Abatacept (Orencia®)

Abdominoplasty and/or Panniculectomy

Acupuncture

Add-on Codes

Attachment A

Adult Sleep Disorder Testing

Agalsidase beta (Fabrazyme®)

Airway-Clearance Devices for Use in the Home Setting

Alglucerase (Ceredase®) and Imiglucerase (Cerezyme®)

Alglucosidase alfa, rhGAA (Myozyme®)

Allergy Immunotherapy

Alternative Therapies and Complementary Medicine

Ambulatory Blood Pressure Monitoring (ABPM)

Ambulatory, Real-Time Cardiac Surveillance System

Anesthesia Services for a Cancelled or Discontinued Procedure

Ankle-Foot/Knee-Ankle-Foot Orthoses

Attachment A

Apheresis Therapy

Application and Removal of Tattoos

Arthroscopic Electrothermal Joint Repair

Artificial Intervertebral Disc Insertion

Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis

Auditory Brainstem Implant

Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)

Autologous Chondrocyte Transplantation (ACT)/Carticel®

Autologous Platelet-Derived Growth Factors as a Treatment for Wound Healing and Other Miscellaneous Conditions

Automatic External and Wearable Cardioverter Defibrillators

Balloon Sinuplasty for the Treatment of Chronic Sinusitis

Bariatric Surgery

Attachment A

Attachment B

Bendamustine hydrochloride (Treanda®)

Bevacizumab (Avastin®)

Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus

Attachment A

Biofeedback Therapy

Bioimpedance for the Detection of Lymphedema

Blepharoplasty with or without Repair of Blepharoptosis and/or Repair of Brow Ptosis

Blood Pressure Devices for Home Use

Bone Growth Stimulators

Bone Mineral Density (BMD) Testing

Bortezomib (Velcade®)

Botulinum Toxin Type A and Type B

Brachytherapy

Attachment A

Breast Ductal Lavage, Suction Collection of Nipple Aspirate Fluid, and Breast Duct Endoscopy

Bulking Agents for the Treatment of Stress Urinary Incontinence (SUI) due to Intrinsic Sphincter Deficiency (ISD) and for the Treatment of Vesicoureteral Reflux (VUR)

Cardiac Event Detection Monitoring (External Loop Monitoring)

Cardiac Rehabilitation

Cast and Splint Applications and Associated Supplies Provided in the Office Setting

Attachment A

Catheter Ablation of Cardiac Arrhythmias

Cervical Traction for In-home Use

Cetuximab (Erbitux®)

Chemical Peels

Chiropractic Spinal and Extraspinal Manipulation Therapy

Circumcision

Clitoral Therapy Devices (CDT)

Cochlear Implant

Cold Laser Therapy

Collection and Interpretation of Physiologic Data

Colorectal Cancer Screening

Complex Regional Pain Syndrome (CRPS) Parenteral Treatments

Compression Garments

Attachment A

Attachment B

Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure

Computer Aided Detection (CAD) System for use with Chest Radiographs

Computer Analysis and Generation of Automated Data in Conjunction with Diagnostic Studies

Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump

Continuous Passive Motion (CPM) Devices in the Home Setting

Corneal Liquid Bandage Lens for the Treatment of Persistent (Corneal) Epithelial Defects

Corneal Pachymetry Using Ultrasound

Cranial Remolding Orthoses (Helmets)

Cryosurgical Ablation of the Prostate Gland

Day Rehabilitation

Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Nails

Decongestive Lymphedema Therapy (DLT)

Deep Brain Stimulation

Dental Extractions Prior to Cardiac Surgery, Radiation Therapy, or Transplant Surgery

Diagnosis Criteria for Reimbursement of Emergency Room Services

Attachment A01

Attachment A02

Attachment A03

Attachment A04

Attachment A05

Attachment A06

Attachment A07

Attachment A08

Attachment A09

Attachment A10

Attachment A11

Attachment A12

Attachment A13

Diagnostic and Therapeutic Radiopharmaceutical Agents

Diagnostic Radiology Services Included in Capitation

Attachment A

Attachment B

Direct Access Obstetrics/Gynecology (OB/GYN)

Direct Measurement of Intermediate-Density Lipoproteins

Dofetilide (Tikosyn®) Use in the Inpatient Setting

Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum

Durable Medical Equipment (DME)

Attachment A1

Attachment A2

Attachment B

Echocardiography Contrast Agents

Elective Abortion

Attachment A

Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds

Electrocardiogram (ECG/EKG) Reported with Single Photon Emission Computed Tomography (SPECT) for Myocardial Perfusion Imaging (MPI)

Electromyography (EMG) (Needle and non-Needle) of the Anal or Urethral Sphincter

Electron Beam Computed Tomography (EBCT) for Screening Evaluations

Electronic Speech Aids

Electrosleep Therapy using a Cranial Electrical Stimulation Device

End-Diastolic Pneumatic Compression Therapy

Endometrial Ablation

Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms

Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysm

Epoprostenol (Flolan®) and Treprostinil (Remodulin®)

Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes

Attachment A

Attachment B

Erythropoiesis Stimulating Agents (ESAs)

Evaluation and Management of Autism Spectrum Disorders (ASD)

Attachment A

Attachment B

Attachment C

Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)

Evaluation and Treatment of Erectile Dysfunction

Evaluation or Setup of a Cardiac Pacemaker Reported with an Electrocardiogram (ECG/EKG)

Excision of Redundant Skin

Experimental/Investigational Services

Attachment A

External Breast Prostheses, Mastectomy Bras, and Post-Mastectomy Camisoles

External Counterpulsation (ECP)

Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions

Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth

Facility Reporting of Observation Services

Fetal Fibronectin Enzyme Immunoassay

Fetal Surgery

First-Trimester Prenatal Screening for Fetal Aneuploidy

Food and Drug Administration (FDA) Approval of Medical Devices

Foot Orthotics and Other Podiatric Appliances

Full-Body Computerized Tomography (CT) Scan Screening

Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy

Attachment A

Attachment B

Gastric Electrical Stimulation (Enterra™), Gastric Pacing

Genetic Testing for Congenital Long QT Syndrome

Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations

Guidelines for Well Mother/Well Baby Visits Under the Mother's Option Program

Hair Transplants and Cranial Prostheses (Wigs)

Hearing Aid Devices, Testing, Fittings, and Accessories

Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)

Attachment A

Attachment B

High-Frequency Chest Wall Oscillation Devices

High-Technology Diagnostic Radiology Services

Attachment A

High Osmolar Contrast Agents

Hip Resurfacing

Home-use Light Box for the Treatment of Seasonal Affective Disorder (SAD)

Home Health Care Services

Home Oxygen Therapy

Home Use of Interferential and Sequential Stimulation Devices

Home Uterine Activity Monitoring (HUAM) Devices

Home Visits by a Physician

Hospice and Respite Care

Hospital Beds and Accessories

Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping

Human Papillomavirus (HPV) Vaccine(s)

Humanitarian Use Devices (HUD) and the Humanitarian Device Exemption (HDE) Process

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Ibandronate Sodium (Boniva®) for Intravenous Injection

Idursulfase (Elaprase™)

Image-Guided Minimally Invasive Lumbar Decompression for Spinal Stenosis

Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)

Immune Prophylaxis for Respiratory Syncytial Virus (RSV)

Implantable Cardiac Loop Monitor

Implantation of Intrastromal Corneal Ring Segments (INTACS)

In Vitro Allergy Testing

In Vitro Chemosensitivity and Chemoresistance Assays

In Vivo Allergy Sensitivity Testing

Infliximab (Remicade®)

Infusion Therapy Services as Performed by Home Infusion Providers

Attachment A

Inpatient Administration of Dihydroergotamine Mesylate (D.H.E. 45®) Injection

Insertion of Implantable Infusion Pumps

Insertion or Application of Urinary Catheters and the Associated Supplies Provided in the Office Setting

Intensity Modulated Radiation Therapy (IMRT)

Attachment A

Interstitial Continuous Glucose Monitoring Systems (CGMS)

Intestinal Rehabilitation Program

Intra-articular Injection of Hyaluronan for the Treatment of Osteoarthritis

Intracoronary Brachytherapy

Intrahepatic Microspheres for Inoperable Liver Neoplasms

Intraoperative Neurophysiological Monitoring (INM)

Intravenous Chelation Therapy

Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances