A Codes

A0021

Ambulance service, outside state per mile, transport (medicaid only)

A0080

Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest

A0090

Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest

A0100

Non-emergency transportation; taxi

A0110

Non-emergency transportation and bus, intra or inter state carrier

A0120

Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems

A0130

Non-emergency transportation: wheelchair van

A0140

Non-emergency transportation and air travel (private or commercial) intra or inter state

A0160

Non-emergency transportation: per mile - case worker or social worker

A0170

Transportation ancillary: parking fees, tolls, other

A0180

Non-emergency transportation: ancillary: lodging-recipient

A0190

Non-emergency transportation: ancillary: meals-recipient

A0200

Non-emergency transportation: ancillary: lodging escort

A0210

Non-emergency transportation: ancillary: meals-escort

A0225

Ambulance service, neonatal transport, base rate, emergency transport, one way

A0380

Bls mileage (per mile)

A0382

Bls routine disposable supplies

A0384

Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances)

A0390

Als mileage (per mile)

A0392

Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances)

A0394

Als specialized service disposable supplies; iv drug therapy

A0396

Als specialized service disposable supplies; esophageal intubation

A0398

Als routine disposable supplies

A0420

Ambulance waiting time (als or bls), one half (1/2) hour increments

A0422

Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation

A0424

Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review)

A0425

Ground mileage, per statute mile

A0426

Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)

A0427

Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)

A0428

Ambulance service, basic life support, non-emergency transport, (bls)

A0429

Ambulance service, basic life support, emergency transport (bls-emergency)

A0430

Ambulance service, conventional air services, transport, one way (fixed wing)

A0431

Ambulance service, conventional air services, transport, one way (rotary wing)

A0432

Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers

A0433

Advanced life support, level 2 (als 2)

A0434

Specialty care transport (sct)

A0435

Fixed wing air mileage, per statute mile

A0436

Rotary wing air mileage, per statute mile

A0888

Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)

A0998

Ambulance response and treatment, no transport

A0999

Unlisted ambulance service

A4206

Syringe with needle, sterile, 1 cc or less, each

A4207

Syringe with needle, sterile 2 cc, each

A4208

Syringe with needle, sterile 3 cc, each

A4209

Syringe with needle, sterile 5 cc or greater, each

A4210

Needle-free injection device, each

A4211

Supplies for self-administered injections

A4212

Non-coring needle or stylet with or without catheter

A4213

Syringe, sterile, 20 cc or greater, each

A4215

Needle, sterile, any size, each

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

A4244

Alcohol or peroxide, per pint

A4245

Alcohol wipes, per box

A4246

Betadine or phisohex solution, per pint

A4247

Betadine or iodine swabs/wipes, per box

A4248

Chlorhexidine containing antiseptic, 1 ml

A4250

Urine test or reagent strips or tablets (100 tablets or strips)

A4252

Blood ketone test or reagent strip, each

A4253

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips

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

A4261

Cervical cap for contraceptive use

A4262

Temporary, absorbable lacrimal duct implant, each

A4263

Permanent, long term, non-dissolvable lacrimal duct implant, each

A4264

Permanent implantable contraceptive intratubal occlusion device(s) and delivery system

A4265

Paraffin, per pound

A4266

Diaphragm for contraceptive use

A4267

Contraceptive supply, condom, male, each

A4268

Contraceptive supply, condom, female, each

A4269

Contraceptive supply, spermicide (e.g., foam, gel), each

A4270

Disposable endoscope sheath, each

A4280

Adhesive skin support attachment for use with external breast prosthesis, each

A4281

Tubing for breast pump, replacement

A4282

Adapter for breast pump, replacement

A4283

Cap for breast pump bottle, replacement

A4284

Breast shield and splash protector for use with breast pump, replacement

A4285

Polycarbonate bottle for use with breast pump, replacement

A4286

Locking ring for breast pump, replacement

A4290

Sacral nerve stimulation test lead, each

A4300

Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access

A4301

Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)

A4305

Disposable drug delivery system, flow rate of 50 ml or greater per hour

A4306

Disposable drug delivery system, flow rate of less than 50 ml per hour

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

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

A4344

Indwelling catheter, foley type, two-way, all silicone, each

A4346

Indwelling catheter; foley type, three way for continuous irrigation, each

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

A4360

Disposable external urethral clamp or compression device, with pad and/or pouch, 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

A4366

Ostomy vent, any type, each

A4367

Ostomy belt, each

A4368