Abatacept (Orencia®) for injection for intravenous use

Abdominoplasty and/or Panniculectomy

Acupuncture

Add-on Codes

Attachment A

Agalsidase beta (Fabrazyme®)

Air or Sea Ambulance Transport Services

Airway-Clearance Devices for Use in the Home Setting

Alglucosidase alfas, rhGAA (Myozyme®, Lumizyme®)

Allergy Immunotherapy

AlloMap™ Molecular Expression Testing for Heart Transplant Rejection

Alpha 1-Proteinase Inhibitor Therapy (eg, Prolastin, Aralast, Aralast NP, Glassia, Zemaira)

Alternative Therapies and Complementary Medicine

Always Bundled Procedure Codes

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

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 Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions

Automatic External and Wearable Cardioverter Defibrillators

Balloon Sinuplasty for the Treatment of Chronic Sinusitis

Bariatric Surgery

Belatacept (Nulojix®)

Belimumab (Benlysta®)

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

Billing Requirements for Multiple Births for Professional Providers

Biofeedback Therapy

Bioimpedance for the Detection of Lymphedema

Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy

Blood Pressure Devices for Home Use

Bone-Anchored (Osseointegrated) Hearing Aids, Implantable Bone-Conduction Hearing Aids, and Semi-Implantable Hearing Aids

Bone Growth Stimulators

Bone Mineral Density (BMD) Testing

Bortezomib (Velcade®)

Botulinum Toxin Agents

Brachytherapy

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

C1 Esterase Inhibitors (Human): Cinryze® and Berinert®

Cabazitaxel (Jevtana®)

Cardiac Event Detection Monitoring (External Loop Monitoring)

Cardiac Rehabilitation

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

Cataract Surgery

Catheter Ablation of Cardiac Arrhythmias

Cervical Traction for In-home Use

Cetuximab (Erbitux®)

Chemical Peels

Chiropractic Spinal and Extraspinal Manipulation Therapy

Circumcision

Coagulation Factors for Hemophilia

Cochlear Implant

Cold Laser Therapy

Colorectal Cancer Screening

Complex Regional Pain Syndrome (CRPS) Parenteral Treatments

Compression Garments

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 (DBS)

Denosumab (Prolia™, Xgeva™)

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

Diagnosis Criteria for Reimbursement of Emergency Room Services

Diagnostic and Therapeutic Radiopharmaceutical Agents

Diagnostic Radiology Services Included in Capitation

Digital Breast Tomosynthesis

Direct Access Obstetrics/Gynecology (OB/GYN)

Dofetilide (Tikosyn®) Use in the Inpatient Setting

Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies

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

Durable Medical Equipment (DME)

Ecallantide (Kalbitor®)

Echocardiography Contrast Agents

Eculizumab (Soliris®)

Elective Abortion

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

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 the Thoracic Aortic Aneurysm and Dissection

Enzyme Replacement for the Treatment of Gaucher's Disease (eg, Alglucerase [Ceredase®], Imiglucerase [Cerezyme®], Velaglucerase Alpha [VPRIV™]).

Epoprostenol (Flolan®) and Treprostinil (Remodulin®)

Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes

Eribulin Mesylate (Halaven™)

Erythropoiesis-Stimulating Agents (ESAs)

Evaluation and Management of Autism Spectrum Disorders (ASD)

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

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 (fFN) 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

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

Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome)

Genetic Testing

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

Hair Transplants and Cranial Prostheses (Wigs)

Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)

High-Frequency Chest Wall Oscillation Devices

High-Technology Diagnostic Radiology Services

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

Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies

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

Injectable Dermal Fillers

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

Inpatient Hospital Readmission

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)

Interstitial Continuous Glucose Monitoring Systems (CGMSs)

Intra-articular Injection of Hyaluronan for the Treatment of Osteoarthritis

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

Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (eg, ranibizumab [Lucentis®], pegaptanib sodium [Macugen®])

Ipilimumab (Yervoy®)

Islet Cell Transplantation

Knee Braces

Labiaplasty

Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

Laronidase (Aldurazyme®)

Lipectomy and/or Liposuction

Low Osmolar Contrast Agents

Lower Limb Prostheses

Lumbar Interspinous Process Decompression

Lung Volume Reduction Surgery

Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Treatment

Lysis of Epidural Adhesions

Magnetic Resonance Imaging (MRI) Contrast Agents

Magnetic Resonance Spectroscopy (MRS)

Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)

Mammography and Computer-Aided Detection (CAD) System for Mammography

Manual Wheelchairs

Marijuana for Medical Use

Maze Procedure

Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders

Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures

Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)

Medical Foods, Low-Protein Modified Food Products, Enteral Nutrition, and Nutritional Formulas

Medicare Part B vs. Part D Crossover Drugs

Meniscal Allograft Transplantation

Mentoplasty or Genioplasty