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

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

A4455

Adhesive remover or solvent (for tape, cement or other adhesive), per ounce

A4456

Adhesive remover, wipes, any type, each

A4458

Enema bag with tubing, reusable

A4459

Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type

A4461

Surgical dressing holder, non-reusable, each

A4463

Surgical dressing holder, reusable, each

A4465

Non-elastic binder for extremity

A4466

Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each

A4467

Belt, strap, sleeve, garment, or covering, any type

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

A4520

Incontinence garment, any type, (e.g., brief, diaper), each

A4550

Surgical trays

A4553

Non-disposable underpads, all sizes

A4554

Disposable underpads, all sizes

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

A4561

Pessary, rubber, any type

A4562

Pessary, non rubber, any type

A4565

Slings

A4566

Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment

A4570

Splint

A4575

Topical hyperbaric oxygen chamber, disposable

A4580

Cast supplies (e.g., plaster)

A4590

Special casting material (e.g., fiberglass)

A4595

Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)

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

A4606

Oxygen probe for use with oximeter device, replacement

A4608

Transtracheal oxygen catheter, 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

A4614

Peak expiratory flow rate meter, hand held

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

A4627

Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler

A4628

Oropharyngeal suction catheter, each

A4629

Tracheostomy care kit for established tracheostomy

A4630

Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient

A4633

Replacement bulb/lamp for ultraviolet light therapy system, each

A4634

Replacement bulb for therapeutic light box, tabletop model

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

A4641

Radiopharmaceutical, diagnostic, not otherwise classified

A4642

Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries

A4648

Tissue marker, implantable, any type, each

A4649

Surgical supply; miscellaneous

A4650

Implantable radiation dosimeter, each

A4651

Calibrated microcapillary tube, each

A4652

Microcapillary tube sealant

A4653

Peritoneal dialysis catheter anchoring device, belt, each

A4657

Syringe, with or without needle, each

A4660

Sphygmomanometer/blood pressure apparatus with cuff and stethoscope

A4663

Blood pressure cuff only

A4670

Automatic blood pressure monitor

A4671

Disposable cycler set used with cycler dialysis machine, each

A4672

Drainage extension line, sterile, for dialysis, each

A4673

Extension line with easy lock connectors, used with dialysis

A4674

Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz

A4680

Activated carbon filter for hemodialysis, each

A4690

Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each

A4706

Bicarbonate concentrate, solution, for hemodialysis, per gallon

A4707

Bicarbonate concentrate, powder, for hemodialysis, per packet

A4708

Acetate concentrate solution, for hemodialysis, per gallon

A4709

Acid concentrate, solution, for hemodialysis, per gallon

A4714

Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon

A4719

"y set" tubing for peritoneal dialysis

A4720

Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis

A4721

Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis

A4722

Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis

A4723

Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis

A4724

Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis

A4725

Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis

A4726

Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis

A4728

Dialysate solution, non-dextrose containing, 500 ml

A4730

Fistula cannulation set for hemodialysis, each

A4736

Topical anesthetic, for dialysis, per gram

A4737

Injectable anesthetic, for dialysis, per 10 ml

A4740

Shunt accessory, for hemodialysis, any type, each

A4750

Blood tubing, arterial or venous, for hemodialysis, each

A4755

Blood tubing, arterial and venous combined, for hemodialysis, each

A4760

Dialysate solution test kit, for peritoneal dialysis, any type, each

A4765

Dialysate concentrate, powder, additive for peritoneal dialysis, per packet

A4766

Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml

A4770

Blood collection tube, vacuum, for dialysis, per 50

A4771

Serum clotting time tube, for dialysis, per 50

A4772

Blood glucose test strips, for dialysis, per 50

A4773

Occult blood test strips, for dialysis, per 50

A4774

Ammonia test strips, for dialysis, per 50

A4802

Protamine sulfate, for hemodialysis, per 50 mg

A4860

Disposable catheter tips for peritoneal dialysis, per 10

A4870

Plumbing and/or electrical work for home hemodialysis equipment

A4890

Contracts, repair and maintenance, for hemodialysis equipment

A4911

Drain bag/bottle, for dialysis, each

A4913

Miscellaneous dialysis supplies, not otherwise specified

A4918

Venous pressure clamp, for hemodialysis, each

A4927

Gloves, non-sterile, per 100

A4928

Surgical mask, per 20

A4929

Tourniquet for dialysis, each

A4930

Gloves, sterile, per pair

A4931

Oral thermometer, reusable, any type, each

A4932

Rectal thermometer, reusable, any type, each

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

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

A5500

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe

A5501

For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe

A5503

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe

A5504

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe

A5505

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe

A5506

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe

A5507

For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

A5508

For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

A5510

For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe

A5512

For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each

A5513

For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher), includes arch filler and other shaping material, custom fabricated, each

A6000

Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card

A6010

Collagen based wound filler, dry form, sterile, per gram of collagen

A6011

Collagen based wound filler, gel/paste, per gram of collagen

A6021

Collagen dressing, sterile, size 16 sq. in. or less, each

A6022

Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each

A6023

Collagen dressing, sterile, size more than 48 sq. in., each

A6024

Collagen dressing wound filler, sterile, per 6 inches

A6025

Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each

A6154

Wound pouch, each

A6196

Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing

A6197

Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing

A6198

Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing

A6199

Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches

A6203

Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6204

Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6205

Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6206

Contact layer, sterile, 16 sq. in. or less, each dressing

A6207

Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing

A6208

Contact layer, sterile, more than 48 sq. in., each dressing

A6209

Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6210

Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6211

Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6212

Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6213

Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6214

Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6215

Foam dressing, wound filler, sterile, per gram

A6216

Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6217

Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6218

Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6219

Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6220

Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6221

Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6222

Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6223

Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing

A6224

Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6228

Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6229

Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6230

Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6231

Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing

A6232

Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing

A6233

Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing

A6234

Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6235

Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6236

Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6237

Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6238

Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6239

Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6240

Hydrocolloid dressing, wound filler, paste, sterile, per ounce

A6241

Hydrocolloid dressing, wound filler, dry form, sterile, per gram

A6242

Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6243

Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6244

Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6245

Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6246

Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6247

Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6248

Hydrogel dressing, wound filler, gel, per fluid ounce

A6250

Skin sealants, protectants, moisturizers, ointments, any type, any size

A6251

Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6252

Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing

A6253

Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6254

Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing

A6255

Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing

A6256

Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

A6257

Transparent film, sterile, 16 sq. in. or less, each dressing

A6258

Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing

A6259

Transparent film, sterile, more than 48 sq. in., each dressing

A6260

Wound cleansers, any type, any size

A6261

Wound filler, gel/paste, per fluid ounce, not otherwise specified

A6262

Wound filler, dry form, per gram, not otherwise specified

A6266

Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard

A6402

Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

A6403

Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing

A6404

Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing

A6407

Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard

A6410

Eye pad, sterile, each

A6411

Eye pad, non-sterile, each

A6412

Eye patch, occlusive, each

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

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

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

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

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

A9150

Non-prescription drugs

A9152

Single vitamin/mineral/trace element, oral, per dose, not otherwise specified

A9153

Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified

A9155

Artificial saliva, 30 ml

A9180

Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker

A9270

Non-covered item or service

A9272

Wound suction, disposable, includes dressing, all accessories and components, any type, each

A9273

Hot water bottle, ice cap or collar, heat and/or cold wrap, any type

A9274

External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories

A9275

Home glucose disposable monitor, includes test strips

A9276

Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply

A9277

Transmitter; external, for use with interstitial continuous glucose monitoring system

A9278

Receiver (monitor); external, for use with interstitial continuous glucose monitoring system

A9279

Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified

A9280

Alert or alarm device, not otherwise classified

A9281

Reaching/grabbing device, any type, any length, each

A9282

Wig, any type, each

A9283

Foot pressure off loading/supportive device, any type, each

A9284

Spirometer, non-electronic, includes all accessories

A9285

Inversion/eversion correction device

A9286

Hygienic item or device, disposable or non-disposable, any type, each

A9300

Exercise equipment

A9500

Technetium tc-99m sestamibi, diagnostic, per study dose

A9501

Technetium tc-99m teboroxime, diagnostic, per study dose

A9502

Technetium tc-99m tetrofosmin, diagnostic, per study dose

A9503

Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries

A9504

Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries

A9505

Thallium tl-201 thallous chloride, diagnostic, per millicurie

A9507

Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries

A9508

Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie

A9509

Iodine i-123 sodium iodide, diagnostic, per millicurie

A9510

Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries

A9512

Technetium tc-99m pertechnetate, diagnostic, per millicurie

A9515

Choline c-11, diagnostic, per study dose up to 20 millicuries

A9516

Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries

A9517

Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie

A9520

Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries

A9521

Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries

A9524

Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries

A9526

Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries

A9527

Iodine i-125, sodium iodide solution, therapeutic, per millicurie

A9528

Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie

A9529

Iodine i-131 sodium iodide solution, diagnostic, per millicurie

A9530

Iodine i-131 sodium iodide solution, therapeutic, per millicurie

A9531

Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)

A9532

Iodine i-125 serum albumin, diagnostic, per 5 microcuries

A9536

Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries

A9537

Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries

A9538

Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries

A9539

Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries

A9540

Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries

A9541

Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries

A9542

Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries

A9543

Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries

A9544

Iodine i-131 tositumomab, diagnostic, per study dose

A9545

Iodine i-131 tositumomab, therapeutic, per treatment dose

A9546

Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie

A9547

Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie

A9548

Indium in-111 pentetate, diagnostic, per 0.5 millicurie

A9550

Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie

A9551

Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries

A9552

Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

A9553

Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries

A9554

Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries

A9555

Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries

A9556

Gallium ga-67 citrate, diagnostic, per millicurie

A9557

Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries

A9558

Xenon xe-133 gas, diagnostic, per 10 millicuries

A9559

Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie

A9560

Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries

A9561

Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries

A9562

Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries

A9563

Sodium phosphate p-32, therapeutic, per millicurie

A9564

Chromic phosphate p-32 suspension, therapeutic, per millicurie

A9566

Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries

A9567

Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries

A9568

Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries

A9569

Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose

A9570

Indium in-111 labeled autologous white blood cells, diagnostic, per study dose

A9571

Indium in-111 labeled autologous platelets, diagnostic, per study dose

A9572

Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries

A9575

Injection, gadoterate meglumine, 0.1 ml

A9576

Injection, gadoteridol, (prohance multipack), per ml

A9577

Injection, gadobenate dimeglumine (multihance), per ml

A9578

Injection, gadobenate dimeglumine (multihance multipack), per ml

A9579

Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml

A9580

Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries

A9581

Injection, gadoxetate disodium, 1 ml

A9582

Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries

A9583

Injection, gadofosveset trisodium, 1 ml

A9584

Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries

A9585

Injection, gadobutrol, 0.1 ml

A9586

Florbetapir f18, diagnostic, per study dose, up to 10 millicuries

A9587

Gallium ga-68, dotatate, diagnostic, 0.1 millicurie

A9588

Fluciclovine f-18, diagnostic, 1 millicurie

A9597

Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified

A9598

Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified

A9599

Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified

A9600

Strontium sr-89 chloride, therapeutic, per millicurie

A9604

Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries

A9606

Radium ra-223 dichloride, therapeutic, per microcurie

A9698

Non-radioactive contrast imaging material, not otherwise classified, per study

A9699

Radiopharmaceutical, therapeutic, not otherwise classified

A9700

Supply of injectable contrast material for use in echocardiography, per study

A9900

Miscellaneous dme supply, accessory, and/or service component of another hcpcs code

A9901

Dme delivery, set up, and/or dispensing service component of another hcpcs code

A9999

Miscellaneous dme supply or accessory, not otherwise specified