equipment, device or accessory, any type | |
| E0701 | HELMET WITH FACE GUARD AND SOFT INTERFACE MATERIAL, PREFABRICATED | |
| E0705 | Transfer device, any type, each | |
| E0710 | Restraints, any type (body, chest, wrist or ankle) | |
| E0711 | Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion | |
| E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation | |
| E0730 | Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation | |
| E0731 | Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric) | |
| E0740 | Non-implanted pelvic floor electrical stimulator, complete system | |
| E0746 | Electromyography (emg), biofeedback device | |
| E0747 | Osteogenesis stimulator, electrical, non-invasive, other than spinal applications | |
| E0748 | Osteogenesis stimulator, electrical, non-invasive, spinal applications | |
| E0752 | IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH | |
| E0754 | PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE NEUROSTIMULATOR PULSE GENERATOR | |
| E0755 | Electronic salivary reflex stimulator (intra-oral/non-invasive) | |
| E0756 | IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR | |
| E0757 | IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER | |
| E0758 | RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER | |
| E0759 | RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT NEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT | |
| E0760 | Osteogenesis stimulator, low intensity ultrasound, non-invasive | |
| E0762 | Transcutaneous electrical joint stimulation device system, includes all accessories | |
| E0764 | Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program | |
| E0765 | Fda approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting | |
| E0770 | Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified | |
| E0776 | Iv pole | |
| E0779 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater | |
| E0780 | Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours | |
| E0782 | Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.) | |
| E0783 | Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) | |
| E0785 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement | |
| E0830 | Ambulatory traction device, all types, each | |
| E0840 | Traction frame, attached to headboard, cervical traction | |
| E0849 | Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible | |
| E0850 | Traction stand, free standing, cervical traction | |
| E0855 | Cervical traction equipment not requiring additional stand or frame | |
| E0856 | Cervical traction device, with inflatable air bladder(s) | |
| E0860 | Traction equipment, overdoor, cervical | |
| E0870 | Traction frame, attached to footboard, extremity traction, (e.g., buck's) | |
| E0880 | Traction stand, free standing, extremity traction | |
| E0890 | Traction frame, attached to footboard, pelvic traction | |
| E0900 | Traction stand, free standing, pelvic traction, (e.g., buck's) | |
| E0942 | Cervical head harness/halter | |
| E0944 | Pelvic belt/harness/boot | |
| E0945 | Extremity belt/harness | |
| E0947 | Fracture frame, attachments for complex pelvic traction | |
| E0948 | Fracture frame, attachments for complex cervical traction | |
| E0950 | Wheelchair accessory, tray, each | |
| E0951 | Heel loop/holder, any type, with or without ankle strap, each | |
| E0952 | Toe loop/holder, any type, each | |
| E0953 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each | |
| E0954 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot | |
| E0955 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each | |
| E0956 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each | |
| E0957 | Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each | |
| E0959 | Manual wheelchair accessory, adapter for amputee, each | |
| E0960 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware | |
| E0961 | Manual wheelchair accessory, wheel lock brake extension (handle), each | |
| E0962 | 1" CUSHION, FOR WHEELCHAIR | |
| E0963 | 2" CUSHION, FOR WHEELCHAIR | |
| E0964 | 3" CUSHION, FOR WHEELCHAIR | |
| E0965 | 4" CUSHION, FOR WHEELCHAIR | |
| E0966 | Manual wheelchair accessory, headrest extension, each | |
| E0967 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each | |
| E0969 | Narrowing device, wheelchair | |
| E0970 | No. 2 footplates, except for elevating leg rest | |
| E0971 | Manual wheelchair accessory, anti-tipping device, each | |
| E0972 | WHEELCHAIR ACCESSORY, TRANSFER BOARD OR DEVICE, EACH | |
| E0973 | Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each | |
| E0974 | Manual wheelchair accessory, anti-rollback device, each | |
| E0977 | WEDGE CUSHION, WHEELCHAIR | |
| E0978 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each | |
| E0980 | Safety vest, wheelchair | |
| E0981 | Wheelchair accessory, seat upholstery, replacement only, each | |
| E0982 | Wheelchair accessory, back upholstery, replacement only, each | |
| E0984 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control | |
| E0985 | Wheelchair accessory, seat lift mechanism | |
| E0986 | Manual wheelchair accessory, push-rim activated power assist system | |
| E0990 | Wheelchair accessory, elevating leg rest, complete assembly, each | |
| E0992 | Manual wheelchair accessory, solid seat insert | |
| E0994 | Arm rest, each | |
| E0995 | Wheelchair accessory, calf rest/pad, replacement only, each | |
| E0996 | TIRE, SOLID, EACH | |
| E0997 | CASTER WITH A FORK | |
| E0998 | CASTER WITHOUT FORK | |
| E0999 | PNEUMATIC TIRE WITH WHEEL | |
| E1000 | TIRE, PNEUMATIC CASTER | |
| E1001 | WHEEL, SINGLE | |
| E1002 | Wheelchair accessory, power seating system, tilt only | |
| E1003 | Wheelchair accessory, power seating system, recline only, without shear reduction | |
| E1004 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction | |
| E1005 | Wheelchair accessory, power seatng system, recline only, with power shear reduction | |
| E1006 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction | |
| E1007 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction | |
| E1008 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction | |
| E1009 | Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each | |
| E1010 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair | |
| E1011 | Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) | |
| E1012 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each | |
| E1013 | INTEGRATED SEATING SYSTEM, CONTOURED, FOR PEDIATRIC WHEELCHAIR | |
| E1014 | Reclining back, addition to pediatric size wheelchair | |
| E1015 | Shock absorber for manual wheelchair, each | |
| E1016 | Shock absorber for power wheelchair, each | |
| E1017 | Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each | |
| E1018 | Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each | |
| E1019 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, HEAVY DUTY FEATURE, PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS AND LESS THAN OR EQUAL TO 400 POUNDS | |
| E1020 | Residual limb support system for wheelchair, any type | |
| E1021 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, EXTRA HEAVY DUTY FEATURE, WEIGHT CAPACITY GREATER THAN 400 POUNDS | |
| E1025 | LATERAL THORACIC SUPPORT, NON-CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE) | |
| E1026 | LATERAL THORACIC SUPPORT, CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE) | |
| E1027 | LATERAL/ANTERIOR SUPPORT, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE) | |
| E1028 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory | |
| E1029 | Wheelchair accessory, ventilator tray, fixed | |
| E1030 | Wheelchair accessory, ventilator tray, gimbaled | |
| E1161 | Manual adult size wheelchair, includes tilt in space | |
| E1210 | MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG RESTS | |
| E1211 | MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH SWING AWAY,DETACHABLE ELEVATING LEG REST | |
| E1212 | MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS | |
| E1213 | MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE FOOT RESTS | |
| E1220 | Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification | |
| E1226 | Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each | |
| E1227 | Special height arms for wheelchair | |
| E1229 | Wheelchair, pediatric size, not otherwise specified | |
| E1230 | Power operated vehicle (three or four wheel nonhighway) specify brand name and model number | |
| E1231 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system | |
| E1232 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system | |
| E1233 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system | |
| E1234 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system | |
| E1235 | Wheelchair, pediatric size, rigid, adjustable, with seating system | |
| E1236 | Wheelchair, pediatric size, folding, adjustable, with seating system | |
| E1237 | Wheelchair, pediatric size, rigid, adjustable, without seating system | |
| E1238 | Wheelchair, pediatric size, folding, adjustable, without seating system | |
| E1239 | Power wheelchair, pediatric size, not otherwise specified | |
| E1296 | Special wheelchair seat height from floor | |
| E1297 | Special wheelchair seat depth, by upholstery | |
| E1298 | Special wheelchair seat depth and/or width, by construction | |
| E1300 | Whirlpool, portable (overtub type) | |
| E1310 | Whirlpool, non-portable (built-in type) | |
| E1352 | Oxygen accessory, flow regulator capable of positive inspiratory pressure | |
| E1354 | Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each | |
| E1356 | Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each | |
| E1357 | Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each | |
| E1358 | Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each | |
| E1372 | Immersion external heater for nebulizer | |
| E1399 | Durable medical equipment, miscellaneous | |
| E1700 | Jaw motion rehabilitation system | |
| E1701 | Replacement cushions for jaw motion rehabilitation system, pkg. of 6 | |
| E1702 | Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200 | |
| E1800 | Dynamic adjustable elbow extension/flexion device, includes soft interface material | |
| E1801 | Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories | |
| E1805 | Dynamic adjustable wrist extension / flexion device, includes soft interface material | |
| E1806 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories | |
| E1810 | Dynamic adjustable knee extension / flexion device, includes soft interface material | |
| E1811 | Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories | |
| E1812 | Dynamic knee, extension/flexion device with active resistance control | |
| E1815 | Dynamic adjustable ankle extension/flexion device, includes soft interface material | |
| E1816 | Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories | |
| E1818 | Static progressive stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories | |
| E1820 | Replacement soft interface material, dynamic adjustable extension/flexion device | |
| E1821 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device | |
| E1825 | Dynamic adjustable finger extension/flexion device, includes soft interface material | |
| E1830 | Dynamic adjustable toe extension/flexion device, includes soft interface material | |
| E1831 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories | |
| E1840 | Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material | |
| E1902 | Communication board, non-electronic augmentative or alternative communication device | |
| E2100 | Blood glucose monitor with integrated voice synthesizer | |
| E2101 | Blood glucose monitor with integrated lancing/blood sample | |
| E2201 | Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches | |
| E2202 | Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches | |
| E2203 | Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches | |
| E2204 | Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches | |
| E2205 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each | |
| E2206 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each | |
| E2207 | Wheelchair accessory, crutch and cane holder, each | |
| E2208 | Wheelchair accessory, cylinder tank carrier, each | |
| E2209 | Accessory, arm trough, with or without hand support, each | |
| E2210 | Wheelchair accessory, bearings, any type, replacement only, each | |
| E2211 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each | |
| E2212 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each | |
| E2213 | Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each | |
| E2214 | Manual wheelchair accessory, pneumatic caster tire, any size, each | |
| E2215 | Manual wheelchair accessory, tube for pneumatic caster tire, any size, each | |
| E2216 | Manual wheelchair accessory, foam filled propulsion tire, any size, each | |
| E2217 | Manual wheelchair accessory, foam filled caster tire, any size, each | |
| E2218 | Manual wheelchair accessory, foam propulsion tire, any size, each | |
| E2219 | Manual wheelchair accessory, foam caster tire, any size, each | |
| E2220 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each | |
| E2221 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each | |
| E2222 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each | |
| E2223 | MANUAL WHEELCHAIR ACCESSORY, VALVE, ANY TYPE, REPLACEMENT ONLY, EACH | |
| E2224 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each | |
| E2225 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each | |
| E2226 | Manual wheelchair accessory, caster fork, any size, replacement only, each | |
| E2227 | Manual wheelchair accessory, gear reduction drive wheel, each | |
| E2228 | Manual wheelchair accessory, wheel braking system and lock, complete, each | |
| E2230 | Manual wheelchair accessory, manual standing system | |
| E2231 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware | |
| E2291 | Back, planar, for pediatric size wheelchair including fixed attaching hardware | |
| E2292 | Seat, planar, for pediatric size wheelchair including fixed attaching hardware | |
| E2293 | Back, contoured, for pediatric size wheelchair including fixed attaching hardware | |
| E2294 | Seat, contoured, for pediatric size wheelchair including fixed attaching hardware | |
| E2295 | Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features | |
| E2300 | Wheelchair accessory, power seat elevation system, any type | |
| E2301 | Wheelchair accessory, power standing system, any type | |
| E2310 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware | |
| E2311 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware | |
| E2312 | Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware | |
| E2313 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each | |
| E2320 | POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, REMOTE JOYSTICK OR TOUCHPAD, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, AND FIXED MOUNTING HARDWARE | |
| E2321 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware | |
| E2322 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware | |
| E2323 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated | |
| E2324 | Power wheelchair accessory, chin cup for chin control interface | |
| E2325 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware | |
| E2326 | Power wheelchair accessory, breath tube kit for sip and puff interface | |
| E2327 | Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware | |
| E2328 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware | |
| E2329 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware | |
| E2330 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware | |
| E2331 | Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware | |
| E2340 | Power wheelchair accessory, nonstandard seat frame width, 20-23 inches | |
| E2341 | Power wheelchair accessory, nonstandard seat frame width, 24-27 inches | |
| E2342 | Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches | |
| E2343 | Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches | |
| E2351 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface | |
| E2358 | Power wheelchair accessory, group 34 non-sealed lead acid battery, each | |
| E2359 | Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) | |
| E2360 | Power wheelchair accessory, 22nf non-sealed lead acid battery, each | |
| E2361 | Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) | |
| E2362 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each | |
| E2363 | Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) | |
| E2364 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each | |
| E2365 | Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) | |
| E2366 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each | |
| E2367 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each | |
| E2368 | Power wheelchair component, drive wheel motor, replacement only | |
| E2369 | Power wheelchair component, drive wheel gear box, replacement only | |
| E2370 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only | |
| E2371 | Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each | |
| E2372 | Power wheelchair accessory, group 27 non-sealed lead acid battery, each | |
| E2373 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware | |
| E2374 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only | |
| E2375 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only | |
| E2376 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only | |
| E2377 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue | |
| E2378 | Power wheelchair component, actuator, replacement only | |
| E2381 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each | |
| E2382 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each | |
| E2383 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each | |
| E2384 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each | |
| E2385 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each | |
| E2386 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each | |
| E2387 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each | |
| E2388 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each | |
| E2389 | Power wheelchair accessory, foam caster tire, any size, replacement only, each | |
| E2390 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each | |
| E2391 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each | |
| E2392 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each | |
| E2393 | POWER WHEELCHAIR ACCESSORY, VALVE FOR PNEUMATIC TIRE TUBE, ANY TYPE, REPLACEMENT ONLY, EACH | |
| E2394 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each | |
| E2395 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each | |
| E2396 | Power wheelchair accessory, caster fork, any size, replacement only, each | |
| E2397 | Power wheelchair accessory, lithium-based battery, each | |
| E2399 | POWER WHEELCHAIR ACCESSORY, NOT OTHERWISE CLASSIFIED INTERFACE, INCLUDING ALL RELATED ELECTRONICS AND ANY TYPE MOUNTING HARDWARE | |
| E2500 | Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time | |
| E2502 | Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time | |
| E2504 | Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time | |
| E2506 | Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time | |
| E2508 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device | |
| E2510 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access | |
| E2511 | Speech generating software program, for personal computer or personal digital assistant | |
| E2512 | Accessory for speech generating device, mounting system | |
| E2599 | Accessory for speech generating device, not otherwise classified | |
| E2601 | General use wheelchair seat cushion, width less than 22 inches, any depth | |
| E2602 | General use wheelchair seat cushion, width 22 inches or greater, any depth | |
| E2603 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth | |
| E2604 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth | |
| E2605 | Positioning wheelchair seat cushion, width less than 22 inches, any depth | |
| E2606 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth | |
| E2607 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth | |
| E2608 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth | |
| E2609 | Custom fabricated wheelchair seat cushion, any size | |
| E2610 | Wheelchair seat cushion, powered | |
| E2611 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware | |
| E2612 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware | |
| E2613 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware | |
| E2614 | Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware | |
| E2615 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware | |
| E2616 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware | |
| E2617 | Custom fabricated wheelchair back cushion, any size, including any type mounting hardware | |
| E2618 | WHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), FOR USE WITH MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, INCLUDES ANY TYPE MOUNTING HARDWARE | |
| E2619 | Replacement cover for wheelchair seat cushion or back cushion, each | |
| E2620 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware | |
| E2621 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware | |
| E2622 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth | |
| E2623 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth | |
| E2624 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth | |
| E2625 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth | |
| E2626 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable | |
| E2627 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type | |
| E2628 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining | |
| E2629 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) | |
| E2630 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support | |
| E2631 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm | |
| E2632 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control | |
| E2633 | Wheelchair accessory, addition to mobile arm support, supinator | |
| J0120 | Injection, tetracycline, up to 250 mg | |
| J0121 | Injection, omadacycline, 1 mg | |
| J0122 | Injection, eravacycline, 1 mg | |
| J0128 | Injection, abarelix, 10 mg | |
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | |
| J0130 | Injection abciximab, 10 mg | |
| J0131 | Injection, acetaminophen, not otherwise specified,10 mg | |
| J0132 | Injection, acetylcysteine, 100 mg | |
| J0133 | Injection, acyclovir, 5 mg | |
| J0134 | Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to j0131, 10 mg | |
| J0135 | Injection, adalimumab, 20 mg | |
| J0136 | Injection, acetaminophen (b braun) not therapeutically equivalent to j0131, 10 mg | |
| J0137 | Injection, acetaminophen (hikma) not therapeutically equivalent to j0131, 10 mg | |
| J0150 | Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270) | |
| J0151 | Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270) | |
| J0152 | Injection, adenosine for diagnostic use, 30 mg (not to be used to report any adenosine phosphate compounds; instead use a9270) | |
| J0153 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | |
| J0170 | Injection, adrenalin, epinephrine, up to 1 ml ampule | |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg | |
| J0172 | Injection, aducanumab-avwa, 2 mg | |
| J0173 | Injection, epinephrine (belcher) not therapeutically equivalent to j0171, 0.1 mg | |
| J0174 | Injection, lecanemab-irmb, 1 mg | |
| J0178 | Injection, aflibercept, 1 mg | |
| J0179 | Injection, brolucizumab-dbll, 1 mg | |
| J0180 | Injection, agalsidase beta, 1 mg | |
| J0185 | Injection, aprepitant, 1 mg | |
| J0190 | Injection, biperiden lactate, per 5 mg | |
| J0200 | Injection, alatrofloxacin mesylate, 100 mg | |
| J0202 | Injection, alemtuzumab, 1 mg | |
| J0205 | Injection, alglucerase, per 10 units | |
| J0206 | Injection, allopurinol sodium, 1 mg | |
| J0207 | Injection, amifostine, 500 mg | |
| J0208 | Injection, sodium thiosulfate, 100 mg | |
| J0210 | Injection, methyldopate hcl, up to 250 mg | |
| J0220 | Injection, alglucosidase alfa, 10 mg, not otherwise specified | |
| J0221 | Injection, alglucosidase alfa, (lumizyme), 10 mg | |
| J0224 | Injection, lumasiran, 0.5 mg | |
| J0225 | Injection, vutrisiran, 1 mg | |
| J0248 | Injection, remdesivir, 1 mg | |
| J0256 | Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg | |
| J0257 | Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg | |
| J0278 | Injection, amikacin sulfate, 100 mg | |
| J0280 | Injection, aminophyllin, up to 250 mg | |
| J0282 | Injection, amiodarone hydrochloride, 30 mg | |
| J0283 | Injection, amiodarone hydrochloride (nexterone), 30 mg | |
| J0285 | Injection, amphotericin b, 50 mg | |
| J0287 | Injection, amphotericin b lipid complex, 10 mg | |
| J0288 | Injection, amphotericin b cholesteryl sulfate complex, 10 mg | |
| J0289 | Injection, amphotericin b liposome, 10 mg | |
| J0290 | Injection, ampicillin sodium, 500 mg | |
| J0295 | Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm | |
| J0300 | Injection, amobarbital, up to 125 mg | |
| J0330 | Injection, succinylcholine chloride, up to 20 mg | |
| J0348 | Injection, anidulafungin, 1 mg | |
| J0350 | Injection, anistreplase, per 30 units | |
| J0360 | Injection, hydralazine hcl, up to 20 mg | |
| J0364 | Injection, apomorphine hydrochloride, 1 mg | |
| J0365 | Injection, aprotonin, 10,000 kiu | |
| J0380 | Injection, metaraminol bitartrate, per 10 mg | |
| J0390 | Injection, chloroquine hydrochloride, up to 250 mg | |
| J0395 | Injection, arbutamine hcl, 1 mg | |
| J0400 | Injection, aripiprazole, intramuscular, 0.25 mg | |
| J0401 | Injection, aripiprazole, extended release, 1 mg | |
| J0456 | Injection, azithromycin, 500 mg | |
| J0457 | Injection, aztreonam, 100 mg | |
| J0460 | INJECTION, ATROPINE SULFATE, UP TO 0.3 MG | |
| J0461 | Injection, atropine sulfate, 0.01 mg | |
| J0470 | Injection, dimercaprol, per 100 mg | |
| J0475 | Injection, baclofen, 10 mg | |
| J0476 | Injection, baclofen, 50 mcg for intrathecal trial | |
| J0485 | Injection, belatacept, 1 mg | |
| J0490 | Injection, belimumab, 10 mg | |
| J0491 | Injection, anifrolumab-fnia, 1 mg | |
| J0500 | Injection, dicyclomine hcl, up to 20 mg | |
| J0515 | Injection, benztropine mesylate, per 1 mg | |
| J0517 | Injection, benralizumab, 1 mg | |
| J0520 | Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg | |
| J0530 | INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 600,000 UNITS | |
| J0540 | INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 1,200,000 UNITS | |
| J0550 | INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 2,400,000 UNITS | |
| J0558 | Injection, penicillin g benzathine and penicillin g procaine, 100,000 units | |
| J0559 | Injection, penicillin g benzathine and penicillin g procaine, 2500 units | |
| J0560 | Injection, penicillin g benzathine, up to 600,000 units | |
| J0561 | Injection, penicillin g benzathine, 100,000 units | |
| J0565 | Injection, bezlotoxumab, 10 mg | |
| J0567 | Injection, cerliponase alfa, 1 mg | |
| J0570 | Buprenorphine implant, 74.2 mg | |
| J0571 | Buprenorphine, oral, 1 mg | |
| J0572 | Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine | |
| J0573 | Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine | |
| J0574 | Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine | |
| J0575 | Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine | |
| J0580 | Injection, penicillin g benzathine, up to 2,400,000 units | |
| J0583 | Injection, bivalirudin, 1 mg | |
| J0584 | Injection, burosumab-twza 1 mg | |
| J0585 | Injection, onabotulinumtoxina, 1 unit | |
| J0586 | Injection, abobotulinumtoxina, 5 units | |
| J0587 | Injection, rimabotulinumtoxinb, 100 units | |
| J0588 | Injection, incobotulinumtoxin a, 1 unit | |
| J0592 | Injection, buprenorphine hydrochloride, 0.1 mg | |
| J0594 | injection, busulfan, 1 mg | |
| J0597 | Injection, c-1 esterase inhibitor (human), berinert, 10 units | |
| J0598 | Injection, c-1 esterase inhibitor (human), cinryze, 10 units | |
| J0599 | Injection, c-1 esterase inhibitor (human), (haegarda), 10 units | |
| J0600 | Injection, edetate calcium disodium, up to 1000 mg | |
| J0604 | Cinacalcet, oral, 1 mg, (for esrd on dialysis) | |
| J0606 | Injection, etelcalcetide, 0.1 mg | |
| J0610 | Injection, calcium gluconate (fresenius kabi), per 10 ml | |
| J0611 | Injection, calcium gluconate (wg critical care), per 10 ml | |
| J0612 | Injection, calcium gluconate (fresenius kabi), per 10 mg | |
| J0613 | Injection, calcium gluconate (wg critical care), per 10 mg | |
| J0620 | Injection, calcium glycerophosphate and calcium lactate, per 10 ml | |
| J0630 | Injection, calcitonin salmon, up to 400 units | |
| J0636 | Injection, calcitriol, 0.1 mcg | |
| J0637 | Injection, caspofungin acetate, 5 mg | |
| J0638 | Injection, canakinumab, 1 mg | |
| J0640 | Injection, leucovorin calcium, per 50 mg | |
| J0641 | Injection, levoleucovorin, not otherwise specified, 0.5 mg | |
| J0642 | Injection, levoleucovorin (khapzory), 0.5 mg | |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | |
| J0670 | Injection, mepivacaine hydrochloride, per 10 ml | |
| J0689 | Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg | |
| J0690 | Injection, cefazolin sodium, 500 mg | |
| J0691 | Injection, lefamulin, 1 mg | |
| J0692 | Injection, cefepime hydrochloride, 500 mg | |
| J0693 | Injection, cefiderocol, 5 mg | |
| J0694 | Injection, cefoxitin sodium, 1 gm | |
| J0695 | Injection, ceftolozane 50 mg and tazobactam 25 mg | |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | |
| J0697 | Injection, sterile cefuroxime sodium, per 750 mg | |
| J0698 | Injection, cefotaxime sodium, per gm | |
| J0699 | Injection, cefiderocol, 10 mg | |
| J0701 | Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500 mg | |
| J0702 | Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg | |
| J0703 | Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500 mg | |
| J0704 | Injection, betamethasone sodium phosphate, per 4 mg | |
| J0706 | Injection, caffeine citrate, 5 mg | |
| J0710 | Injection, cephapirin sodium, up to 1 gm | |
| J0712 | Injection, ceftaroline fosamil, 10 mg | |
| J0713 | Injection, ceftazidime, per 500 mg | |
| J0714 | Injection, ceftazidime and avibactam, 0.5 g/0.125 g | |
| J0715 | Injection, ceftizoxime sodium, per 500 mg | |
| J0716 | Injection, centruroides immune f(ab)2, up to 120 milligrams | |
| J0717 | Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | |
| J0718 | Injection, certolizumab pegol, 1 mg | |
| J0720 | Injection, chloramphenicol sodium succinate, up to 1 gm | |
| J0725 | Injection, chorionic gonadotropin, per 1,000 usp units | |
| J0735 | Injection, clonidine hydrochloride, 1 mg | |
| J0736 | Injection, clindamycin phosphate, 300 mg | |
| J0737 | Injection, clindamycin phosphate (baxter), not therapeutically equivalent to j0736, 300 mg | |
| J0739 | Injection, cabotegravir, 1 mg | |
| J0740 | Injection, cidofovir, 375 mg | |
| J0741 | Injection, cabotegravir and rilpivirine, 2mg/3mg | |
| J0742 | Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg | |
| J0743 | Injection, cilastatin sodium; imipenem, per 250 mg | |
| J0744 | Injection, ciprofloxacin for intravenous infusion, 200 mg | |
| J0745 | Injection, codeine phosphate, per 30 mg | |
| J0760 | Injection, colchicine, per 1 mg | |
| J0770 | Injection, colistimethate sodium, up to 150 mg | |
| J0775 | Injection, collagenase, clostridium histolyticum, 0.01 mg | |
| J0780 | Injection, prochlorperazine, up to 10 mg | |
| J0791 | Injection, crizanlizumab-tmca, 5 mg | |
| J0795 | Injection, corticorelin ovine triflutate, 1 microgram | |
| J0800 | Injection, corticotropin, up to 40 units | |
| J0833 | Injection, cosyntropin, not otherwise specified, 0.25 mg | |
| J0834 | Injection, cosyntropin, 0.25 mg | |
| J0835 | INJECTION, COSYNTROPIN, PER 0.25 MG | |
| J0840 | Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram | |
| J0841 | Injection, crotalidae immune f(ab')2 (equine), 120 mg | |
| J0850 | Injection, cytomegalovirus immune globulin intravenous (human), per vial | |
| J0875 | Injection, dalbavancin, 5 mg | |
| J0877 | Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg | |
| J0878 | Injection, daptomycin, 1 mg | |
| J0879 | Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis) | |
| J0880 | INJECTION, DARBEPOETIN ALFA, 5 MCG | |
| J0890 | Injection, peginesatide, 0.1 mg (for esrd on dialysis) | |
| J0891 | Injection, argatroban (accord), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) | |
| J0892 | Injection, argatroban (accord), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) | |
| J0893 | Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg | |
| J0894 | Injection, decitabine, 1 mg | |
| J0895 | Injection, deferoxamine mesylate, 500 mg | |
| J0897 | Injection, denosumab, 1 mg | |
| J0898 | Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) | |
| J0899 | Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) | |
| J0900 | Injection, testosterone enanthate and estradiol valerate, up to 1 cc | |
| J0945 | Injection, brompheniramine maleate, per 10 mg | |
| J0970 | Injection, estradiol valerate, up to 40 mg | |
| J1000 | Injection, depo-estradiol cypionate, up to 5 mg | |
| J1020 | Injection, methylprednisolone acetate, 20 mg | |
| J1030 | Injection, methylprednisolone acetate, 40 mg | |
| J1040 | Injection, methylprednisolone acetate, 80 mg | |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | |
| J1051 | Injection, medroxyprogesterone acetate, 50 mg | |
| J1055 | Injection, medroxyprogesterone acetate for contraceptive use, 150 mg | |
| J1056 | Injection, medroxyprogesterone acetate / estradiol cypionate, 5mg / 25mg | |
| J1060 | Injection, testosterone cypionate and estradiol cypionate, up to 1 ml | |
| J1070 | Injection, testosterone cypionate, up to 100 mg | |
| J1071 | Injection, testosterone cypionate, 1 mg | |
| J1080 | Injection, testosterone cypionate, 1 cc, 200 mg | |
| J1094 | Injection, dexamethasone acetate, 1 mg | |
| J1095 | Injection, dexamethasone 9 percent, intraocular, 1 microgram | |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | |
| J1110 | Injection, dihydroergotamine mesylate, per 1 mg | |
| J1120 | Injection, acetazolamide sodium, up to 500 mg | |
| J1130 | Injection, diclofenac sodium, 0.5 mg | |
| J1160 | Injection, digoxin, up to 0.5 mg | |
| J1162 | Injection, digoxin immune fab (ovine), per vial | |
| J1165 | Injection, phenytoin sodium, per 50 mg | |
| J1170 | Injection, hydromorphone, up to 4 mg | |
| J1180 | Injection, dyphylline, up to 500 mg | |
| J1190 | Injection, dexrazoxane hydrochloride, per 250 mg | |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | |
| J1205 | Injection, chlorothiazide sodium, per 500 mg | |
| J1212 | Injection, dmso, dimethyl sulfoxide, 50%, 50 ml | |
| J1230 | Injection, methadone hcl, up to 10 mg | |
| J1240 | Injection, dimenhydrinate, up to 50 mg | |
| J1245 | Injection, dipyridamole, per 10 mg | |
| J1250 | Injection, dobutamine hydrochloride, per 250 mg | |
| J1260 | Injection, dolasetron mesylate, 10 mg | |
| J1265 | Injection, dopamine hcl, 40 mg | |
| J1267 | Injection, doripenem, 10 mg | |
| J1270 | Injection, doxercalciferol, 1 mcg | |
| J1290 | Injection, ecallantide, 1 mg | |
| J1300 | Injection, eculizumab, 10 mg | |
| J1301 | Injection, edaravone, 1 mg | |
| J1302 | Injection, sutimlimab-jome, 10 mg | |
| J1303 | Injection, ravulizumab-cwvz, 10 mg | |
| J1305 | Injection, evinacumab-dgnb, 5mg | |
| J1306 | Injection, inclisiran, 1 mg | |
| J1320 | Injection, amitriptyline hcl, up to 20 mg | |
| J1322 | Injection, elosulfase alfa, 1 mg | |
| J1324 | Injection, enfuvirtide, 1 mg | |
| J1325 | Injection, epoprostenol, 0.5 mg | |
| J1327 | Injection, eptifibatide, 5 mg | |
| J1330 | Injection, ergonovine maleate, up to 0.2 mg | |
| J1335 | Injection, ertapenem sodium, 500 mg | |
| J1364 | Injection, erythromycin lactobionate, per 500 mg | |
| J1380 | Injection, estradiol valerate, up to 10 mg | |
| J1390 | Injection, estradiol valerate, up to 20 mg | |
| J1410 | Injection, estrogen conjugated, per 25 mg | |
| J1411 | Injection, etranacogene dezaparvovec-drlb, per therapeutic dose | |
| J1426 | Injection, casimersen, 10 mg | |
| J1427 | Injection, viltolarsen, 10 mg | |
| J1428 | Injection, eteplirsen, 10 mg | |
| J1429 | Injection, golodirsen, 10 mg | |
| J1430 | Injection, ethanolamine oleate, 100 mg | |
| J1435 | Injection, estrone, per 1 mg | |
| J1436 | Injection, etidronate disodium, per 300 mg | |
| J1437 | Injection, ferric derisomaltose, 10 mg | |
| J1438 | Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | |
| J1439 | Injection, ferric carboxymaltose, 1 mg | |
| J1441 | Injection, filgrastim (g-csf), 480 mcg | |
| J1442 | Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram | |
| J1443 | Injection, ferric pyrophosphate citrate solution (triferic), 0.1 mg of iron | |
| J1444 | Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron | |
| J1445 | Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron | |
| J1446 | Injection, tbo-filgrastim, 5 micrograms | |
| J1447 | Injection, tbo-filgrastim, 1 microgram | |
| J1448 | Injection, trilaciclib, 1mg | |
| J1449 | Injection, eflapegrastim-xnst, 0.1 mg | |
| J1450 | Injection fluconazole, 200 mg | |
| J1451 | Injection, fomepizole, 15 mg | |
| J1452 | Injection, fomivirsen sodium, intraocular, 1.65 mg | |
| J1453 | Injection, fosaprepitant, 1 mg | |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | |
| J1455 | Injection, foscarnet sodium, per 1000 mg | |
| J1456 | Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg | |
| J1457 | Injection, gallium nitrate, 1 mg | |
| J1458 | Injection, galsulfase, 1 mg | |
| J1459 | Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg | |
| J1460 | Injection, gamma globulin, intramuscular, 1 cc | |
| J1470 | Injection, gamma globulin, intramuscular, 2 cc | |
| J1480 | Injection, gamma globulin, intramuscular, 3 cc | |
| J1490 | Injection, gamma globulin, intramuscular, 4 cc | |
| J1500 | Injection, gamma globulin, intramuscular, 5 cc | |
| J1510 | Injection, gamma globulin, intramuscular, 6 cc | |
| J1520 | Injection, gamma globulin, intramuscular, 7 cc | |
| J1530 | Injection, gamma globulin, intramuscular, 8 cc | |
| J1540 | Injection, gamma globulin, intramuscular, 9 cc | |
| J1550 | Injection, gamma globulin, intramuscular, 10 cc | |
| J1551 | Injection, immune globulin (cutaquig), 100 mg | |
| J1554 | Injection, immune globulin (asceniv), 500 mg | |
| J1555 | Injection, immune globulin (cuvitru), 100 mg | |
| J1556 | Injection, immune globulin (bivigam), 500 mg | |
| J1557 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg | |
| J1558 | Injection, immune globulin (xembify), 100 mg | |
| J1559 | Injection, immune globulin (hizentra), 100 mg | |
| J1560 | Injection, gamma globulin, intramuscular, over 10 cc | |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | |
| J1562 | Injection, immune globulin (vivaglobin), 100 mg | |
| J1563 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G | |
| J1564 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 10 MG | |
| J1565 | INJECTION, RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN, INTRAVENOUS, 50 MG | |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg | |
| J1567 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG | |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | |
| J1570 | Injection, ganciclovir sodium, 500 mg | |
| J1571 | Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml | |
| J1572 | Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg | |
| J1573 | Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml | |
| J1574 | Injection, ganciclovir sodium (exela) not therapeutically equivalent to j1570, 500 mg | |
| J1575 | Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin | |
| J1576 | Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg | |
| J1580 | Injection, garamycin, gentamicin, up to 80 mg | |
| J1590 | Injection, gatifloxacin, 10 mg | |
| J1595 | Injection, glatiramer acetate, 20 mg | |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg | |
| J1600 | Injection, gold sodium thiomalate, up to 50 mg | |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | |
| J1610 | Injection, glucagon hydrochloride, per 1 mg | |
| J1611 | Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg | |
| J1620 | Injection, gonadorelin hydrochloride, per 100 mcg | |
| J1626 | Injection, granisetron hydrochloride, 100 mcg | |
| J1627 | Injection, granisetron, extended-release, 0.1 mg | |
| J1628 | Injection, guselkumab, 1 mg | |
| J1630 | Injection, haloperidol, up to 5 mg | |
| J1631 | Injection, haloperidol decanoate, per 50 mg | |
| J1632 | Injection, brexanolone, 1 mg | |
| J1640 | Injection, hemin, 1 mg | |
| J1642 | Injection, heparin sodium, (heparin lock flush), per 10 units | |
| J1644 | Injection, heparin sodium, per 1000 units | |
| J1645 | Injection, dalteparin sodium, per 2500 iu | |
| J1650 | Injection, enoxaparin sodium, 10 mg | |
| J1652 | Injection, fondaparinux sodium, 0.5 mg | |
| J1655 | Injection, tinzaparin sodium, 1000 iu | |
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | |
| J1680 | Injection, human fibrinogen concentrate, 100 mg | |
| J1700 | Injection, hydrocortisone acetate, up to 25 mg | |
| J1710 | Injection, hydrocortisone sodium phosphate, up to 50 mg | |
| J1720 | Injection, hydrocortisone sodium succinate, up to 100 mg | |
| J1725 | Injection, hydroxyprogesterone caproate, 1 mg | |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | |
| J1729 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg | |
| J1730 | Injection, diazoxide, up to 300 mg | |
| J1740 | Injection, ibandronate sodium, 1 mg | |
| J1741 | Injection, ibuprofen, 100 mg | |
| J1742 | Injection, ibutilide fumarate, 1 mg | |
| J1743 | Injection, idursulfase, 1 mg | |
| J1744 | Injection, icatibant, 1 mg | |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | |
| J1746 | Injection, ibalizumab-uiyk, 10 mg | |
| J1747 | Injection, spesolimab-sbzo, 1 mg | |
| J1750 | Injection, iron dextran, 50 mg | |
| J1751 | INJECTION, IRON DEXTRAN 165, 50 MG | |
| J1752 | INJECTION, IRON DEXTRAN 267, 50 MG | |
| J1756 | Injection, iron sucrose, 1 mg | |
| J1785 | Injection, imiglucerase, per unit | |
| J1786 | Injection, imiglucerase, 10 units | |
| J1790 | Injection, droperidol, up to 5 mg | |
| J1800 | Injection, propranolol hcl, up to 1 mg | |
| J1805 | Injection, esmolol hydrochloride, 10 mg | |
| J1806 | Injection, esmolol hydrochloride (wg critical care) not therapeutically equivalent to j1805, 10 mg | |
| J1810 | Injection, droperidol and fentanyl citrate, up to 2 ml ampule | |
| J1811 | Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units | |
| J1812 | Insulin (fiasp), per 5 units | |
| J1813 | Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units | |
| J1814 | Insulin (lyumjev), per 5 units | |
| J1815 | Injection, insulin, per 5 units | |
| J1817 | Insulin for administration through dme (i.e., insulin pump) per 50 units | |
| J1835 | Injection, itraconazole, 50 mg | |
| J1836 | Injection, metronidazole, 10 mg | |
| J1840 | Injection, kanamycin sulfate, up to 500 mg | |
| J1850 | Injection, kanamycin sulfate, up to 75 mg | |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | |
| J1890 | Injection, cephalothin sodium, up to 1 gram | |
| J1920 | Injection, labetalol hydrochloride, 5 mg | |
| J1921 | Injection, labetalol hydrochloride (hikma) not therapeutically equivalent to j1820, 5 mg | |
| J1930 | Injection, lanreotide, 1 mg | |
| J1931 | Injection, laronidase, 0.1 mg | |
| J1932 | Injection, lanreotide, (cipla), 1 mg | |
| J1940 | Injection, furosemide, up to 20 mg | |
| J1941 | Injection, furosemide (furoscix), 20 mg | |
| J1942 | Injection, aripiprazole lauroxil, 1 mg | |
| J1945 | Injection, lepirudin, 50 mg | |
| J1950 | Injection, leuprolide acetate (for depot suspension), per 3.75 mg | |
| J1951 | Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg | |
| J1952 | Leuprolide injectable, camcevi, 1 mg | |
| J1953 | Injection, levetiracetam, 10 mg | |
| J1954 | Injection, leuprolide acetate for depot suspension (cipla), 7.5 mg | |
| J1955 | Injection, levocarnitine, per 1 gm | |
| J1956 | Injection, levofloxacin, 250 mg | |
| J1960 | Injection, levorphanol tartrate, up to 2 mg | |
| J1961 | Injection, lenacapavir, 1 mg | |
| J1980 | Injection, hyoscyamine sulfate, up to 0.25 mg | |
| J1990 | Injection, chlordiazepoxide hcl, up to 100 mg | |
| J2001 | Injection, lidocaine hcl for intravenous infusion, 10 mg | |
| J2010 | Injection, lincomycin hcl, up to 300 mg | |
| J2020 | Injection, linezolid, 200 mg | |
| J2021 | Injection, linezolid (hospira) not therapeutically equivalent to j2020, 200 mg | |
| J2060 | Injection, lorazepam, 2 mg | |
| J2062 | Loxapine for inhalation, 1 mg | |
| J2150 | Injection, mannitol, 25% in 50 ml | |
| J2170 | Injection, mecasermin, 1 mg | |
| J2175 | Injection, meperidine hydrochloride, per 100 mg | |
| J2180 | Injection, meperidine and promethazine hcl, up to 50 mg | |
| J2182 | Injection, mepolizumab, 1 mg | |
| J2184 | Injection, meropenem (b. braun) not therapeutically equivalent to j2185, 100 mg | |
| J2185 | Injection, meropenem, 100 mg | |
| J2186 | Injection, meropenem and vaborbactam, 10mg/10mg (20mg) | |
| J2210 | Injection, methylergonovine maleate, up to 0.2 mg | |
| J2212 | Injection, methylnaltrexone, 0.1 mg | |
| J2247 | Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg | |
| J2248 | Injection, micafungin sodium, 1 mg | |
| J2249 | Injection, remimazolam, 1 mg | |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | |
| J2251 | Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to j2250, per 1 mg | |
| J2260 | Injection, milrinone lactate, 5 mg | |
| J2265 | Injection, minocycline hydrochloride, 1 mg | |
| J2270 | Injection, morphine sulfate, up to 10 mg | |
| J2271 | Injection, morphine sulfate, 100mg | |
| J2272 | Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to j2270, up to 10 mg | |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | |
| J2275 | Injection, morphine sulfate (preservative-free sterile solution), per 10 mg | |
| J2278 | Injection, ziconotide, 1 microgram | |
| J2280 | Injection, moxifloxacin, 100 mg | |
| J2281 | Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to j2280, 100 mg | |
| J2300 | Injection, nalbuphine hydrochloride, per 10 mg | |
| J2305 | Injection, nitroglycerin, 5 mg | |
| J2310 | Injection, naloxone hydrochloride, per 1 mg | |
| J2311 | Injection, naloxone hydrochloride (zimhi), 1 mg | |
| J2315 | Injection, naltrexone, depot form, 1 mg | |
| J2320 | Injection, nandrolone decanoate, up to 50 mg | |
| J2321 | Injection, nandrolone decanoate, up to 100 mg | |
| J2322 | Injection, nandrolone decanoate, up to 200 mg | |
| J2323 | Injection, natalizumab, 1 mg | |
| J2324 | INJECTION, NESIRITIDE, 0.25 MG | |
| J2325 | Injection, nesiritide, 0.1 mg | |
| J2326 | Injection, nusinersen, 0.1 mg | |
| J2327 | Injection, risankizumab-rzaa, intravenous, 1 mg | |
| J2329 | Injection, ublituximab-xiiy, 1mg | |
| J2350 | Injection, ocrelizumab, 1 mg | |
| J2353 | Injection, octreotide, depot form for intramuscular injection, 1 mg | |
| J2354 | Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg | |
| J2355 | Injection, oprelvekin, 5 mg | |
| J2356 | Injection, tezepelumab-ekko, 1 mg | |
| J2357 | Injection, omalizumab, 5 mg | |
| J2358 | Injection, olanzapine, long-acting, 1 mg | |
| J2360 | Injection, orphenadrine citrate, up to 60 mg | |
| J2370 | Injection, phenylephrine hcl, up to 1 ml | |
| J2371 | Injection, phenylephrine hydrochloride, 20 micrograms | |
| J2372 | Injection, phenylephrine hydrochloride (biorphen), 20 micrograms | |
| J2400 | Injection, chloroprocaine hydrochloride, per 30 ml | |
| J2401 | Injection, chloroprocaine hydrochloride, per 1 mg | |
| J2402 | Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg | |
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | |
| J2406 | Injection, oritavancin (kimyrsa), 10 mg | |
| J2407 | Injection, oritavancin (orbactiv), 10 mg | |
| J2410 | Injection, oxymorphone hcl, up to 1 mg | |
| J2425 | Injection, palifermin, 50 micrograms | |
| J2426 | Injection, paliperidone palmitate extended release (invega sustenna), 1 mg | |
| J2427 | Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg | |
| J2430 | Injection, pamidronate disodium, per 30 mg | |
| J2440 | Injection, papaverine hcl, up to 60 mg | |
| J2460 | Injection, oxytetracycline hcl, up to 50 mg | |
| J2469 | Injection, palonosetron hcl, 25 mcg | |
| J2501 | Injection, paricalcitol, 1 mcg | |
| J2502 | Injection, pasireotide long acting, 1 mg | |
| J2503 | Injection, pegaptanib sodium, 0.3 mg | |
| J2504 | Injection, pegademase bovine, 25 iu | |
| J2505 | Injection, pegfilgrastim, 6 mg | |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | |
| J2507 | Injection, pegloticase, 1 mg | |
| J2510 | Injection, penicillin g procaine, aqueous, up to 600,000 units | |
| J2513 | Injection, pentastarch, 10% solution, 100 ml | |
| J2515 | Injection, pentobarbital sodium, per 50 mg | |
| J2540 | Injection, penicillin g potassium, up to 600,000 units | |
| J2543 | Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | |
| J2545 | Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg | |
| J2547 | Injection, peramivir, 1 mg | |
| J2550 | Injection, promethazine hcl, up to 50 mg | |
| J2560 | Injection, phenobarbital sodium, up to 120 mg | |
| J2561 | Injection, phenobarbital sodium (sezaby), 1 mg | |
| J2562 | Injection, plerixafor, 1 mg | |
| J2590 | Injection, oxytocin, up to 10 units | |
| J2597 | Injection, desmopressin acetate, per 1 mcg | |
| J2598 | Injection, vasopressin, 1 unit | |
| J2599 | Injection, vasopressin (american regent) not therapeutically equivalent to j2598, 1 unit | |
| J2650 | Injection, prednisolone acetate, up to 1 ml | |
| J2670 | Injection, tolazoline hcl, up to 25 mg | |
| J2675 | Injection, progesterone, per 50 mg | |
| J2680 | Injection, fluphenazine decanoate, up to 25 mg | |
| J2690 | Injection, procainamide hcl, up to 1 gm | |
| J2700 | Injection, oxacillin sodium, up to 250 mg | |
| J2704 | Injection, propofol, 10 mg | |
| J2710 | Injection, neostigmine methylsulfate, up to 0.5 mg | |
| J2720 | Injection, protamine sulfate, per 10 mg | |
| J2724 | Injection, protein c concentrate, intravenous, human, 10 iu | |
| J2725 | Injection, protirelin, per 250 mcg | |
| J2730 | Injection, pralidoxime chloride, up to 1 gm | |
| J2760 | Injection, phentolamine mesylate, up to 5 mg | |
| J2765 | Injection, metoclopramide hcl, up to 10 mg | |
| J2770 | Injection, quinupristin/dalfopristin, 500 mg (150/350) | |
| J2777 | Injection, faricimab-svoa, 0.1 mg | |
| J2778 | Injection, ranibizumab, 0.1 mg | |
| J2779 | Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg | |
| J2780 | Injection, ranitidine hydrochloride, 25 mg | |
| J2783 | Injection, rasburicase, 0.5 mg | |
| J2785 | Injection, regadenoson, 0.1 mg | |
| J2786 | Injection, reslizumab, 1 mg | |
| J2787 | Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml | |
| J2788 | Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) | |
| J2790 | Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) | |
| J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | |
| J2792 | Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu | |
| J2793 | Injection, rilonacept, 1 mg | |
| J2794 | Injection, risperidone (risperdal consta), 0.5 mg | |
| J2795 | Injection, ropivacaine hydrochloride, 1 mg | |
| J2796 | Injection, romiplostim, 10 micrograms | |
| J2797 | Injection, rolapitant, 0.5 mg | |
| J2798 | Injection, risperidone, (perseris), 0.5 mg | |
| J2800 | Injection, methocarbamol, up to 10 ml | |
| J2805 | Injection, sincalide, 5 micrograms | |
| J2806 | Injection, sincalide (maia) not therapeutically equivalent to j2805, 5 micrograms | |
| J2810 | Injection, theophylline, per 40 mg | |
| J2820 | Injection, sargramostim (gm-csf), 50 mcg | |
| J2840 | Injection, sebelipase alfa, 1 mg | |
| J2850 | Injection, secretin, synthetic, human, 1 microgram | |
| J2860 | Injection, siltuximab, 10 mg | |
| J2910 | Injection, aurothioglucose, up to 50 mg | |
| J2912 | INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML | |
| J2916 | Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg | |
| J2940 | Injection, somatrem, 1 mg | |
| J2941 | Injection, somatropin, 1 mg | |
| J2950 | Injection, promazine hcl, up to 25 mg | |
| J2993 | Injection, reteplase, 18.1 mg | |
| J2995 | Injection, streptokinase, per 250,000 iu | |
| J2997 | Injection, alteplase recombinant, 1 mg | |
| J2998 | Injection, plasminogen, human-tvmh, 1 mg | |
| J3000 | Injection, streptomycin, up to 1 gm | |
| J3010 | Injection, fentanyl citrate, 0.1 mg | |
| J3030 | Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | |
| J3031 | Injection, fremanezumab-vfrm, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered) | |
| J3032 | Injection, eptinezumab-jjmr, 1 mg | |
| J3060 | Injection, taliglucerase alfa, 10 units | |
| J3070 | Injection, pentazocine, 30 mg | |
| J3090 | Injection, tedizolid phosphate, 1 mg | |
| J3095 | Injection, telavancin, 10 mg | |
| J3100 | INJECTION, TENECTEPLASE, 50MG | |
| J3101 | Injection, tenecteplase, 1 mg | |
| J3105 | Injection, terbutaline sulfate, up to 1 mg | |
| J3110 | Injection, teriparatide, 10 mcg | |
| J3120 | Injection, testosterone enanthate, up to 100 mg | |
| J3121 | Injection, testosterone enanthate, 1 mg | |
| J3130 | Injection, testosterone enanthate, up to 200 mg | |
| J3140 | Injection, testosterone suspension, up to 50 mg | |
| J3145 | Injection, testosterone undecanoate, 1 mg | |
| J3150 | Injection, testosterone propionate, up to 100 mg | |
| J3230 | Injection, chlorpromazine hcl, up to 50 mg | |
| J3240 | Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial | |
| J3241 | Injection, teprotumumab-trbw, 10 mg | |
| J3243 | Injection, tigecycline, 1 mg | |
| J3244 | Injection, tigecycline (accord) not therapeutically equivalent to j3243, 1 mg | |
| J3245 | Injection, tildrakizumab, 1 mg | |
| J3246 | Injection, tirofiban hcl, 0.25 mg | |
| J3250 | Injection, trimethobenzamide hcl, up to 200 mg | |
| J3260 | Injection, tobramycin sulfate, up to 80 mg | |
| J3262 | Injection, tocilizumab, 1 mg | |
| J3265 | Injection, torsemide, 10 mg/ml | |
| J3280 | Injection, thiethylperazine maleate, up to 10 mg | |
| J3285 | Injection, treprostinil, 1 mg | |
| J3299 | Injection, triamcinolone acetonide (xipere), 1 mg | |
| J3300 | Injection, triamcinolone acetonide, preservative free, 1 mg | |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | |
| J3302 | Injection, triamcinolone diacetate, per 5 mg | |
| J3303 | Injection, triamcinolone hexacetonide, per 5 mg | |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | |
| J3305 | Injection, trimetrexate glucuronate, per 25 mg | |
| J3310 | Injection, perphenazine, up to 5 mg | |
| J3315 | Injection, triptorelin pamoate, 3.75 mg | |
| J3316 | Injection, triptorelin, extended-release, 3.75 mg | |
| J3320 | Injection, spectinomycin dihydrochloride, up to 2 gm | |
| J3350 | Injection, urea, up to 40 gm | |
| J3355 | Injection, urofollitropin, 75 iu | |
| J3357 | Ustekinumab, for subcutaneous injection, 1 mg | |
| J3358 | Ustekinumab, for intravenous injection, 1 mg | |
| J3360 | Injection, diazepam, up to 5 mg | |
| J3364 | Injection, urokinase, 5000 iu vial | |
| J3365 | Injection, iv, urokinase, 250,000 i.u. vial | |
| J3370 | Injection, vancomycin hcl, 500 mg | |
| J3371 | Injection, vancomycin hcl (mylan) not therapeutically equivalent to j3370, 500 mg | |
| J3372 | Injection, vancomycin hcl (xellia) not therapeutically equivalent to j3370, 500 mg | |
| J3380 | Injection, vedolizumab, 1 mg | |
| J3385 | Injection, velaglucerase alfa, 100 units | |
| J3395 | INJECTION, VERTEPORFIN, 15MG | |
| J3399 | Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes | |
| J3400 | Injection, triflupromazine hcl, up to 20 mg | |
| J3410 | Injection, hydroxyzine hcl, up to 25 mg | |
| J3411 | Injection, thiamine hcl, 100 mg | |
| J3415 | Injection, pyridoxine hcl, 100 mg | |
| J3420 | Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | |
| J3430 | Injection, phytonadione (vitamin k), per 1 mg | |
| J3465 | Injection, voriconazole, 10 mg | |
| J3470 | Injection, hyaluronidase, up to 150 units | |
| J3471 | Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) | |
| J3472 | Injection, hyaluronidase, ovine, preservative free, per 1000 usp units | |
| J3473 | Injection, hyaluronidase, recombinant, 1 usp unit | |
| J3475 | Injection, magnesium sulfate, per 500 mg | |
| J3480 | Injection, potassium chloride, per 2 meq | |
| J3485 | Injection, zidovudine, 10 mg | |
| J3486 | Injection, ziprasidone mesylate, 10 mg | |
| J3487 | Injection, zoledronic acid (zometa), 1 mg | |
| J3488 | Injection, zoledronic acid (reclast), 1 mg | |
| J3489 | Injection, zoledronic acid, 1 mg | |
| J3490 | Unclassified drugs | |
| J3520 | Edetate disodium, per 150 mg | |
| J3530 | Nasal vaccine inhalation | |
| J3535 | Drug administered through a metered dose inhaler | |
| J3570 | Laetrile, amygdalin, vitamin b17 | |
| J3590 | Unclassified biologics | |
| J3591 | Unclassified drug or biological used for esrd on dialysis | |
| J7030 | Infusion, normal saline solution , 1000 cc | |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | |
| J7042 | 5% dextrose/normal saline (500 ml = 1 unit) | |
| J7050 | Infusion, normal saline solution, 250 cc | |
| J7051 | STERILE SALINE OR WATER, UP TO 5 CC | |
| J7060 | 5% dextrose/water (500 ml = 1 unit) | |
| J7070 | Infusion, d5w, 1000 cc | |
| J7100 | Infusion, dextran 40, 500 ml | |
| J7110 | Infusion, dextran 75, 500 ml | |
| J7120 | Ringers lactate infusion, up to 1000 cc | |
| J7121 | 5% dextrose in lactated ringers infusion, up to 1000 cc | |
| J7130 | Hypertonic saline solution, 50 or 100 meq, 20 cc vial | |
| J7131 | Hypertonic saline solution, 1 ml | |
| J7168 | Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity | |
| J7169 | Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg | |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | |
| J7175 | Injection, factor x, (human), 1 i.u. | |
| J7177 | Injection, human fibrinogen concentrate (fibryga), 1 mg | |
| J7178 | Injection, human fibrinogen concentrate, not otherwise specified, 1 mg | |
| J7179 | Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco | |
| J7180 | Injection, factor xiii (antihemophilic factor, human), 1 i.u. | |
| J7169 | Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg | |
| J7184 | Injection, von willebrand factor complex (human), wilate, per 100 iu vwf:rco | |
| J7185 | Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. | |
| J7186 | Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. | |
| J7187 | Injection, von willebrand factor complex (humate-p), per iu vwf:rco | |
| J7188 | Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. | |
| J7189 | Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram | |
| J7190 | Factor viii (antihemophilic factor, human) per i.u. | |
| J7191 | Factor viii (antihemophilic factor (porcine)), per i.u. | |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | |
| J7193 | Factor ix (antihemophilic factor, purified, non-recombinant) per i.u. | |
| J7194 | Factor ix, complex, per i.u. | |
| J7195 | Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified | |
| J7196 | Injection, antithrombin recombinant, 50 i.u. | |
| J7197 | Antithrombin iii (human), per i.u. | |
| J7198 | Anti-inhibitor, per i.u. | |
| J7199 | Hemophilia clotting factor, not otherwise classified | |
| J7204 | Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu | |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | |
| J7315 | Mitomycin, ophthalmic, 0.2 mg | |
| J7316 | Injection, ocriplasmin, 0.125 mg | |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg | |
| J7326 | Hyaluronan or derivative, gel-one, for intra-articular injection, per dose | |
| J7327 | Hyaluronan or derivative, monovisc, for intra-articular injection, per dose | |
| J7328 | Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg | |
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | |
| J7330 | Autologous cultured chondrocytes, implant | |
| J7604 | Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram | |
| J7605 | Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms | |
| J7606 | Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms | |
| J7607 | Levalbuterol, inhalation solution, compounded product, administered through dme, concentrated form, 0.5 mg | |
| J7608 | Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram | |
| J7609 | Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg | |
| J7610 | Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg | |
| J7611 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg | |
| J7612 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg | |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | |
| J7614 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg | |
| J7615 | Levalbuterol, inhalation solution, compounded product, administered through dme, unit dose, 0.5 mg | |
| J7616 | ALBUTEROL, UP TO 5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME | |
| J7617 | LEVALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME | |
| J7618 | ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) | |
| J7619 | ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) | |
| J7620 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme | |
| J7621 | ALBUTEROL, ALL FORMULATIONS, INCLUDING SEPARATED ISOMERS, UP TO 5 MG (ALBUTEROL) OR 2.5 MG (LEVOALBUTEROL), AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME | |
| J7622 | Beclomethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7624 | Betamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7626 | Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg | |
| J7627 | Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg | |
| J7628 | Bitolterol mesylate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7629 | Bitolterol mesylate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7631 | Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams | |
| J7632 | Cromolyn sodium, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams | |
| J7633 | Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 0.25 milligram | |
| J7634 | Budesonide, inhalation solution, compounded product, administered through dme, concentrated form, per 0.25 milligram | |
| J7635 | Atropine, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7636 | Atropine, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7637 | Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7638 | Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7639 | Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | |
| J7640 | Formoterol, inhalation solution, compounded product, administered through dme, unit dose form, 12 micrograms | |
| J7641 | Flunisolide, inhalation solution, compounded product, administered through dme, unit dose, per milligram | |
| J7642 | Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7643 | Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7644 | Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | |
| J7645 | Ipratropium bromide, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7647 | Isoetharine hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7648 | Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram | |
| J7649 | Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | |
| J7650 | Isoetharine hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7657 | Isoproterenol hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7658 | Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram | |
| J7659 | Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | |
| J7660 | Isoproterenol hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7667 | Metaproterenol sulfate, inhalation solution, compounded product, concentrated form, per 10 milligrams | |
| J7668 | Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 10 milligrams | |
| J7669 | Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams | |
| J7670 | Metaproterenol sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams | |
| J7674 | Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg | |
| J7676 | Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg | |
| J7677 | Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram | |
| J7680 | Terbutaline sulfate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7681 | Terbutaline sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7682 | Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams | |
| J7683 | Triamcinolone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram | |
| J7684 | Triamcinolone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | |
| J7685 | Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams | |
| J7686 | Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg | |
| J7699 | Noc drugs, inhalation solution administered through dme | |
| J7799 | Noc drugs, other than inhalation drugs, administered through dme | |
| J8499 | Prescription drug, oral, non chemotherapeutic, nos | |
| J8510 | Busulfan; oral, 2 mg | |
| J8515 | Cabergoline, oral, 0.25 mg | |
| J8520 | Capecitabine, oral, 150 mg | |
| J8521 | Capecitabine, oral, 500 mg | |
| J8530 | Cyclophosphamide; oral, 25 mg | |
| J8560 | Etoposide; oral, 50 mg | |
| J8600 | Melphalan; oral, 2 mg | |
| J8610 | Methotrexate; oral, 2.5 mg | |
| J8700 | Temozolomide, oral, 5 mg | |
| J8705 | Topotecan, oral, 0.25 mg | |
| J8999 | Prescription drug, oral, chemotherapeutic, nos | |
| J9000 | Injection, doxorubicin hydrochloride, 10 mg | |
| J9001 | Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg | |
| J9002 | Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg | |
| J9010 | Injection, alemtuzumab, 10 mg | |
| J9015 | Injection, aldesleukin, per single use vial | |
| J9017 | Injection, arsenic trioxide, 1 mg | |
| J9019 | Injection, asparaginase (erwinaze), 1,000 iu | |
| J9020 | Injection, asparaginase, not otherwise specified, 10,000 units | |
| J9021 | Injection, asparaginase, recombinant, (rylaze), 0.1 mg | |
| J9022 | Injection, atezolizumab, 10 mg | |
| J9023 | Injection, avelumab, 10 mg | |
| J9025 | Injection, azacitidine, 1 mg | |
| J9027 | Injection, clofarabine, 1 mg | |
| J9029 | Injection, nadofaragene firadenovec-vncg, per therapeutic dose | |
| J9030 | Bcg live intravesical instillation, 1 mg | |
| J9031 | Bcg (intravesical) per instillation | |
| J9032 | Injection, belinostat, 10 mg | |
| J9033 | Injection, bendamustine hcl (treanda), 1 mg | |
| J9034 | Injection, bendamustine hcl (bendeka), 1 mg | |
| J9035 | Injection, bevacizumab, 10 mg | |
| J9037 | Injection, belantamab mafodotin-blmf, 0.5 mg | |
| J9039 | Injection, blinatumomab, 1 microgram | |
| J9040 | Injection, bleomycin sulfate, 15 units | |
| J9041 | Injection, bortezomib, 0.1 mg | |
| J9042 | Injection, brentuximab vedotin, 1 mg | |
| J9043 | Injection, cabazitaxel, 1 mg | |
| J9044 | Injection, bortezomib, not otherwise specified, 0.1 mg | |
| J9045 | Injection, carboplatin, 50 mg | |
| J9046 | Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg | |
| J9047 | Injection, carfilzomib, 1 mg | |
| J9048 | Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg | |
| J9049 | Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg | |
| J9050 | Injection, carmustine, 100 mg | |
| J9055 | Injection, cetuximab, 10 mg | |
| J9056 | Injection, bendamustine hydrochloride (vivimusta), 1 mg | |
| J9057 | Injection, copanlisib, 1 mg | |
| J9058 | Injection, bendamustine hydrochloride (apotex), 1 mg | |
| J9059 | Injection, bendamustine hydrochloride (baxter), 1 mg | |
| J9060 | Injection, cisplatin, powder or solution, 10 mg | |
| J9061 | Injection, amivantamab-vmjw, 2 mg | |
| J9062 | Cisplatin, 50 mg | |
| J9063 | Injection, mirvetuximab soravtansine-gynx, 1 mg | |
| J9065 | Injection, cladribine, per 1 mg | |
| J9070 | Cyclophosphamide, 100 mg | |
| J9071 | Injection, cyclophosphamide, (auromedics), 5 mg | |
| J9080 | Cyclophosphamide, 200 mg | |
| J9090 | Cyclophosphamide, 500 mg | |
| J9091 | Cyclophosphamide, 1.0 gram | |
| J9092 | Cyclophosphamide, 2.0 gram | |
| J9093 | Cyclophosphamide, lyophilized, 100 mg | |
| J9094 | Cyclophosphamide, lyophilized, 200 mg | |
| J9095 | Cyclophosphamide, lyophilized, 500 mg | |
| J9096 | Cyclophosphamide, lyophilized, 1.0 gram | |
| J9097 | Cyclophosphamide, lyophilized, 2.0 gram | |
| J9098 | Injection, cytarabine liposome, 10 mg | |
| J9100 | Injection, cytarabine, 100 mg | |
| J9110 | Injection, cytarabine, 500 mg | |
| J9118 | Injection, calaspargase pegol-mknl, 10 units | |
| J9120 | Injection, dactinomycin, 0.5 mg | |
| J9130 | Dacarbazine, 100 mg | |
| J9140 | Dacarbazine, 200 mg | |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | |
| J9145 | Injection, daratumumab, 10 mg | |
| J9150 | Injection, daunorubicin, 10 mg | |
| J9151 | Injection, daunorubicin citrate, liposomal formulation, 10 mg | |
| J9153 | Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine | |
| J9155 | Injection, degarelix, 1 mg | |
| J9160 | Injection, denileukin diftitox, 300 micrograms | |
| J9165 | Injection, diethylstilbestrol diphosphate, 250 mg | |
| J9170 | INJECTION, DOCETAXEL, 20 MG | |
| J9171 | Injection, docetaxel, 1 mg | |
| J9173 | Injection, durvalumab, 10 mg | |
| J9175 | Injection, elliotts' b solution, 1 ml | |
| J9176 | Injection, elotuzumab, 1 mg | |
| J9177 | Injection, enfortumab vedotin-ejfv, 0.25 mg | |
| J9178 | Injection, epirubicin hcl, 2 mg | |
| J9179 | Injection, eribulin mesylate, 0.1 mg | |
| J9181 | Injection, etoposide, 10 mg | |
| J9182 | ETOPOSIDE, 100 MG | |
| J9185 | Injection, fludarabine phosphate, 50 mg | |
| J9190 | Injection, fluorouracil, 500 mg | |
| J9196 | Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg | |
| J9198 | Injection, gemcitabine hydrochloride, (infugem), 100 mg | |
| J9199 | Injection, gemcitabine hydrochloride (infugem), 200 mg | |
| J9200 | Injection, floxuridine, 500 mg | |
| J9201 | Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg | |
| J9202 | Goserelin acetate implant, per 3.6 mg | |
| J9203 | Injection, gemtuzumab ozogamicin, 0.1 mg | |
| J9204 | Injection, mogamulizumab-kpkc, 1 mg | |
| J9205 | Injection, irinotecan liposome, 1 mg | |
| J9206 | Injection, irinotecan, 20 mg | |
| J9207 | Injection, ixabepilone, 1 mg | |
| J9208 | Injection, ifosfamide, 1 gram | |
| J9209 | Injection, mesna, 200 mg | |
| J9211 | Injection, idarubicin hydrochloride, 5 mg | |
| J9212 | Injection, interferon alfacon-1, recombinant, 1 microgram | |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | |
| J9218 | Leuprolide acetate, per 1 mg | |
| J9219 | Leuprolide acetate implant, 65 mg | |
| J9223 | Injection, lurbinectedin, 0.1 mg | |
| J9225 | Histrelin implant (vantas), 50 mg | |
| J9226 | Histrelin implant (supprelin la), 50 mg | |
| J9227 | Injection, isatuximab-irfc, 10 mg | |
| J9228 | Injection, ipilimumab, 1 mg | |
| J9229 | Injection, inotuzumab ozogamicin, 0.1 mg | |
| J9230 | Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg | |
| J9245 | Injection, melphalan hydrochloride, not otherwise specified, 50 mg | |
| J9246 | Injection, melphalan (evomela), 1 mg | |
| J9247 | Injection, melphalan flufenamide, 1mg | |
| J9250 | Methotrexate sodium, 5 mg | |
| J9259 | Injection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264, 1 mg | |
| J9260 | Methotrexate sodium, 50 mg | |
| J9261 | Injection, nelarabine, 50 mg | |
| J9262 | Injection, omacetaxine mepesuccinate, 0.01 mg | |
| J9263 | Injection, oxaliplatin, 0.5 mg | |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | |
| J9265 | Injection, paclitaxel, 30 mg | |
| J9266 | Injection, pegaspargase, per single dose vial | |
| J9267 | Injection, paclitaxel, 1 mg | |
| J9268 | Injection, pentostatin, 10 mg | |
| J9270 | Injection, plicamycin, 2.5 mg | |
| J9271 | Injection, pembrolizumab, 1 mg | |
| J9272 | Injection, dostarlimab-gxly, 10 mg | |
| J9273 | Injection, tisotumab vedotin-tftv, 1 mg | |
| J9274 | Injection, tebentafusp-tebn, 1 microgram | |
| J9280 | Injection, mitomycin, 5 mg | |
| J9281 | Mitomycin pyelocalyceal instillation, 1 mg | |
| J9285 | Injection, olaratumab, 10 mg | |
| J9290 | Mitomycin, 20 mg | |
| J9291 | Mitomycin, 40 mg | |
| J9293 | Injection, mitoxantrone hydrochloride, per 5 mg | |
| J9294 | Injection, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg | |
| J9295 | Injection, necitumumab, 1 mg | |
| J9296 | Injection, pemetrexed (accord) not therapeutically equivalent to j9305, 10 mg | |
| J9297 | Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg | |
| J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg | |
| J9299 | Injection, nivolumab, 1 mg | |
| J9300 | Injection, gemtuzumab ozogamicin, 5 mg | |
| J9301 | Injection, obinutuzumab, 10 mg | |
| J9302 | Injection, ofatumumab, 10 mg | |
| J9303 | Injection, panitumumab, 10 mg | |
| J9304 | Injection, pemetrexed (pemfexy), 10 mg | |
| J9305 | Injection, pemetrexed, not otherwise specified, 10 mg | |
| J9306 | Injection, pertuzumab, 1 mg | |
| J9307 | Injection, pralatrexate, 1 mg | |
| J9308 | Injection, ramucirumab, 5 mg | |
| J9309 | Injection, polatuzumab vedotin-piiq, 1 mg | |
| J9310 | Injection, rituximab, 100 mg | |
| J9311 | Injection, rituximab 10 mg and hyaluronidase | |
| J9312 | Injection, rituximab, 10 mg | |
| J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | |
| J9314 | Injection, pemetrexed (teva) not therapeutically equivalent to J9305, 10 mg | |
| J9315 | Injection, romidepsin, 1 mg | |
| J9316 | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg | |
| J9317 | Injection, sacituzumab govitecan-hziy, 2.5 mg | |
| J9318 | Injection, romidepsin, non-lyophilized, 0.1 mg | |
| J9319 | Injection, romidepsin, lyophilized, 0.1 mg | |
| J9320 | Injection, streptozocin, 1 gram | |
| J9321 | Injection, pemetrexed (sandoz) not therapeutically equivalent to j9305, 10 mg | |
| J9322 | Injection, pemetrexed (bluepoint) not therapeutically equivalent to j9305, 10 mg | |
| J9323 | Injection, pemetrexed ditromethamine, 10 mg | |
| J9325 | Injection, talimogene laherparepvec, per 1 million plaque forming units | |
| J9328 | Injection, temozolomide, 1 mg | |
| J9330 | Injection, temsirolimus, 1 mg | |
| J9331 | Injection, sirolimus protein-bound particles, 1 mg | |
| J9332 | Injection, efgartigimod alfa-fcab, 2mg | |
| J9340 | Injection, thiotepa, 15 mg | |
| J9347 | Injection, tremelimumab-actl, 1 mg | |
| J9348 | Injection, naxitamab-gqgk, 1 mg | |
| J9349 | Injection, tafasitamab-cxix, 2 mg | |
| J9350 | Injection, mosunetuzumab-axgb, 1 mg | |
| J9351 | Injection, topotecan, 0.1 mg | |
| J9352 | Injection, trabectedin, 0.1 mg | |
| J9353 | Injection, margetuximab-cmkb, 5 mg | |
| J9354 | Injection, ado-trastuzumab emtansine, 1 mg | |
| J9355 | Injection, trastuzumab, excludes biosimilar, 10 mg | |
| J9357 | Injection, valrubicin, intravesical, 200 mg | |
| J9358 | Injection, fam-trastuzumab deruxtecan-nxki, 1 mg | |
| J9359 | Injection, loncastuximab tesirine-lpyl, 0.075 mg | |
| J9360 | Injection, vinblastine sulfate, 1 mg | |
| J9370 | Vincristine sulfate, 1 mg | |
| J9371 | Injection, vincristine sulfate liposome, 1 mg | |
| J9375 | Vincristine sulfate, 2 mg | |
| J9380 | Injection, teclistamab-cqyv, 0.5 mg | |
| J9381 | Injection, teplizumab-mzwv, 5 mcg | |
| J9390 | Injection, vinorelbine tartrate, 10 mg | |
| J9393 | Injection, fulvestrant (teva) not therapeutically equivalent to j9395, 25 mg | |
| J9394 | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg | |
| J9395 | Injection, fulvestrant, 25 mg | |
| J9600 | Injection, porfimer sodium, 75 mg | |
| J9999 | Not otherwise classified, antineoplastic drugs | |
| K0005 | Ultralightweight wheelchair | |
| K0008 | Custom manual wheelchair/base | |
| K0009 | Other manual wheelchair/base | |
| K0010 | Standard - weight frame motorized/power wheelchair | |
| K0011 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking | |
| K0012 | Lightweight portable motorized/power wheelchair | |
| K0013 | Custom motorized/power wheelchair base | |
| K0014 | Other motorized/power wheelchair base | |
| K0015 | Detachable, non-adjustable height armrest, replacement only, each | |
| K0017 | Detachable, adjustable height armrest, base, replacement only, each | |
| K0018 | Detachable, adjustable height armrest, upper portion, replacement only, each | |
| K0019 | Arm pad, replacement only, each | |
| K0020 | Fixed, adjustable height armrest, pair | |
| K0023 | SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, ATTACHED WITH STRAPS | |
| K0024 | SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, WITH ADJUSTABLE HOOK-ON HARDWARE | |
| K0037 | High mount flip-up footrest, each | |
| K0038 | Leg strap, each | |
| K0039 | Leg strap, h style, each | |
| K0040 | Adjustable angle footplate, each | |
| K0041 | Large size footplate, each | |
| K0042 | Standard size footplate, replacement only, each | |
| K0043 | Footrest, lower extension tube, replacement only, each | |
| K0044 | Footrest, upper hanger bracket, replacement only, each | |
| K0045 | Footrest, complete assembly, replacement only, each | |
| K0046 | Elevating legrest, lower extension tube, replacement only, each | |
| K0047 | Elevating legrest, upper hanger bracket, replacement only, each | |
| K0050 | Ratchet assembly, replacement only | |
| K0051 | Cam release assembly, footrest or legrest, replacement only, each | |
| K0052 | Swingaway, detachable footrests, replacement only, each | |
| K0053 | Elevating footrests, articulating (telescoping), each | |
| K0056 | Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair | |
| K0059 | PLASTIC COATED HANDRIM, EACH | |
| K0060 | STEEL HANDRIM, EACH | |
| K0061 | ALUMINUM HANDRIM, EACH | |
| K0064 | ZERO PRESSURE TUBE (FLAT FREE INSERTS), ANY SIZE, EACH | |
| K0065 | Spoke protectors, each | |
| K0066 | SOLID TIRE, ANY SIZE, EACH | |
| K0067 | PNEUMATIC TIRE, ANY SIZE, EACH | |
| K0068 | PNEUMATIC TIRE TUBE, EACH | |
| K0069 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each | |
| K0070 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each | |
| K0071 | Front caster assembly, complete, with pneumatic tire, replacement only, each | |
| K0072 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each | |
| K0073 | Caster pin lock, each | |
| K0074 | PNEUMATIC CASTER TIRE, ANY SIZE, EACH | |
| K0075 | SEMI-PNEUMATIC CASTER TIRE, ANY SIZE, EACH | |
| K0076 | SOLID CASTER TIRE, ANY SIZE, EACH | |
| K0077 | Front caster assembly, complete, with solid tire, replacement only, each | |
| K0078 | PNEUMATIC CASTER TIRE TUBE, EACH | |
| K0081 | WHEEL LOCK ASSEMBLY, COMPLETE, EACH | |
| K0090 | REAR WHEEL TIRE FOR POWER WHEELCHAIR, ANY SIZE, EACH | |
| K0091 | REAR WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR POWER WHEELCHAIR, ANY SIZE,EACH | |
| K0092 | REAR WHEEL ASSEMBLY FOR POWER WHEELCHAIR, COMPLETE, EACH | |
| K0093 | REAR WHEEL, ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER WHEELCHAIR, ANY SIZE, EACH | |
| K0094 | WHEEL TIRE FOR POWER BASE, ANY SIZE, EACH | |
| K0095 | WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR EACH BASE, ANY SIZE, EACH | |
| K0096 | WHEEL ASSEMBLY FOR POWER BASE, COMPLETE, EACH | |
| K0097 | WHEEL ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER BASE, ANY SIZE, EACH | |
| K0098 | Drive belt for power wheelchair, replacement only | |
| K0099 | FRONT CASTER FOR POWER WHEELCHAIR, EACH | |
| K0102 | CRUTCH AND CANE HOLDER, EACH | |
| K0104 | CYLINDER TANK CARRIER, EACH | |
| K0105 | Iv hanger, each | |
| K0106 | ARM TROUGH, EACH | |
| K0108 | Wheelchair component or accessory, not otherwise specified | |
| K0114 | BACK SUPPORT SYSTEM FOR USE WITH A WHEELCHAIR, WITH INNER FRAME, PREFABRICATED | |
| K0115 | SEATING SYSTEM, BACK MODULE, POSTERIORLATERAL CONTROL, WITH OR WITHOUT LATERAL SUPPORTS, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE | |
| K0116 | SEATING SYSTEM, COMBINED BACK AND SEAT MODULE, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE | |
| K0452 | WHEELCHAIR BEARINGS, ANY TYPE | |
| K0552 | Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each | |
| K0554 | Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system | |
| K0555 | NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR | |
| K0600 | FUNCTIONAL NEUROMUSCULAR STIMULATOR, TRANSCUTANEOUS STIMULATION OF MUSCLES OF AMBULATION WITH COMPUTER CONTROL, USED FOR WALKING BY SPINAL CORD INJURED, ENTIRE SYSTEM, AFTER COMPLETION OF TRAINING PROGRAM | |
| K0601 | Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each | |
| K0602 | Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each | |
| K0603 | Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each | |
| K0604 | Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each | |
| K0605 | Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each | |
| K0606 | Automatic external defibrillator, with integrated electrocardiogram analysis, garment type | |
| K0607 | Replacement battery for automated external defibrillator, garment type only, each | |
| K0608 | Replacement garment for use with automated external defibrillator, each | |
| K0609 | Replacement electrodes for use with automated external defibrillator, garment type only, each | |
| K0618 | TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE XIPHOID, SOF | |
| K0619 | TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE XIPHOID, S | |
| K0627 | TRACTION EQUIPMENT, CERVICAL, FREE-STANDING, PNEUMATIC, APPLYING TRACTION FORCE TO OTHER THAN MANDIBLE | |
| K0630 | SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| K0631 | SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED | |
| K0632 | SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PANELS OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING A | |
| K0633 | SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PANELS PLACED OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED | |
| K0634 | LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, SHOULDER STRA | |
| K0635 | LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR EXTENDS FROM L1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER | |
| K0636 | LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOU | |
| K0637 | LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE STAYS, SHOU | |
| K0638 | LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE STAYS, SHOU | |
| K0639 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PAD | |
| K0640 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, PENDULOUS ABDO | |
| K0641 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY | |
| K0642 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD | |
| K0643 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD | |
| K0644 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERA | |
| K0645 | LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERA | |
| K0646 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO R | |
| K0647 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO R | |
| K0648 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S) POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRA | |
| K0649 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S) POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRA | |
| K0650 | GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH | |
| K0651 | GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH | |
| K0652 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH | |
| K0653 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH | |
| K0654 | POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH | |
| K0655 | POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH | |
| K0656 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH | |
| K0657 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH | |
| K0658 | CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE | |
| K0659 | WHEELCHAIR SEAT CUSHION, POWERED | |
| K0660 | GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE | |
| K0661 | GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE | |
| K0662 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE | |
| K0663 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE | |
| K0664 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE | |
| K0665 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE | |
| K0666 | CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE MOUNTING HARDWARE | |
| K0667 | MOUNTING HARDWARE, ANY TYPE, FOR SEAT CUSHION OR SEAT SUPPORT BASE ATTACHED TO A MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, PER CUSHION/BASE | |
| K0668 | REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH | |
| K0669 | Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac | |
| K0670 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE | |
| K0672 | Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each | |
| K0730 | Controlled dose inhalation drug delivery system | |
| K0731 | LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, OTHER THAN EAR LEVEL, REPLACEMENT, EACH | |
| K0732 | LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR LEVEL, REPLACEMENT, EACH | |
| K0733 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) | |
| K0734 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth | |
| K0735 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth | |
| K0736 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth | |
| K0737 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth | |
| K0738 | Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing | |
| K0741 | Portable gaseous oxygen system, rental, includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing, for cluster headaches | |
| K0742 | Portable oxygen contents, gaseous, 1 month's supply = 1 unit, for cluster headaches, for initial months supply or to replace used contents | |
| K0800 | Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds | |
| K0801 | Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds | |
| K0802 | Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds | |
| K0806 | Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds | |
| K0807 | Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds | |
| K0808 | Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds | |
| K0812 | Power operated vehicle, not otherwise classified | |
| K0813 | Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds | |
| K0814 | Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds | |
| K0815 | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds | |
| K0816 | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds | |
| K0820 | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0821 | Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds | |
| K0822 | Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0823 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds | |
| K0824 | Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0825 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds | |
| K0826 | Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds | |
| K0827 | Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds | |
| K0828 | Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more | |
| K0829 | Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more | |
| K0830 | Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0831 | Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds | |
| K0835 | Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0836 | Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds | |
| K0837 | Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0838 | Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds | |
| K0839 | Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds | |
| K0840 | Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more | |
| K0841 | Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0842 | Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds | |
| K0843 | Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0848 | Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0849 | Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds | |
| K0850 | Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0851 | Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds | |
| K0852 | Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds | |
| K0853 | Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds | |
| K0854 | Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more | |
| K0855 | Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more | |
| K0856 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0857 | Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds | |
| K0858 | Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds | |
| K0859 | Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds | |
| K0860 | Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds | |
| K0861 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0862 | Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0863 | Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds | |
| K0864 | Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more | |
| K0868 | Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0869 | Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds | |
| K0870 | Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0871 | Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds | |
| K0877 | Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0878 | Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds | |
| K0879 | Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0880 | Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds | |
| K0884 | Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | |
| K0885 | Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds | |
| K0886 | Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds | |
| K0890 | Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds | |
| K0891 | Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds | |
| K0898 | Power wheelchair, not otherwise classified | |
| K0899 | Power mobility device, not coded by dme pdac or does not meet criteria | |
| K0900 | Customized durable medical equipment, other than wheelchair | |
| L0100 | CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT INTERFACE, MOLDED TO PATIENT MODEL | |
| L0110 | CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT-INTERFACE, NON-MOLDED | |
| L0112 | Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated | |
| L0113 | Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment | |
| L0120 | Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) | |
| L0130 | Cervical, flexible, thermoplastic collar, molded to patient | |
| L0140 | Cervical, semi-rigid, adjustable (plastic collar) | |
| L0150 | Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) | |
| L0160 | Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf | |
| L0170 | Cervical, collar, molded to patient model | |
| L0172 | Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf | |
| L0174 | Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf | |
| L0180 | Cervical, multiple post collar, occipital/mandibular supports, adjustable | |
| L0190 | Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types) | |
| L0200 | Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension | |
| L0210 | THORACIC, RIB BELT | |
| L0220 | Thoracic, rib belt, custom fabricated | |
| L0430 | Spinal orthosis, anterior-posterior-lateral control, with interface material, custom fitted (dewall posture protector only) | |
| L0450 | Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf | |
| L0452 | Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated | |
| L0454 | Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0455 | Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf | |
| L0456 | Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0457 | Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf | |
| L0458 | Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment | |
| L0460 | Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0462 | Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment | |
| L0464 | Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment | |
| L0466 | Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0467 | Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf | |
| L0468 | Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0469 | Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf | |
| L0470 | Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment | |
| L0472 | Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment | |
| L0476 | TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC SHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, USUALLY LA | |
| L0478 | TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC SHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, USUALLY LA | |
| L0480 | Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated | |
| L0482 | Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated | |
| L0484 | Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated | |
| L0486 | Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated | |
| L0488 | Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment | |
| L0490 | Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment | |
| L0491 | Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment | |
| L0492 | Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment | |
| L0500 | LUMBAR-SACRAL-ORTHOSIS (LSO), FLEXIBLE, (LUMBO-SACRAL SUPPORT) | |
| L0510 | LSO, FLEXIBLE (LUMBO-SACRAL SUPPORT), CUSTOM FABRICATED | |
| L0515 | LSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED | |
| L0520 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT, WILCOX TYPES), WITH APRON FRONT | |
| L0530 | LSO, ANTERIOR-POSTERIOR CONTROL (MACAUSLAND TYPE), WITH APRON FRONT | |
| L0540 | LSO, LUMBAR FLEXION (WILLIAMS FLEXION TYPE) | |
| L0550 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL | |
| L0560 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, WITH INTERFACE MATERIAL | |
| L0561 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED | |
| L0565 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, CUSTOM FITTED | |
| L0600 | SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT) | |
| L0610 | SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT), CUSTOM FABRICATED | |
| L0620 | SACROILIAC, SEMI-RIGID (GOLDTHWAITE, OSGOOD TYPES), WITH APRON FRONT | |
| L0621 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf | |
| L0622 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated | |
| L0623 | Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf | |
| L0624 | Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated | |
| L0625 | Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf | |
| L0626 | Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0627 | Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0628 | Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0629 | Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated | |
| L0630 | Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0631 | Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0632 | Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated | |
| L0633 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0634 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated | |
| L0635 | Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment | |
| L0636 | Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated | |
| L0637 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0638 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated | |
| L0639 | Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L0640 | Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated | |
| L0641 | Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0642 | Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0643 | Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0648 | Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0649 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0650 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0651 | Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf | |
| L0700 | Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type) | |
| L0710 | Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type) | |
| L0810 | Halo procedure, cervical halo incorporated into jacket vest | |
| L0820 | Halo procedure, cervical halo incorporated into plaster body jacket | |
| L0830 | Halo procedure, cervical halo incorporated into milwaukee type orthosis | |
| L0859 | Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material | |
| L0860 | ADDITION TO HALO PROCEDURES, MAGNETIC REASONANCE IMAGE COMPATIBLE SYSTEM | |
| L0861 | Addition to halo procedure, replacement liner/interface material | |
| L0960 | TORSO SUPPORT, POST SURGICAL SUPPORT, PADS FOR POST SURGICAL SUPPORT | |
| L0970 | Tlso, corset front | |
| L0972 | Lso, corset front | |
| L0974 | Tlso, full corset | |
| L0976 | Lso, full corset | |
| L0978 | Axillary crutch extension | |
| L0980 | Peroneal straps, prefabricated, off-the-shelf, pair | |
| L0982 | Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) | |
| L0984 | Protective body sock, prefabricated, off-the-shelf, each | |
| L0999 | Addition to spinal orthosis, not otherwise specified | |
| L1000 | Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model | |
| L1001 | Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment | |
| L1005 | Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment | |
| L1010 | Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling | |
| L1020 | Addition to ctlso or scoliosis orthosis, kyphosis pad | |
| L1025 | Addition to ctlso or scoliosis orthosis, kyphosis pad, floating | |
| L1030 | Addition to ctlso or scoliosis orthosis, lumbar bolster pad | |
| L1040 | Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad | |
| L1050 | Addition to ctlso or scoliosis orthosis, sternal pad | |
| L1060 | Addition to ctlso or scoliosis orthosis, thoracic pad | |
| L1070 | Addition to ctlso or scoliosis orthosis, trapezius sling | |
| L1080 | Addition to ctlso or scoliosis orthosis, outrigger | |
| L1085 | Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions | |
| L1090 | Addition to ctlso or scoliosis orthosis, lumbar sling | |
| L1100 | Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather | |
| L1110 | Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model | |
| L1120 | Addition to ctlso, scoliosis orthosis, cover for upright, each | |
| L1200 | Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only | |
| L1210 | Addition to tlso, (low profile), lateral thoracic extension | |
| L1220 | Addition to tlso, (low profile), anterior thoracic extension | |
| L1230 | Addition to tlso, (low profile), milwaukee type superstructure | |
| L1240 | Addition to tlso, (low profile), lumbar derotation pad | |
| L1250 | Addition to tlso, (low profile), anterior asis pad | |
| L1260 | Addition to tlso, (low profile), anterior thoracic derotation pad | |
| L1270 | Addition to tlso, (low profile), abdominal pad | |
| L1280 | Addition to tlso, (low profile), rib gusset (elastic), each | |
| L1290 | Addition to tlso, (low profile), lateral trochanteric pad | |
| L1300 | Other scoliosis procedure, body jacket molded to patient model | |
| L1310 | Other scoliosis procedure, post-operative body jacket | |
| L1499 | Spinal orthosis, not otherwise specified | |
| L1500 | Thoracic-hip-knee-ankle orthosis (thkao), mobility frame (newington, parapodium types) | |
| L1510 | Thkao, standing frame, with or without tray and accessories | |
| L1520 | Thkao, swivel walker | |
| L1600 | Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise | |
| L1610 | Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L1620 | Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L1630 | Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated | |
| L1640 | Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated | |
| L1650 | Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment | |
| L1652 | Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type | |
| L1660 | Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment | |
| L1680 | Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated | |
| L1685 | Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated | |
| L1686 | Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment | |
| L1690 | Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment | |
| L1700 | Legg perthes orthosis, (toronto type), custom fabricated | |
| L1710 | Legg perthes orthosis, (newington type), custom fabricated | |
| L1720 | Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated | |
| L1730 | Legg perthes orthosis, (scottish rite type), custom fabricated | |
| L1750 | LEGG PERTHES ORTHOSIS, LEGG PERTHES SLING (SAM BROWN TYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L1755 | Legg perthes orthosis, (patten bottom type), custom fabricated | |
| L1800 | KNEE ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L1810 | Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L1812 | Knee orthosis, elastic with joints, prefabricated, off-the-shelf | |
| L1815 | KNEE ORTHOSIS, ELASTIC OR OTHER ELASTIC TYPE MATERIAL WITH CONDYLAR PAD(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L1820 | Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment | |
| L1825 | KNEE ORTHOSIS, ELASTIC KNEE CAP, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L1830 | Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf | |
| L1831 | Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment | |
| L1832 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L1833 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf | |
| L1834 | Knee orthosis, without knee joint, rigid, custom fabricated | |
| L1836 | Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf | |
| L1840 | Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated | |
| L1843 | Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L1844 | Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated | |
| L1845 | Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L1846 | Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated | |
| L1847 | Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L1848 | Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf | |
| L1850 | Knee orthosis, swedish type, prefabricated, off-the-shelf | |
| L1851 | Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf | |
| L1852 | Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf | |
| L1855 | KNEE ORTHOSIS, MOLDED PLASTIC, THIGH AND CALF SECTIONS, WITH DOUBLE UPRIGHT KNEE JOINTS, CUSTOM-FABRICATED | |
| L1858 | KNEE ORTHOSIS, MOLDED PLASTIC, POLYCENTRIC KNEE JOINTS, PNEUMATIC KNEE PADS (CTI), CUSTOM-FABRICATED | |
| L1860 | Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk) | |
| L1870 | KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF LACERS WITH KNEE JOINTS, CUSTOM-FABRICATED | |
| L1880 | KNEE ORTHOSIS, DOUBLE UPRIGHT, NON-MOLDED THIGH AND CALF CUFFS/LACERS WITH KNEE JOINTS, CUSTOM-FABRICATED | |
| L1900 | Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated | |
| L1901 | ANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) | |
| L1902 | Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf | |
| L1904 | Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated | |
| L1906 | Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf | |
| L1907 | Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated | |
| L1910 | Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment | |
| L1920 | Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated | |
| L1930 | Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment | |
| L1932 | Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment | |
| L1940 | Ankle foot orthosis, plastic or other material, custom fabricated | |
| L1945 | Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated | |
| L1950 | Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated | |
| L1951 | Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment | |
| L1960 | Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated | |
| L1970 | Ankle foot orthosis, plastic with ankle joint, custom fabricated | |
| L1971 | Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment | |
| L1980 | Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated | |
| L1990 | Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated | |
| L2000 | Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated | |
| L2005 | Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated | |
| L2006 | Knee ankle foot device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated | |
| L2010 | Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated | |
| L2020 | Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated | |
| L2030 | Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated | |
| L2034 | Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated | |
| L2035 | Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment | |
| L2036 | Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated | |
| L2037 | Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated | |
| L2038 | Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated | |
| L2039 | KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE, MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED | |
| L2040 | Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated | |
| L2050 | Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated | |
| L2060 | Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated | |
| L2070 | Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated | |
| L2080 | Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated | |
| L2090 | Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated | |
| L2106 | Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated | |
| L2108 | Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated | |
| L2112 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment | |
| L2114 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment | |
| L2116 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment | |
| L2126 | Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated | |
| L2128 | Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated | |
| L2132 | Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment | |
| L2134 | Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment | |
| L2136 | Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment | |
| L2180 | Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints | |
| L2182 | Addition to lower extremity fracture orthosis, drop lock knee joint | |
| L2184 | Addition to lower extremity fracture orthosis, limited motion knee joint | |
| L2186 | Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type | |
| L2188 | Addition to lower extremity fracture orthosis, quadrilateral brim | |
| L2190 | Addition to lower extremity fracture orthosis, waist belt | |
| L2192 | Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt | |
| L2200 | Addition to lower extremity, limited ankle motion, each joint | |
| L2210 | Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint | |
| L2220 | Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint | |
| L2230 | Addition to lower extremity, split flat caliper stirrups and plate attachment | |
| L2232 | Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only | |
| L2240 | Addition to lower extremity, round caliper and plate attachment | |
| L2250 | Addition to lower extremity, foot plate, molded to patient model, stirrup attachment | |
| L2260 | Addition to lower extremity, reinforced solid stirrup (scott-craig type) | |
| L2265 | Addition to lower extremity, long tongue stirrup | |
| L2270 | Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad | |
| L2275 | Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined | |
| L2280 | Addition to lower extremity, molded inner boot | |
| L2300 | Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable | |
| L2310 | Addition to lower extremity, abduction bar-straight | |
| L2320 | Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only | |
| L2330 | Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only | |
| L2335 | Addition to lower extremity, anterior swing band | |
| L2340 | Addition to lower extremity, pre-tibial shell, molded to patient model | |
| L2350 | Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses) | |
| L2360 | Addition to lower extremity, extended steel shank | |
| L2370 | Addition to lower extremity, patten bottom | |
| L2375 | Addition to lower extremity, torsion control, ankle joint and half solid stirrup | |
| L2380 | Addition to lower extremity, torsion control, straight knee joint, each joint | |
| L2385 | Addition to lower extremity, straight knee joint, heavy duty, each joint | |
| L2387 | Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint | |
| L2390 | Addition to lower extremity, offset knee joint, each joint | |
| L2395 | Addition to lower extremity, offset knee joint, heavy duty, each joint | |
| L2397 | Addition to lower extremity orthosis, suspension sleeve | |
| L2405 | Addition to knee joint, drop lock, each | |
| L2415 | Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint | |
| L2425 | Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint | |
| L2430 | Addition to knee joint, ratchet lock for active and progressive knee extension, each joint | |
| L2435 | ADDITION TO KNEE JOINT, POLYCENTRIC JOINT, EACH JOINT | |
| L2492 | Addition to knee joint, lift loop for drop lock ring | |
| L2500 | Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring | |
| L2510 | Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model | |
| L2520 | Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted | |
| L2525 | Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model | |
| L2526 | Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted | |
| L2530 | Addition to lower extremity, thigh-weight bearing, lacer, non-molded | |
| L2540 | Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model | |
| L2550 | Addition to lower extremity, thigh/weight bearing, high roll cuff | |
| L2570 | Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each | |
| L2580 | Addition to lower extremity, pelvic control, pelvic sling | |
| L2600 | Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each | |
| L2610 | Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each | |
| L2620 | Addition to lower extremity, pelvic control, hip joint, heavy duty, each | |
| L2622 | Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each | |
| L2624 | Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each | |
| L2627 | Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables | |
| L2628 | Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables | |
| L2630 | Addition to lower extremity, pelvic control, band and belt, unilateral | |
| L2640 | Addition to lower extremity, pelvic control, band and belt, bilateral | |
| L2650 | Addition to lower extremity, pelvic and thoracic control, gluteal pad, each | |
| L2660 | Addition to lower extremity, thoracic control, thoracic band | |
| L2670 | Addition to lower extremity, thoracic control, paraspinal uprights | |
| L2680 | Addition to lower extremity, thoracic control, lateral support uprights | |
| L2750 | Addition to lower extremity orthosis, plating chrome or nickel, per bar | |
| L2755 | Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only | |
| L2760 | Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth) | |
| L2768 | Orthotic side bar disconnect device, per bar | |
| L2770 | ADDITION TO LOWER EXTREMITY ORTHOSIS, ANY MATERIAL - PER BAR OR JOINT | |
| L2780 | Addition to lower extremity orthosis, non-corrosive finish, per bar | |
| L2785 | Addition to lower extremity orthosis, drop lock retainer, each | |
| L2795 | Addition to lower extremity orthosis, knee control, full kneecap | |
| L2800 | Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only | |
| L2810 | Addition to lower extremity orthosis, knee control, condylar pad | |
| L2820 | Addition to lower extremity orthosis, soft interface for molded plastic, below knee section | |
| L2830 | Addition to lower extremity orthosis, soft interface for molded plastic, above knee section | |
| L2840 | Addition to lower extremity orthosis, tibial length sock, fracture or equal, each | |
| L2850 | Addition to lower extremity orthosis, femoral length sock, fracture or equal, each | |
| L2860 | ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM, EACH | |
| L2861 | Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each | |
| L2999 | Lower extremity orthoses, not otherwise specified | |
| L3000 | Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each | |
| L3001 | Foot, insert, removable, molded to patient model, spenco, each | |
| L3002 | Foot, insert, removable, molded to patient model, plastazote or equal, each | |
| L3003 | Foot, insert, removable, molded to patient model, silicone gel, each | |
| L3010 | Foot, insert, removable, molded to patient model, longitudinal arch support, each | |
| L3020 | Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each | |
| L3030 | Foot, insert, removable, formed to patient foot, each | |
| L3031 | Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each | |
| L3040 | Foot, arch support, removable, premolded, longitudinal, each | |
| L3050 | Foot, arch support, removable, premolded, metatarsal, each | |
| L3060 | Foot, arch support, removable, premolded, longitudinal/ metatarsal, each | |
| L3070 | Foot, arch support, non-removable attached to shoe, longitudinal, each | |
| L3080 | Foot, arch support, non-removable attached to shoe, metatarsal, each | |
| L3090 | Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each | |
| L3100 | Hallus-valgus night dynamic splint, prefabricated, off-the-shelf | |
| L3140 | Foot, abduction rotation bar, including shoes | |
| L3150 | Foot, abduction rotation bar, without shoes | |
| L3160 | Foot, adjustable shoe-styled positioning device | |
| L3170 | Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each | |
| L3201 | Orthopedic shoe, oxford with supinator or pronator, infant | |
| L3202 | Orthopedic shoe, oxford with supinator or pronator, child | |
| L3203 | Orthopedic shoe, oxford with supinator or pronator, junior | |
| L3204 | Orthopedic shoe, hightop with supinator or pronator, infant | |
| L3206 | Orthopedic shoe, hightop with supinator or pronator, child | |
| L3207 | Orthopedic shoe, hightop with supinator or pronator, junior | |
| L3208 | Surgical boot, each, infant | |
| L3209 | Surgical boot, each, child | |
| L3211 | Surgical boot, each, junior | |
| L3212 | Benesch boot, pair, infant | |
| L3213 | Benesch boot, pair, child | |
| L3214 | Benesch boot, pair, junior | |
| L3215 | Orthopedic footwear, ladies shoe, oxford, each | |
| L3216 | Orthopedic footwear, ladies shoe, depth inlay, each | |
| L3217 | Orthopedic footwear, ladies shoe, hightop, depth inlay, each | |
| L3219 | Orthopedic footwear, mens shoe, oxford, each | |
| L3221 | Orthopedic footwear, mens shoe, depth inlay, each | |
| L3222 | Orthopedic footwear, mens shoe, hightop, depth inlay, each | |
| L3224 | Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) | |
| L3225 | Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) | |
| L3230 | Orthopedic footwear, custom shoe, depth inlay, each | |
| L3250 | Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each | |
| L3251 | Foot, shoe molded to patient model, silicone shoe, each | |
| L3252 | Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each | |
| L3253 | Foot, molded shoe plastazote (or similar) custom fitted, each | |
| L3254 | Non-standard size or width | |
| L3255 | Non-standard size or length | |
| L3257 | Orthopedic footwear, additional charge for split size | |
| L3260 | Surgical boot/shoe, each | |
| L3265 | Plastazote sandal, each | |
| L3300 | Lift, elevation, heel, tapered to metatarsals, per inch | |
| L3310 | Lift, elevation, heel and sole, neoprene, per inch | |
| L3320 | Lift, elevation, heel and sole, cork, per inch | |
| L3330 | Lift, elevation, metal extension (skate) | |
| L3332 | Lift, elevation, inside shoe, tapered, up to one-half inch | |
| L3334 | Lift, elevation, heel, per inch | |
| L3340 | Heel wedge, sach | |
| L3350 | Heel wedge | |
| L3360 | Sole wedge, outside sole | |
| L3370 | Sole wedge, between sole | |
| L3380 | Clubfoot wedge | |
| L3390 | Outflare wedge | |
| L3400 | Metatarsal bar wedge, rocker | |
| L3410 | Metatarsal bar wedge, between sole | |
| L3420 | Full sole and heel wedge, between sole | |
| L3430 | Heel, counter, plastic reinforced | |
| L3440 | Heel, counter, leather reinforced | |
| L3450 | Heel, sach cushion type | |
| L3455 | Heel, new leather, standard | |
| L3460 | Heel, new rubber, standard | |
| L3465 | Heel, thomas with wedge | |
| L3470 | Heel, thomas extended to ball | |
| L3480 | Heel, pad and depression for spur | |
| L3485 | Heel, pad, removable for spur | |
| L3500 | Orthopedic shoe addition, insole, leather | |
| L3510 | Orthopedic shoe addition, insole, rubber | |
| L3520 | Orthopedic shoe addition, insole, felt covered with leather | |
| L3530 | Orthopedic shoe addition, sole, half | |
| L3540 | Orthopedic shoe addition, sole, full | |
| L3550 | Orthopedic shoe addition, toe tap standard | |
| L3560 | Orthopedic shoe addition, toe tap, horseshoe | |
| L3570 | Orthopedic shoe addition, special extension to instep (leather with eyelets) | |
| L3580 | Orthopedic shoe addition, convert instep to velcro closure | |
| L3590 | Orthopedic shoe addition, convert firm shoe counter to soft counter | |
| L3595 | Orthopedic shoe addition, march bar | |
| L3600 | Transfer of an orthosis from one shoe to another, caliper plate, existing | |
| L3610 | Transfer of an orthosis from one shoe to another, caliper plate, new | |
| L3620 | Transfer of an orthosis from one shoe to another, solid stirrup, existing | |
| L3630 | Transfer of an orthosis from one shoe to another, solid stirrup, new | |
| L3640 | Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes | |
| L3649 | Orthopedic shoe, modification, addition or transfer, not otherwise specified | |
| L3650 | Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf | |
| L3651 | SHOULDER ORTHOSIS, SINGLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) | |
| L3652 | SHOULDER ORTHOSIS, DOUBLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) | |
| L3660 | Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf | |
| L3670 | Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf | |
| L3671 | Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3672 | Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may inlcude soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3673 | Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, includes nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3674 | Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3675 | Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf | |
| L3677 | Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L3678 | Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf | |
| L3700 | ELBOW ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3701 | ELBOW ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) | |
| L3702 | Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3710 | Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf | |
| L3720 | Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated | |
| L3730 | Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated | |
| L3740 | Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated | |
| L3760 | Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L3761 | Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf | |
| L3762 | Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf | |
| L3763 | Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3764 | Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3765 | Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3766 | Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3800 | WRIST HAND FINGER ORTHOSIS, SHORT OPPONENS, NO ATTACHMENTS, CUSTOM-FABRICATED | |
| L3805 | WRIST HAND FINGER ORTHOSIS, LONG OPPONENS, NO ATTACHMENT, CUSTOM-FABRICATED | |
| L3806 | Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment | |
| L3807 | Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L3808 | Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment | |
| L3809 | Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type | |
| L3810 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB ABDUCTION ('C') BAR | |
| L3815 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, SECOND M.P. ABDUCTION ASSIST | |
| L3820 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, I.P. EXTENSION ASSIST, WITH M.P. EXTENSION STOP | |
| L3825 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION STOP | |
| L3830 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION ASSIST | |
| L3835 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. SPRING EXTENSION ASSIST | |
| L3840 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, SPRING SWIVEL THUMB | |
| L3845 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB I.P. EXTENSION ASSIST, WITH M.P. STOP | |
| L3850 | WHO, ADDITION TO SHORT AND LONG OPPONENS, ACTION WRIST, WITH DORSIFLEXION ASSIST | |
| L3855 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL | |
| L3860 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL AND I.P. | |
| L3890 | ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM, EACH | |
| L3891 | Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each | |
| L3900 | Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated | |
| L3901 | Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated | |
| L3902 | WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, COMPRESSED GAS, CUSTOM-FABRICATED | |
| L3904 | Wrist hand finger orthosis, external powered, electric, custom fabricated | |
| L3905 | Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3906 | Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3907 | WRIST HAND FINGER ORTHOSIS, WRIST GAUNTLET WITH THUMB SPICA, CUSTOM-FABRICATED | |
| L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf | |
| L3909 | WRIST ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) | |
| L3910 | WRIST HAND FINGER ORTHOSIS, SWANSON DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3911 | WRIST HAND FINGER ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) | |
| L3912 | Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf | |
| L3913 | Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3914 | WRIST HAND ORTHOSIS, WRIST EXTENSION COCK-UP, PREFABRICATED, INCLUDES FITTING/ADJUSTMENT | |
| L3915 | Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L3916 | Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf | |
| L3917 | Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L3918 | Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf | |
| L3919 | Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3920 | HAND FINGER ORTHOSIS, KNUCKLE BENDER WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3921 | Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3922 | HAND FINGER ORTHOSIS, KNUCKLE BENDER, TWO SEGMENT TO FLEX JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3923 | Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L3924 | Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf | |
| L3925 | Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf | |
| L3926 | WRIST HAND FINGER ORTHOSIS, THOMAS SUSPENSION, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3927 | Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf | |
| L3928 | HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH CLOCK SPRING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3929 | Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L3930 | Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf | |
| L3931 | Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment | |
| L3932 | FINGER ORTHOSIS, SAFETY PIN, SPRING WIRE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3933 | Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment | |
| L3934 | FINGER ORTHOSIS, SAFETY PIN, MODIFIED, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3935 | Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment | |
| L3936 | WRIST HAND FINGER ORTHOSIS, PALMER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3938 | WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3940 | WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, WITH OUTRIGGER ATTACHMENT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3942 | HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3944 | HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3946 | HAND FINGER ORTHOSIS, COMPOSITE ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3948 | FINGER ORTHOSIS, FINGER KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3950 | WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH KNUCKLE BENDER AND TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3952 | WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH REVERSE KNUCKLE AND TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3954 | HAND FINGER ORTHOSIS, SPREADING HAND, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT | |
| L3956 | Addition of joint to upper extremity orthosis, any material; per joint | |
| L3960 | Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment | |
| L3961 | Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3962 | Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment | |
| L3963 | SHOULDER ELBOW WRIST HAND ORTHOSIS, MOLDED SHOULDER, ARM, FOREARM AND WRIST, WITH ARTICULATING ELBOW JOINT, CUSTOM-FABRICATED | |
| L3964 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, adjustable, prefabricated, includes fitting and adjustment | |
| L3965 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, adjustable rancho type, prefabricated, includes fitting and adjustment | |
| L3966 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, reclining, prefabricated, includes fitting and adjustment | |
| L3967 | Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3968 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints), prefabricated, includes fitting and adjustment | |
| L3969 | Shoulder elbow orthosis, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support, prefabricated, includes fitting and adjustment | |
| L3970 | Seo, addition to mobile arm support, elevating proximal arm | |
| L3971 | Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3972 | Seo, addition to mobile arm support, offset or lateral rocker arm with elastic balance control | |
| L3973 | Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3974 | Seo, addition to mobile arm support, supinator | |
| L3975 | Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3976 | Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3977 | Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3978 | Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | |
| L3980 | Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment | |
| L3981 | Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments | |
| L3982 | Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment | |
| L3984 | Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment | |
| L3985 | UPPER EXTREMITY FRACTURE ORTHOSIS, FOREARM, HAND WITH WRIST HINGE, CUSTOM-FABRICATED | |
| L3986 | UPPER EXTREMITY FRACTURE ORTHOSIS, COMBINATION OF HUMERAL, RADIUS/ULNAR, WRIST, (EXAMPLE--COLLES' FRACTURE), CUSTOM FABRICATED | |
| L3995 | Addition to upper extremity orthosis, sock, fracture or equal, each | |
| L3999 | Upper limb orthosis, not otherwise specified | |
| L4000 | Replace girdle for spinal orthosis (ctlso or so) | |
| L4002 | Replacement strap, any orthosis, includes all components, any length, any type | |
| L4010 | Replace trilateral socket brim | |
| L4020 | Replace quadrilateral socket brim, molded to patient model | |
| L4030 | Replace quadrilateral socket brim, custom fitted | |
| L4040 | Replace molded thigh lacer, for custom fabricated orthosis only | |
| L4045 | Replace non-molded thigh lacer, for custom fabricated orthosis only | |
| L4050 | Replace molded calf lacer, for custom fabricated orthosis only | |
| L4055 | Replace non-molded calf lacer, for custom fabricated orthosis only | |
| L4060 | Replace high roll cuff | |
| L4070 | Replace proximal and distal upright for kafo | |
| L4080 | Replace metal bands kafo, proximal thigh | |
| L4090 | Replace metal bands kafo-afo, calf or distal thigh | |
| L4100 | Replace leather cuff kafo, proximal thigh | |
| L4110 | Replace leather cuff kafo-afo, calf or distal thigh | |
| L4130 | Replace pretibial shell | |
| L4205 | Repair of orthotic device, labor component, per 15 minutes | |
| L4210 | Repair of orthotic device, repair or replace minor parts | |
| L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf | |
| L4360 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | |
| L4370 | Pneumatic full leg splint, prefabricated, off-the-shelf | |
| L4380 | Pneumatic knee splint, prefabricated, includes fitting and adjustment | |
| L4386 | Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L4387 | Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf | |
| L4392 | Replacement, soft interface material, static afo | |
| L4394 | Replace soft interface material, foot drop splint | |
| L4396 | Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | |
| L4397 | Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf | |
| L4398 | Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf | |
| L4631 | Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated | |
| L5000 | Partial foot, shoe insert with longitudinal arch, toe filler | |
| L5010 | Partial foot, molded socket, ankle height, with toe filler | |
| L5020 | Partial foot, molded socket, tibial tubercle height, with toe filler | |
| L5050 | Ankle, symes, molded socket, sach foot | |
| L5060 | Ankle, symes, metal frame, molded leather socket, articulated ankle/foot | |
| L5100 | Below knee, molded socket, shin, sach foot | |
| L5105 | Below knee, plastic socket, joints and thigh lacer, sach foot | |
| L5150 | Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot | |
| L5160 | Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot | |
| L5200 | Above knee, molded socket, single axis constant friction knee, shin, sach foot | |
| L5210 | Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each | |
| L5220 | Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each | |
| L5230 | Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot | |
| L5250 | Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot | |
| L5270 | Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot | |
| L5280 | Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot | |
| L5301 | Below knee, molded socket, shin, sach foot, endoskeletal system | |
| L5311 | Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot, endoskeletal system | |
| L5312 | Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system | |
| L5321 | Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee | |
| L5331 | Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot | |
| L5341 | Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot | |
| L5400 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee | |
| L5410 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment | |
| L5420 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation | |
| L5430 | Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment | |
| L5450 | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee | |
| L5460 | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee | |
| L5500 | Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed | |
| L5505 | Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed | |
| L5510 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model | |
| L5520 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed | |
| L5530 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model | |
| L5535 | Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket | |
| L5540 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model | |
| L5560 | Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model | |
| L5570 | Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed | |
| L5580 | Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model | |
| L5585 | Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket | |
| L5590 | Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model | |
| L5595 | Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model | |
| L5600 | Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model | |
| L5610 | Addition to lower extremity, endoskeletal system, above knee, hydracadence system | |
| L5611 | Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control | |
| L5613 | Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control | |
| L5614 | Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control | |
| L5616 | Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control | |
| L5617 | Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each | |
| L5618 | Addition to lower extremity, test socket, symes | |
| L5620 | Addition to lower extremity, test socket, below knee | |
| L5622 | Addition to lower extremity, test socket, knee disarticulation | |
| L5624 | Addition to lower extremity, test socket, above knee | |
| L5626 | Addition to lower extremity, test socket, hip disarticulation | |
| L5628 | Addition to lower extremity, test socket, hemipelvectomy | |
| L5629 | Addition to lower extremity, below knee, acrylic socket | |
| L5630 | Addition to lower extremity, symes type, expandable wall socket | |
| L5631 | Addition to lower extremity, above knee or knee disarticulation, acrylic socket | |
| L5632 | Addition to lower extremity, symes type, 'ptb' brim design socket | |
| L5634 | Addition to lower extremity, symes type, posterior opening (canadian) socket | |
| L5636 | Addition to lower extremity, symes type, medial opening socket | |
| L5637 | Addition to lower extremity, below knee, total contact | |
| L5638 | Addition to lower extremity, below knee, leather socket | |
| L5639 | Addition to lower extremity, below knee, wood socket | |
| L5640 | Addition to lower extremity, knee disarticulation, leather socket | |
| L5642 | Addition to lower extremity, above knee, leather socket | |
| L5643 | Addition to lower extremity, hip disarticulation, flexible inner socket, external frame | |
| L5644 | Addition to lower extremity, above knee, wood socket | |
| L5645 | Addition to lower extremity, below knee, flexible inner socket, external frame | |
| L5646 | Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket | |
| L5647 | Addition to lower extremity, below knee suction socket | |
| L5648 | Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket | |
| L5649 | Addition to lower extremity, ischial containment/narrow m-l socket | |
| L5650 | Additions to lower extremity, total contact, above knee or knee disarticulation socket | |
| L5651 | Addition to lower extremity, above knee, flexible inner socket, external frame | |
| L5652 | Addition to lower extremity, suction suspension, above knee or knee disarticulation socket | |
| L5653 | Addition to lower extremity, knee disarticulation, expandable wall socket | |
| L5654 | Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal) | |
| L5655 | Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal) | |
| L5656 | Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal) | |
| L5658 | Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal) | |
| L5661 | Addition to lower extremity, socket insert, multi-durometer symes | |
| L5665 | Addition to lower extremity, socket insert, multi-durometer, below knee | |
| L5666 | Addition to lower extremity, below knee, cuff suspension | |
| L5668 | Addition to lower extremity, below knee, molded distal cushion | |
| L5670 | Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar) | |
| L5671 | Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert | |
| L5672 | Addition to lower extremity, below knee, removable medial brim suspension | |
| L5673 | Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism | |
| L5674 | ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, ANY MATERIAL, EACH | |
| L5675 | ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, HEAVY DUTY, ANY MATERIAL, EACH | |
| L5676 | Additions to lower extremity, below knee, knee joints, single axis, pair | |
| L5677 | Additions to lower extremity, below knee, knee joints, polycentric, pair | |
| L5678 | Additions to lower extremity, below knee, joint covers, pair | |
| L5679 | Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism | |
| L5680 | Addition to lower extremity, below knee, thigh lacer, nonmolded | |
| L5681 | Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) | |
| L5682 | Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded | |
| L5683 | Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) | |
| L5684 | Addition to lower extremity, below knee, fork strap | |
| L5685 | Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each | |
| L5686 | Addition to lower extremity, below knee, back check (extension control) | |
| L5688 | Addition to lower extremity, below knee, waist belt, webbing | |
| L5690 | Addition to lower extremity, below knee, waist belt, padded and lined | |
| L5692 | Addition to lower extremity, above knee, pelvic control belt, light | |
| L5694 | Addition to lower extremity, above knee, pelvic control belt, padded and lined | |
| L5695 | Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each | |
| L5696 | Addition to lower extremity, above knee or knee disarticulation, pelvic joint | |
| L5697 | Addition to lower extremity, above knee or knee disarticulation, pelvic band | |
| L5698 | Addition to lower extremity, above knee or knee disarticulation, silesian bandage | |
| L5699 | All lower extremity prostheses, shoulder harness | |
| L5700 | Replacement, socket, below knee, molded to patient model | |
| L5701 | Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model | |
| L5702 | Replacement, socket, hip disarticulation, including hip joint, molded to patient model | |
| L5703 | Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only | |
| L5704 | Custom shaped protective cover, below knee | |
| L5705 | Custom shaped protective cover, above knee | |
| L5706 | Custom shaped protective cover, knee disarticulation | |
| L5707 | Custom shaped protective cover, hip disarticulation | |
| L5710 | Addition, exoskeletal knee-shin system, single axis, manual lock | |
| L5711 | Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material | |
| L5712 | Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) | |
| L5714 | Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control | |
| L5716 | Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock | |
| L5718 | Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control | |
| L5722 | Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control | |
| L5724 | Addition, exoskeletal knee-shin system, single axis, fluid swing phase control | |
| L5726 | Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control | |
| L5728 | Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control | |
| L5780 | Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control | |
| L5781 | Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system | |
| L5782 | Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty | |
| L5785 | Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) | |
| L5790 | Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) | |
| L5795 | Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) | |
| L5810 | Addition, endoskeletal knee-shin system, single axis, manual lock | |
| L5811 | Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material | |
| L5812 | Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) | |
| L5814 | Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock | |
| L5816 | Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock | |
| L5818 | Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control | |
| L5822 | Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control | |
| L5824 | Addition, endoskeletal knee-shin system, single axis, fluid swing phase control | |
| L5826 | Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame | |
| L5828 | Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control | |
| L5830 | Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control | |
| L5840 | Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control | |
| L5845 | Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable | |
| L5846 | ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY | |
| L5847 | ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE | |
| L5848 | Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability | |
| L5850 | Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist | |
| L5855 | Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist | |
| L5856 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type | |
| L5857 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type | |
| L5858 | Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type | |
| L5859 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s) | |
| L5910 | Addition, endoskeletal system, below knee, alignable system | |
| L5920 | Addition, endoskeletal system, above knee or hip disarticulation, alignable system | |
| L5925 | Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock | |
| L5930 | Addition, endoskeletal system, high activity knee control frame | |
| L5940 | Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) | |
| L5950 | Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) | |
| L5960 | Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) | |
| L5961 | Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control | |
| L5962 | Addition, endoskeletal system, below knee, flexible protective outer surface covering system | |
| L5964 | Addition, endoskeletal system, above knee, flexible protective outer surface covering system | |
| L5966 | Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system | |
| L5968 | Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature | |
| L5969 | Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) | |
| L5970 | All lower extremity prostheses, foot, external keel, sach foot | |
| L5971 | All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only | |
| L5972 | All lower extremity prostheses, foot, flexible keel | |
| L5973 | Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source | |
| L5974 | All lower extremity prostheses, foot, single axis ankle/foot | |
| L5975 | All lower extremity prosthesis, combination single axis ankle and flexible keel foot | |
| L5976 | All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal) | |
| L5978 | All lower extremity prostheses, foot, multiaxial ankle/foot | |
| L5979 | All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system | |
| L5980 | All lower extremity prostheses, flex foot system | |
| L5981 | All lower extremity prostheses, flex-walk system or equal | |
| L5982 | All exoskeletal lower extremity prostheses, axial rotation unit | |
| L5984 | All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability | |
| L5985 | All endoskeletal lower extremity prostheses, dynamic prosthetic pylon | |
| L5986 | All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) | |
| L5987 | All lower extremity prosthesis, shank foot system with vertical loading pylon | |
| L5988 | Addition to lower limb prosthesis, vertical shock reducing pylon feature | |
| L5989 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL SYSTEM, PYLON WITH INTEGRATED ELECTRONIC FORCE SENSORS | |
| L5990 | Addition to lower extremity prosthesis, user adjustable heel height | |
| L5993 | ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, FOOT ONLY, (FOR PATIENT WEIGHT GREATER THAN 300 LBS) | |
| L5994 | ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, KNEE ONLY, (FOR PATIENT WEIGHT GREATER THAN 300 LBS) | |
| L5995 | ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, OTHER THAN FOOT OR KNEE, (FOR PATIENT WEIGHT GREATER THAN 300 LBS) | |
| L5999 | Lower extremity prosthesis, not otherwise specified | |
| L6000 | Partial hand, thumb remaining | |
| L6010 | Partial hand, little and/or ring finger remaining | |
| L6020 | Partial hand, no finger remaining | |
| L6025 | Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device | |
| L6026 | Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s) | |
| L6050 | Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad | |
| L6055 | Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad | |
| L6100 | Below elbow, molded socket, flexible elbow hinge, triceps pad | |
| L6110 | Below elbow, molded socket, (muenster or northwestern suspension types) | |
| L6120 | Below elbow, molded double wall split socket, step-up hinges, half cuff | |
| L6130 | Below elbow, molded double wall split socket, stump activated locking hinge, half cuff | |
| L6200 | Elbow disarticulation, molded socket, outside locking hinge, forearm | |
| L6205 | Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm | |
| L6250 | Above elbow, molded double wall socket, internal locking elbow, forearm | |
| L6300 | Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm | |
| L6310 | Shoulder disarticulation, passive restoration (complete prosthesis) | |
| L6320 | Shoulder disarticulation, passive restoration (shoulder cap only) | |
| L6350 | Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm | |
| L6360 | Interscapular thoracic, passive restoration (complete prosthesis) | |
| L6370 | Interscapular thoracic, passive restoration (shoulder cap only) | |
| L6380 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow | |
| L6382 | Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow | |
| L6384 | Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic | |
| L6386 | Immediate post surgical or early fitting, each additional cast change and realignment | |
| L6388 | Immediate post surgical or early fitting, application of rigid dressing only | |
| L6400 | Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping | |
| L6450 | Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping | |
| L6500 | Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping | |
| L6550 | Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping | |
| L6570 | Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping | |
| L6580 | Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model | |
| L6582 | Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed | |
| L6584 | Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model | |
| L6586 | Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed | |
| L6588 | Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model | |
| L6590 | Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed | |
| L6600 | Upper extremity additions, polycentric hinge, pair | |
| L6605 | Upper extremity additions, single pivot hinge, pair | |
| L6610 | Upper extremity additions, flexible metal hinge, pair | |
| L6611 | Addition to upper extremity prosthesis, external powered, additional switch, any type | |
| L6615 | Upper extremity addition, disconnect locking wrist unit | |
| L6616 | Upper extremity addition, additional disconnect insert for locking wrist unit, each | |
| L6620 | Upper extremity addition, flexion/extension wrist unit, with or without friction | |
| L6621 | Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device | |
| L6623 | Upper extremity addition, spring assisted rotational wrist unit with latch release | |
| L6624 | Upper extremity addition, flexion/extension and rotation wrist unit | |
| L6625 | Upper extremity addition, rotation wrist unit with cable lock | |
| L6628 | Upper extremity addition, quick disconnect hook adapter, otto bock or equal | |
| L6629 | Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal | |
| L6630 | Upper extremity addition, stainless steel, any wrist | |
| L6632 | Upper extremity addition, latex suspension sleeve, each | |
| L6635 | Upper extremity addition, lift assist for elbow | |
| L6637 | Upper extremity addition, nudge control elbow lock | |
| L6638 | Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow | |
| L6639 | UPPER EXTREMITY ADDITION, HEAVY DUTY FEATURE, ANY ELBOW | |
| L6640 | Upper extremity additions, shoulder abduction joint, pair | |
| L6641 | Upper extremity addition, excursion amplifier, pulley type | |
| L6642 | Upper extremity addition, excursion amplifier, lever type | |
| L6645 | Upper extremity addition, shoulder flexion-abduction joint, each | |
| L6646 | Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system | |
| L6647 | Upper extremity addition, shoulder lock mechanism, body powered actuator | |
| L6648 | Upper extremity addition, shoulder lock mechanism, external powered actuator | |
| L6650 | Upper extremity addition, shoulder universal joint, each | |
| L6655 | Upper extremity addition, standard control cable, extra | |
| L6660 | Upper extremity addition, heavy duty control cable | |
| L6665 | Upper extremity addition, teflon, or equal, cable lining | |
| L6670 | Upper extremity addition, hook to hand, cable adapter | |
| L6672 | Upper extremity addition, harness, chest or shoulder, saddle type | |
| L6675 | Upper extremity addition, harness, (e.g., figure of eight type), single cable design | |
| L6676 | Upper extremity addition, harness, (e.g., figure of eight type), dual cable design | |
| L6677 | Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow | |
| L6680 | Upper extremity addition, test socket, wrist disarticulation or below elbow | |
| L6682 | Upper extremity addition, test socket, elbow disarticulation or above elbow | |
| L6684 | Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic | |
| L6686 | Upper extremity addition, suction socket | |
| L6687 | Upper extremity addition, frame type socket, below elbow or wrist disarticulation | |
| L6688 | Upper extremity addition, frame type socket, above elbow or elbow disarticulation | |
| L6689 | Upper extremity addition, frame type socket, shoulder disarticulation | |
| L6690 | Upper extremity addition, frame type socket, interscapular-thoracic | |
| L6691 | Upper extremity addition, removable insert, each | |
| L6692 | Upper extremity addition, silicone gel insert or equal, each | |
| L6693 | Upper extremity addition, locking elbow, forearm counterbalance | |
| L6694 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism | |
| L6695 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism | |
| L6696 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) | |
| L6697 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) | |
| L6698 | Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert | |
| L6700 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #3 | |
| L6703 | Terminal device, passive hand/mitt, any material, any size | |
| L6704 | Terminal device, sport/recreational/work attachment, any material, any size | |
| L6705 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5 | |
| L6706 | Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined | |
| L6707 | Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined | |
| L6708 | Terminal device, hand, mechanical, voluntary opening, any material, any size | |
| L6709 | Terminal device, hand, mechanical, voluntary closing, any material, any size | |
| L6710 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5X | |
| L6711 | Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric | |
| L6712 | Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric | |
| L6713 | Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric | |
| L6714 | Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric | |
| L6715 | Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement | |
| L6720 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #6 | |
| L6721 | Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined | |
| L6722 | Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined | |
| L6725 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7 | |
| L6730 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7LO | |
| L6735 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8 | |
| L6740 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8X | |
| L6745 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #88X | |
| L6750 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10P | |
| L6755 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10X | |
| L6765 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #12P | |
| L6770 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #99X | |
| L6775 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #555 | |
| L6780 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #SS555 | |
| L6790 | TERMINAL DEVICE, HOOK-ACCU HOOK, OR EQUAL | |
| L6795 | TERMINAL DEVICE, HOOK-2 LOAD, OR EQUAL | |
| L6800 | TERMINAL DEVICE, HOOK-APRL VC, OR EQUAL | |
| L6805 | Addition to terminal device, modifier wrist unit | |
| L6806 | TERMINAL DEVICE, HOOK, TRS GRIP, GRIP III, VC, OR EQUAL | |
| L6807 | TERMINAL DEVICE, HOOK, GRIP I, GRIP II, VC, OR EQUAL | |
| L6808 | TERMINAL DEVICE, HOOK, TRS ADEPT, INFANT OR CHILD, VC, OR EQUAL | |
| L6809 | TERMINAL DEVICE, HOOK, TRS SUPER SPORT, PASSIVE | |
| L6810 | Addition to terminal device, precision pinch device | |
| L6825 | TERMINAL DEVICE, HAND, DORRANCE, VO | |
| L6830 | TERMINAL DEVICE, HAND, APRL, VC | |
| L6835 | TERMINAL DEVICE, HAND, SIERRA, VO | |
| L6840 | TERMINAL DEVICE, HAND, BECKER IMPERIAL | |
| L6845 | TERMINAL DEVICE, HAND, BECKER LOCK GRIP | |
| L6850 | TERMINAL DEVICE, HAND, BECKER PLYLITE | |
| L6855 | TERMINAL DEVICE, HAND, ROBIN-AIDS, VO | |
| L6860 | TERMINAL DEVICE, HAND, ROBIN-AIDS, VO SOFT | |
| L6865 | TERMINAL DEVICE, HAND, PASSIVE HAND | |
| L6867 | TERMINAL DEVICE, HAND, DETROIT INFANT HAND (MECHANICAL) | |
| L6868 | TERMINAL DEVICE, HAND, PASSIVE INFANT HAND, (STEEPER, HOSMER OR EQUAL) | |
| L6870 | TERMINAL DEVICE, HAND, CHILD MITT | |
| L6872 | TERMINAL DEVICE, HAND, NYU CHILD HAND | |
| L6873 | TERMINAL DEVICE, HAND, MECHANICAL INFANT HAND, STEEPER OR EQUAL | |
| L6875 | TERMINAL DEVICE, HAND, BOCK, VC | |
| L6880 | Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) | |
| L6881 | Automatic grasp feature, addition to upper limb electric prosthetic terminal device | |
| L6882 | Microprocessor control feature, addition to upper limb prosthetic terminal device | |
| L6883 | Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power | |
| L6884 | Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power | |
| L6885 | Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power | |
| L6890 | Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment | |
| L6895 | Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated | |
| L6900 | Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining | |
| L6905 | Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining | |
| L6910 | Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining | |
| L6915 | Hand restoration (shading, and measurements included), replacement glove for above | |
| L6920 | Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device | |
| L6925 | Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | |
| L6930 | Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device | |
| L6935 | Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | |
| L6940 | Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device | |
| L6945 | Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | |
| L6950 | Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device | |
| L6955 | Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | |
| L6960 | Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device | |
| L6965 | Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | |
| L6970 | Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device | |
| L6975 | Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device | |
| L7007 | Electric hand, switch or myoelectric controlled, adult | |
| L7008 | Electric hand, switch or myoelectric, controlled, pediatric | |
| L7009 | Electric hook, switch or myoelectric controlled, adult | |
| L7010 | ELECTRONIC HAND, OTTO BOCK, STEEPER OR EQUAL, SWITCH CONTROLLED | |
| L7015 | ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED | |
| L7020 | ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, SWITCH CONTROLLED | |
| L7025 | ELECTRONIC HAND, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED | |
| L7030 | ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED | |
| L7035 | ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED | |
| L7040 | Prehensile actuator, switch controlled | |
| L7045 | Electric hook, switch or myoelectric controlled, pediatric | |
| L7170 | Electronic elbow, hosmer or equal, switch controlled | |
| L7180 | Electronic elbow, microprocessor sequential control of elbow and terminal device | |
| L7181 | Electronic elbow, microprocessor simultaneous control of elbow and terminal device | |
| L7185 | Electronic elbow, adolescent, variety village or equal, switch controlled | |
| L7186 | Electronic elbow, child, variety village or equal, switch controlled | |
| L7190 | Electronic elbow, adolescent, variety village or equal, myoelectronically controlled | |
| L7191 | Electronic elbow, child, variety village or equal, myoelectronically controlled | |
| L7259 | Electronic wrist rotator, any type | |
| L7260 | Electronic wrist rotator, otto bock or equal | |
| L7261 | Electronic wrist rotator, for utah arm | |
| L7266 | Servo control, steeper or equal | |
| L7272 | Analogue control, unb or equal | |
| L7274 | Proportional control, 6-12 volt, liberty, utah or equal | |
| L7360 | Six volt battery, each | |
| L7362 | Battery charger, six volt, each | |
| L7364 | Twelve volt battery, each | |
| L7366 | Battery charger, twelve volt, each | |
| L7367 | Lithium ion battery, rechargeable, replacement | |
| L7368 | Lithium ion battery charger, replacement only | |
| L7400 | Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) | |
| L7401 | Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) | |
| L7402 | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) | |
| L7403 | Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material | |
| L7404 | Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material | |
| L7405 | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material | |
| L7499 | Upper extremity prosthesis, not otherwise specified | |
| L7500 | Repair of prosthetic device, hourly rate (excludes v5335 repair of oral or laryngeal prosthesis or artificial larynx) | |
| L7510 | Repair of prosthetic device, repair or replace minor parts | |
| L7520 | Repair prosthetic device, labor component, per 15 minutes | |
| L7600 | Prosthetic donning sleeve, any material, each | |
| L7611 | TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC | |
| L7612 | TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC | |
| L7613 | TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, PEDIATRIC | |
| L7614 | TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, PEDIATRIC | |
| L7621 | TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED | |
| L7622 | TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED | |
| L7700 | Gasket or seal, for use with prosthetic socket insert, any type, each | |
| L7900 | Male vacuum erection system | |
| L7902 | Tension ring, for vacuum erection device, any type, replacement only, each | |
| L8000 | Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type | |
| L8001 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type | |
| L8002 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type | |
| L8010 | Breast prosthesis, mastectomy sleeve | |
| L8015 | External breast prosthesis garment, with mastectomy form, post mastectomy | |
| L8020 | Breast prosthesis, mastectomy form | |
| L8030 | Breast prosthesis, silicone or equal, without integral adhesive | |
| L8031 | Breast prosthesis, silicone or equal, with integral adhesive | |
| L8032 | Nipple prosthesis, prefabricated, reusable, any type, each | |
| L8033 | Nipple prosthesis, custom fabricated, reusable, any material, any type, each | |
| L8035 | Custom breast prosthesis, post mastectomy, molded to patient model | |
| L8039 | Breast prosthesis, not otherwise specified | |
| L8040 | Nasal prosthesis, provided by a non-physician | |
| L8041 | Midfacial prosthesis, provided by a non-physician | |
| L8042 | Orbital prosthesis, provided by a non-physician | |
| L8043 | Upper facial prosthesis, provided by a non-physician | |
| L8044 | Hemi-facial prosthesis, provided by a non-physician | |
| L8045 | Auricular prosthesis, provided by a non-physician | |
| L8046 | Partial facial prosthesis, provided by a non-physician | |
| L8047 | Nasal septal prosthesis, provided by a non-physician | |
| L8048 | Unspecified maxillofacial prosthesis, by report, provided by a non-physician | |
| L8049 | Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician | |
| L8100 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH | |
| L8110 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH | |
| L8120 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH | |
| L8130 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH | |
| L8140 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH | |
| L8150 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH | |
| L8160 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH | |
| L8170 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH | |
| L8180 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH | |
| L8190 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH | |
| L8195 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH | |
| L8200 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH | |
| L8210 | GRADIENT COMPRESSION STOCKING, CUSTOM MADE | |
| L8220 | GRADIENT COMPRESSION STOCKING, LYMPHEDEMA | |
| L8230 | GRADIENT COMPRESSION STOCKING, GARTER BELT | |
| L8239 | GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED | |
| L8300 | Truss, single with standard pad | |
| L8310 | Truss, double with standard pads | |
| L8320 | Truss, addition to standard pad, water pad | |
| L8330 | Truss, addition to standard pad, scrotal pad | |
| L8400 | Prosthetic sheath, below knee, each | |
| L8410 | Prosthetic sheath, above knee, each | |
| L8415 | Prosthetic sheath, upper limb, each | |
| L8417 | Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each | |
| L8420 | Prosthetic sock, multiple ply, below knee, each | |
| L8430 | Prosthetic sock, multiple ply, above knee, each | |
| L8435 | Prosthetic sock, multiple ply, upper limb, each | |
| L8440 | Prosthetic shrinker, below knee, each | |
| L8460 | Prosthetic shrinker, above knee, each | |
| L8465 | Prosthetic shrinker, upper limb, each | |
| L8470 | Prosthetic sock, single ply, fitting, below knee, each | |
| L8480 | Prosthetic sock, single ply, fitting, above knee, each | |
| L8485 | Prosthetic sock, single ply, fitting, upper limb, each | |
| L8490 | ADDITION TO PROSTHETIC SHEATH/SOCK, AIR SEAL SUCTION RETENTION SYSTEM | |
| L8499 | Unlisted procedure for miscellaneous prosthetic services | |
| L8500 | Artificial larynx, any type | |
| L8501 | Tracheostomy speaking valve | |
| L8505 | Artificial larynx replacement battery / accessory, any type | |
| L8507 | Tracheo-esophageal voice prosthesis, patient inserted, any type, each | |
| L8509 | Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type | |
| L8510 | Voice amplifier | |
| L8511 | Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each | |
| L8512 | Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 | |
| L8513 | Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each | |
| L8514 | Tracheoesophageal puncture dilator, replacement only, each | |
| L8515 | Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each | |
| L8600 | Implantable breast prosthesis, silicone or equal | |
| L8603 | Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies | |
| L8604 | Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies | |
| L8605 | Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies | |
| L8606 | Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies | |
| L8607 | Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies | |
| L8608 | Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system | |
| L8609 | Artificial cornea | |
| L8610 | Ocular implant | |
| L8612 | Aqueous shunt | |
| L8613 | Ossicula implant | |
| L8614 | Cochlear device, includes all internal and external components | |
| L8615 | Headset/headpiece for use with cochlear implant device, replacement | |
| L8616 | Microphone for use with cochlear implant device, replacement | |
| L8617 | Transmitting coil for use with cochlear implant device, replacement | |
| L8618 | Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement | |
| L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement | |
| L8620 | LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH | |
| L8621 | Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each | |
| L8622 | Alkaline battery for use with cochlear implant device, any size, replacement, each | |
| L8623 | Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each | |
| L8624 | Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each | |
| L8625 | External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each | |
| L8627 | Cochlear implant, external speech processor, component, replacement | |
| L8628 | Cochlear implant, external controller component, replacement | |
| L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement | |
| L8630 | Metacarpophalangeal joint implant | |
| L8631 | Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system) | |
| L8641 | Metatarsal joint implant | |
| L8642 | Hallux implant | |
| L8658 | Interphalangeal joint spacer, silicone or equal, each | |
| L8659 | Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size | |
| L8670 | Vascular graft material, synthetic, implant | |
| L8678 | Electrical stimulator supplies (external) for use with implantable neurostimulator, per month | |
| L8679 | Implantable neurostimulator, pulse generator, any type | |
| L8680 | Implantable neurostimulator electrode, each | |
| L8681 | Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only | |
| L8682 | Implantable neurostimulator radiofrequency receiver | |
| L8683 | Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver | |
| L8684 | Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement | |
| L8685 | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension | |
| L8686 | Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension | |
| L8687 | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension | |
| L8688 | Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension | |
| L8689 | External recharging system for battery (internal) for use with implantable neurostimulator, replacement only | |
| L8690 | Auditory osseointegrated device, includes all internal and external components | |
| L8691 | Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each | |
| L8692 | Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment | |
| L8693 | Auditory osseointegrated device abutment, any length, replacement only | |
| L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each | |
| L8695 | External recharging system for battery (external) for use with implantable neurostimulator, replacement only | |
| L8696 | Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each | |
| L8698 | Miscellaneous component, supply or accessory for use with total artificial heart system | |
| L8699 | Prosthetic implant, not otherwise specified | |
| L9900 | Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code | |
| Q0138 | Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) | |
| Q0139 | Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis) | |
| Q0162 | Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | |
| Q0187 | FACTOR VIIA (COAGULATION FACTOR, RECOMBINANT) PER 1.2 MG | |
| Q0478 | Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type | |
| Q0479 | Power module for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0480 | Driver for use with pneumatic ventricular assist device, replacement only | |
| Q0481 | Microprocessor control unit for use with electric ventricular assist device, replacement only | |
| Q0482 | Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only | |
| Q0483 | Monitor/display module for use with electric ventricular assist device, replacement only | |
| Q0484 | Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0485 | Monitor control cable for use with electric ventricular assist device, replacement only | |
| Q0486 | Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only | |
| Q0487 | Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only | |
| Q0488 | Power pack base for use with electric ventricular assist device, replacement only | |
| Q0489 | Power pack base for use with electric/pneumatic ventricular assist device, replacement only | |
| Q0490 | Emergency power source for use with electric ventricular assist device, replacement only | |
| Q0491 | Emergency power source for use with electric/pneumatic ventricular assist device, replacement only | |
| Q0492 | Emergency power supply cable for use with electric ventricular assist device, replacement only | |
| Q0493 | Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only | |
| Q0494 | Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0495 | Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0496 | Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0497 | Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0498 | Holster for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0499 | Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only | |
| Q0500 | Filters for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0501 | Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0502 | Mobility cart for pneumatic ventricular assist device, replacement only | |
| Q0503 | Battery for pneumatic ventricular assist device, replacement only, each | |
| Q0504 | Power adapter for pneumatic ventricular assist device, replacement only, vehicle type | |
| Q0505 | Miscellaneous supply or accessory for use with ventricular assist device | |
| Q0506 | Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only | |
| Q0507 | Miscellaneous supply or accessory for use with an external ventricular assist device | |
| Q0508 | Miscellaneous supply or accessory for use with an implanted ventricular assist device | |
| Q0509 | Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a | |
| Q0515 | Injection, sermorelin acetate, 1 microgram | |
| Q2001 | ORAL, CABERGOLINE, 0.5 MG | |
| Q2002 | INJECTION, ELLIOTTS B SOLUTION, PER ML | |
| Q2003 | INJECTION, APROTININ, 10,000 KIU | |
| Q2004 | Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml | |
| Q2005 | INJECTION, CORTICORELIN OVINE TRIFLUTATE, PER DOSE | |
| Q2006 | INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL | |
| Q2007 | INJECTION, ETHANOLAMINE OLEATE, 100 MG | |
| Q2008 | INJECTION, FOMEPIZOLE, 15 MG | |
| Q2009 | Injection, fosphenytoin, 50 mg phenytoin equivalent | |
| Q2011 | INJECTION, HEMIN, PER 1 MG | |
| Q2012 | INJECTION, PEGADEMASE BOVINE, 25 IU | |
| Q2013 | INJECTION, PENTASTARCH, 10% SOLUTION, PER 100 ML | |
| Q2014 | INJECTION, SERMORELIN ACETATE, 0.5 MG | |
| Q2017 | Injection, teniposide, 50 mg | |
| Q2018 | INJECTION, UROFOLLITROPIN, 75 IU | |
| Q2020 | INJECTION, HISTRELIN ACETATE, 10 MCG | |
| Q2021 | INJECTION, LEPIRUDIN, 50 MG | |
| Q2022 | VON WILLEBRAND FACTOR COMPLEX, HUMAN, PER IU | |
| Q2023 | INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U. | |
| Q2024 | INJECTION, BEVACIZUMAB, 0.25 MG | |
| Q2040 | Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion | |
| Q2049 | Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg | |
| Q3025 | Injection, interferon beta-1a, 11 mcg for intramuscular use | |
| Q3026 | Injection, interferon beta-1a, 11 mcg for subcutaneous use | |
| Q3027 | Injection, interferon beta-1a, 1 mcg for intramuscular use | |
| Q3028 | Injection, interferon beta-1a, 1 mcg for subcutaneous use | |
| Q4074 | Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms | |
| Q4075 | INJECTION, ACYCLOVIR, 5 MG | |
| Q4076 | INJECTION, DOPAMINE HCL, 40 MG | |
| Q4077 | INJECTION, TREPROSTINIL, 1 MG | |
| Q4079 | INJECTION, NATALIZUMAB, 1 MG | |
| Q4080 | ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 20 MICROGRAMS | |
| Q4087 | INJECTION, IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG | |
| Q4088 | INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), INTRAVENOUS, NON-LYOPHILIZED, (E.G. LIQUID), 500 MG | |
| Q4089 | INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTRAMUSCULAR OR INTRAVENOUS, 100 IU | |
| Q4090 | INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUSCULAR, 0.5 ML | |
| Q4091 | INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED, (E.G. LIQUID), 500 MG | |
| Q4092 | INJECTION, IMMUNE GLOBULIN, (GAMUNEX), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG | |
| Q4093 | ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) | |
| Q4094 | ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) | |
| Q4095 | INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG | |
| Q4096 | INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN COFACTOR (NOT OTHERWISE SPECIFIED), PER I.U. VWF: RCO | |
| Q4097 | INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG | |
| Q4098 | INJECTION, IRON DEXTRAN, 50 MG | |
| Q4099 | FORMOTEROL FUMARATE, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 20 MICROGRAMS | |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | |
| Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg | |
| Q5109 | Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg | |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram | |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | |
| Q5112 | Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg | |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg | |
| Q5114 | Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg | |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | |
| Q5116 | Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg | |
| Q5117 | Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg | |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg | |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | |
| Q5120 | Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg | |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | |
| Q9941 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 1G | |
| Q9942 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 10 MG | |
| Q9943 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 1G | |
| Q9944 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 10 MG | |
| Q9985 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg | |
| Q9986 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | |
| Q9989 | Ustekinumab, for intravenous injection, 1 mg | |
| S0014 | Tacrine hydrochloride, 10 mg | |
| S0016 | INJECTION, AMIKACIN SULFATE, 500 MG | |
| S0017 | Injection, aminocaproic acid, 5 grams | |
| S0020 | Injection, bupivicaine hydrochloride, 30 ml | |
| S0021 | Injection, cefoperazone sodium, 1 gram | |
| S0023 | Injection, cimetidine hydrochloride, 300 mg | |
| S0028 | Injection, famotidine, 20 mg | |
| S0030 | Injection, metronidazole, 500 mg | |
| S0032 | Injection, nafcillin sodium, 2 grams | |
| S0034 | Injection, ofloxacin, 400 mg | |
| S0039 | Injection, sulfamethoxazole and trimethoprim, 10 ml | |
| S0040 | Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams | |
| S0071 | INJECTION, ACYCLOVIR SODIUM, 50 MG | |
| S0072 | INJECTION, AMIKACIN SULFATE, 100 MG | |
| S0073 | Injection, aztreonam, 500 mg | |
| S0074 | Injection, cefotetan disodium, 500 mg | |
| S0077 | Injection, clindamycin phosphate, 300 mg | |
| S0078 | Injection, fosphenytoin sodium, 750 mg | |
| S0080 | Injection, pentamidine isethionate, 300 mg | |
| S0081 | Injection, piperacillin sodium, 500 mg | |
| S0090 | Sildenafil citrate, 25 mg | |
| S0122 | Injection, menotropins, 75 iu | |
| S0126 | Injection, follitropin alfa, 75 iu | |
| S0128 | Injection, follitropin beta, 75 iu | |
| S0132 | Injection, ganirelix acetate, 250 mcg | |
| S0170 | Anastrozole, oral, 1 mg | |
| S0179 | Megestrol acetate, oral, 20 mg | |
| S0189 | Testosterone pellet, 75 mg | |
| S1001 | Deluxe item, patient aware (list in addition to code for basic item) | |
| S1002 | Customized item (list in addition to code for basic item) | |
| S1030 | Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code) | |
| S1031 | Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code) | |
| S1040 | Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) | |
| S8260 | ORAL ORTHOTIC FOR TREATMENT OF SLEEP APNEA, INCLUDES FITTING, FABRICATION, AND MATERIALS | |
| S8450 | Splint, prefabricated, digit (specify digit by use of modifier) | |
| S8451 | Splint, prefabricated, wrist or ankle | |
| S8452 | Splint, prefabricated, elbow | |
| V2623 | Prosthetic eye, plastic, custom | |
| V2624 | Polishing/resurfacing of ocular prosthesis | |
| V2625 | Enlargement of ocular prosthesis | |
| V2626 | Reduction of ocular prosthesis | |
| V2627 | Scleral cover shell | |
| V2628 | Fabrication and fitting of ocular conformer | |
| V2629 | Prosthetic eye, other type | |
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