|  | | 6709 | Low-LevelLaserTherapy07.00.14h | Medicine (07) | 07.00.14h | 07.00.14 | ec305867-b5e4-42d0-bd87-940bbeedb003 | Low-Level Laser Therapy | Low-Level Laser Therapy | |
| | | 6750 | Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62q | Pharmacy (08) | 08.00.62q | 08.00.62 | 408beb37-be23-40d5-9040-0c51e879186e | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"6751": {"Id":6751,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8937,"PolicyAttachmentPageName":"9d28e400-af9b-441b-84d4-db5f121b43a7"},} |
| | | 7257 | Acupuncture12.00.01i | Miscellaneous (12) | 12.00.01i | 12.00.01 | 4548e4c6-d93b-45e5-af3e-9b97720605c6 | Acupuncture | Acupuncture | {"7258": {"Id":7258,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":9445,"PolicyAttachmentPageName":"a1e3fcaf-e5fb-4838-ad8b-20dab6e12848"},} |
| | | 6289 | AcuteCareFacilityInpatientTransfers12.04.04b | Miscellaneous (12) | 12.04.04b | 12.04.04 | 041a205f-0c15-47d8-b360-7e2ae95890a4 | Acute Care Facility Inpatient Transfers | Acute Care Facility Inpatient Transfers | |
| | | 6624 | ADAMTS13,recombinant-krhn(Adzynma)08.02.21 | Pharmacy (08) | 08.02.21 | 08.02.21 | 48b73346-595a-453a-a012-7e53761de789 | ADAMTS13, recombinant-krhn (Adzynma) | ADAMTS13, recombinant-krhn (Adzynma) | |
| | | 6203 | Ado-TrastuzumabEmtansine(Kadcyla®)08.01.11i | Pharmacy (08) | 08.01.11i | 08.01.11 | 6376f7cc-44ba-4f5a-8572-660cfea3b4bb | Ado-Trastuzumab Emtansine (Kadcyla®) | Ado-Trastuzumab Emtansine (Kadcyla®) | {"6204": {"Id":6204,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes and Narratives","MPPolicyAttachmentInternalSourceId":8429,"PolicyAttachmentPageName":"544c1cad-3eb3-435b-85f8-112bfaa35d21"},} |
| | | 7393 | Afamitresgeneautoleucel(Tecelra®)08.02.32a | Pharmacy (08) | 08.02.32a | 08.02.32 | 90dfd292-8f6d-4abe-a80d-dcd2eaa00eda | Afamitresgene autoleucel (Tecelra®) | Afamitresgene autoleucel (Tecelra®) | |
| | | 6725 | Agalsidasebeta(Fabrazyme®)andpegunigalsidasealfa-iwxj(Elfabrio)08.00.69d | Pharmacy (08) | 08.00.69d | 08.00.69 | 06566e59-609d-44b8-9945-f7df309a8893 | Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) | Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) | |
| | | 6522 | AirAmbulanceServices12.04.03c | Miscellaneous (12) | 12.04.03c | 12.04.03 | 0c439ba9-9ae5-469b-9a3d-6b3059dd86ad | Air Ambulance Services | Air Ambulance Services | |
| | | 7373 | Alemtuzumab(Lemtrada®)08.01.22d | Pharmacy (08) | 08.01.22d | 08.01.22 | 8eeb9989-18c4-4498-b801-f2b9a1e0b234 | Alemtuzumab (Lemtrada®) | Alemtuzumab (Lemtrada®) | |
| | | 6343 | Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)08.00.72l | Pharmacy (08) | 08.00.72l | 08.00.72 | e5d1f91c-5781-472e-8a8f-aba999bdf8ee | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ ) | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ ) | |
| | | 6365 | AllergyImmunotherapy07.00.21j | Medicine (07) | 07.00.21j | 07.00.21 | e97c8f42-c197-410b-a30b-751901494dc7 | Allergy Immunotherapy | Allergy Immunotherapy | |
| | | 7332 | AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88 | Pharmacy (08) | 08.01.88 | 08.01.88 | 1558da1d-7903-437c-91ff-3852d19bec97 | Allogeneic Processed Thymus Tissue-agdc (Rethymic®) | Allogeneic Processed Thymus Tissue-agdc (Rethymic®) | |
| | | 7251 | AlloMap™MolecularExpressionTestingforHeartTransplantRejection(AmeriHealthAdministrators)06.02.29g | Pathology and Laboratory (06) | 06.02.29g | 06.02.29 | 587903d8-b256-4658-8e19-ae9c4dd9ac2e | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators) | AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators) | |
| | | 6369 | Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C®,AralastNP®,Glassia®,Zemaira®)08.00.91e | Pharmacy (08) | 08.00.91e | 08.00.91 | a0803772-4e4f-4d53-950e-4ee17a5c49bb | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®) | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®) | |
| | | 7166 | AlwaysBundledProcedureCodes00.01.52x | Administrative (00) | 00.01.52x | 00.01.52 | 722c8be7-9c9d-4742-a2d1-70450bfd3f83 | Always Bundled Procedure Codes | Always Bundled Procedure Codes | {"7167": {"Id":7167,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":9400,"PolicyAttachmentPageName":"57bbd658-de11-40de-98dd-4ff84165cedd"},"7168": {"Id":7168,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":9401,"PolicyAttachmentPageName":"d5e6c843-82d7-4d34-86e9-41c3fca2de78"},"7169": {"Id":7169,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (Indicator B)","MPPolicyAttachmentInternalSourceId":9402,"PolicyAttachmentPageName":"40487fd6-0efd-4a66-bb53-9bc336f3f903"},} |
| | | 7425 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09k | Medicine (07) | 07.02.09k | 07.02.09 | 27dc232b-fa0b-4b59-b2f4-f196d1b68930 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | |
| | | 7125 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21q | Medicine (07) | 07.02.21q | 07.02.21 | b3854c91-41aa-4539-aca0-29585c2aafa0 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | |
| | | 6427 | Amivantamab-vmjw(Rybrevant®)08.01.90a | Pharmacy (08) | 08.01.90a | 08.01.90 | d486df02-e380-4bbf-a9da-16d8462925fd | Amivantamab-vmjw (Rybrevant®) | Amivantamab-vmjw (Rybrevant®) | |
| | | 6784 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12c | Anesthesia (01) | 01.00.12c | 01.00.12 | e9c9f22f-4996-4b56-864f-d7416e17906f | Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management | Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management | {"6785": {"Id":6785,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9043,"PolicyAttachmentPageName":"247b6adb-e4db-410a-aed9-ad0f5527430c"},} |
| | | 6492 | Anifrolumab-fnia(Saphnelo®)08.01.82c | Pharmacy (08) | 08.01.82c | 08.01.82 | e33cb071-de8f-4aad-aa56-740c78fa063a | Anifrolumab-fnia (Saphnelo®) | Anifrolumab-fnia (Saphnelo®) | |
| | | 7452 | Ankle-Foot/Knee-Ankle-FootOrthoses05.00.39v | DME (05) | 05.00.39v | 05.00.39 | 53cfb2e6-b706-4374-927f-e6d3a57e1b00 | Ankle-Foot/Knee-Ankle-Foot Orthoses | Ankle-Foot/Knee-Ankle-Foot Orthoses | {"7453": {"Id":7453,"MPAttachmentLetter":"A","Title":"HCPCS Codes","MPPolicyAttachmentInternalSourceId":9617,"PolicyAttachmentPageName":"3144a8e1-f2d1-464b-90ab-d3822ce5d79d"},} |
| | | 7051 | ApheresisTherapy06.03.04o | Pathology and Laboratory (06) | 06.03.04o | 06.03.04 | 98097fd8-0342-47d9-ba1a-37ff95519513 | Apheresis Therapy | Apheresis Therapy | |
| | | 6970 | Apos®biomechanicalshoesystem05.00.84 | DME (05) | 05.00.84 | 05.00.84 | dcae2951-b257-4a13-a658-e9c9c8eb2102 | Apos® biomechanical shoe system | Apos® biomechanical shoe system | |
| | | 6145 | ApplicationandRemovalofTattoos11.08.05g | Surgery (11) | 11.08.05g | 11.08.05 | 8c8a85cf-d21e-4de9-8dba-2b996e35dbe4 | Application and Removal of Tattoos | Application and Removal of Tattoos | |
| | | 6705 | AppliedBehaviorAnalysis(ABA)fortheTreatmentofAutismSpectrumDisorders(ASD)14.00.03a | Behavioral Health (14) | 14.00.03a | 14.00.03 | 6ce912d3-f485-4ddf-bcef-902616736b67 | Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD) | Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD) | |
| | | 6434 | AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucoma11.05.16l | Surgery (11) | 11.05.16l | 11.05.16 | 3b29ff29-2825-4509-a933-5c95d4212c15 | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | {"6435": {"Id":6435,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8590,"PolicyAttachmentPageName":"77818cea-df5d-429c-a35c-a6f408125fbc"},} |
| | | 7479 | ArtificialIntervertebralCervicalDiscInsertion(AmeriHealthAdministrators)11.14.19p | Surgery (11) | 11.14.19p | 11.14.19 | 35245b24-5bf6-4802-9442-902d406c9e67 | Artificial Intervertebral Cervical Disc Insertion (AmeriHealth Administrators) | Artificial Intervertebral Cervical Disc Insertion (AmeriHealth Administrators) | |
| | | 7130 | AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)08.01.35i | Pharmacy (08) | 08.01.35i | 08.01.35 | ae518819-f5a1-49dd-b91e-882d8c56cdc3 | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | |
| | | 7261 | AssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(AmeriHealthAdministrators)06.02.27p | Pathology and Laboratory (06) | 06.02.27p | 06.02.27 | 56cacc55-1d7c-498d-927b-8a69cac0aca7 | Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators) | Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators) | |
| | | 6631 | AssistedReproductiveTechnologyforInfertilityandOocyteCryopreservation07.10.06j | Medicine (07) | 07.10.06j | 07.10.06 | 6f3e894a-05bc-4cd3-bdef-f6cbc845ef41 | Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation | Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation | |
| | | 7314 | Atezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybrezaTM)08.01.69e | Pharmacy (08) | 08.01.69e | 08.01.69 | c9c985d1-8f12-4946-b560-6c72f67713cd | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | {"7315": {"Id":7315,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9571,"PolicyAttachmentPageName":"bcc59619-03d7-4097-a828-39560cefe3c4"},} |
| | | 7052 | Atidarsageneautotemcel(Lenmeldy)08.02.24 | Pharmacy (08) | 08.02.24 | 08.02.24 | df93a237-63a0-4414-b64f-2edea97c47b4 | Atidarsagene autotemcel (Lenmeldy) | Atidarsagene autotemcel (Lenmeldy) | |
| | | 6424 | AuricularProstheses05.00.82 | DME (05) | 05.00.82 | 05.00.82 | 48247e2c-24d2-47e5-abb3-f29984e2fd33 | Auricular Prostheses | Auricular Prostheses | |
| | | 7408 | AutologousChondrocyteImplantation(ACI)andOtherCell-basedTreatmentsofFocalArticularCartilageLesions(AmerihealthAdministrators)11.14.06j | Surgery (11) | 11.14.06j | 11.14.06 | 6ad85a47-647a-42a9-8246-484c14154169 | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Amerihealth Administrators) | Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Amerihealth Administrators) | |
| | | 7358 | AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29o | DME (05) | 05.00.29o | 05.00.29 | b070d704-cac3-4d95-a688-af44923ad4c7 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"7359": {"Id":7359,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9496,"PolicyAttachmentPageName":"b88cf6f5-b2af-4a66-ba3e-b679772bdb77"},"7360": {"Id":7360,"MPAttachmentLetter":"A","Title":"ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9497,"PolicyAttachmentPageName":"af7d0a09-cd8a-4014-8ebb-fc602687e3ce"},} |
| | | 6805 | AutonomicNervousSystemTesting07.03.23g | Medicine (07) | 07.03.23g | 07.03.23 | 26fa6b18-0041-4f7a-b58a-bc314042689a | Autonomic Nervous System Testing | Autonomic Nervous System Testing | |
| | | 7067 | Avelumab(Bavencio®)08.01.64d | Pharmacy (08) | 08.01.64d | 08.01.64 | 043b3455-85fd-4892-a807-142649f1fd12 | Avelumab (Bavencio®) | Avelumab (Bavencio®) | {"7068": {"Id":7068,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9267,"PolicyAttachmentPageName":"13f5a18a-794f-48bb-ac11-2f904b0b0041"},} |
| | | 7335 | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisorRecurrentAcuteRhinosinusitis11.16.06k | Surgery (11) | 11.16.06k | 11.16.06 | 9999fe02-c4cf-48bc-82cc-4ce3045f0ad8 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | |
| | | 7177 | BariatricSurgery11.03.02v | Surgery (11) | 11.03.02v | 11.03.02 | 5ef09b1e-c832-4342-b5b7-0e406e12a03d | Bariatric Surgery | Bariatric Surgery | {"7178": {"Id":7178,"MPAttachmentLetter":"A","Title":"Body Mass Index (BMI) Charts","MPPolicyAttachmentInternalSourceId":6615,"PolicyAttachmentPageName":"22012b45-6064-485e-9b10-fed7f5ba902a"},"7179": {"Id":7179,"MPAttachmentLetter":"B","Title":"Tanner Staging System Criteria for Adolescents","MPPolicyAttachmentInternalSourceId":6616,"PolicyAttachmentPageName":"6f4a64ab-f4b0-42b1-b583-2965c92b867a"},} |
| | | 6415 | Belimumab(Benlysta®)forIntravenousUse08.00.99e | Pharmacy (08) | 08.00.99e | 08.00.99 | 51a01731-c3c5-4aa9-95c8-83a2cf8e12d3 | Belimumab (Benlysta®) for Intravenous Use | Belimumab (Benlysta®) for Intravenous Use | |
| | | 6625 | BeremageneGeperpavec(Vyjuvek™)08.02.10b | Pharmacy (08) | 08.02.10b | 08.02.10 | 67bd6cc4-ddf0-488d-96d2-3475d10fba45 | Beremagene Geperpavec (Vyjuvek™) | Beremagene Geperpavec (Vyjuvek™) | |
| | | 6561 | BetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89a | Pharmacy (08) | 08.01.89a | 08.01.89 | 8cdc388e-ec5b-49de-a6f9-a2140f482cf9 | Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)] | Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)] | |
| | | 7069 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66w | Pharmacy (08) | 08.00.66w | 08.00.66 | 7231530b-27b5-4e1e-b814-7210e19f1277 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"7070": {"Id":7070,"MPAttachmentLetter":"A","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":9221,"PolicyAttachmentPageName":"b2e1de9a-e39f-4b5e-96f5-9ad6f07871b0"},} |
| | | 7181 | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39q | Administrative (00) | 00.10.39q | 00.10.39 | de259c08-e0f9-4d77-a9c4-752a7154ffc0 | Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus | Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus | {"7182": {"Id":7182,"MPAttachmentLetter":"A","Title":"Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus","MPPolicyAttachmentInternalSourceId":9408,"PolicyAttachmentPageName":"d2637980-01a3-4b94-ae4d-4507ca7c01bd"},} |
| | | 6405 | BillingRequirementsforMultipleBirthsforProfessionalProviders00.10.38a | Administrative (00) | 00.10.38a | 00.10.38 | 9be43eff-6b64-4e0b-a426-ef73f2537ec3 | Billing Requirements for Multiple Births for Professional Providers | Billing Requirements for Multiple Births for Professional Providers | {"6406": {"Id":6406,"MPAttachmentLetter":"C","Title":"CODING SCENARIOS FOR REPORTING HIGH-ORDER MULTIPLE (TRIPLETS, QUADRUPLETS, ETC) BIRTHS WHEN ROUTINE OBSTETRIC (GLOBAL MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED","MPPolicyAttachmentInternalSourceId":8677,"PolicyAttachmentPageName":"8f6b9a74-008f-4e82-8be7-60a9d2b4131a"},"6407": {"Id":6407,"MPAttachmentLetter":"A","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ROUTINE OBSTETRIC (GLOBALE MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED","MPPolicyAttachmentInternalSourceId":8678,"PolicyAttachmentPageName":"b5c1c52a-6755-40e1-89ab-106d03f7d9d6"},"6408": {"Id":6408,"MPAttachmentLetter":"D","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES WHEN ANTEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":8679,"PolicyAttachmentPageName":"5ae8f316-7805-4e4c-ac92-1e147d896d76"},"6409": {"Id":6409,"MPAttachmentLetter":"B","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ANETEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":8680,"PolicyAttachmentPageName":"1aace5b3-ccc4-4d23-9916-fd982ce3e6ab"},} |
| | | 7229 | BiofeedbackTherapy07.00.01n | Medicine (07) | 07.00.01n | 07.00.01 | f73f4ca0-79b2-4c0e-879a-389b1145f640 | Biofeedback Therapy | Biofeedback Therapy | |
| | | 6708 | BioimpedancefortheDetectionofLymphedema07.06.03b | Medicine (07) | 07.06.03b | 07.06.03 | 30a57ce7-8380-4072-8656-3a9103506911 | Bioimpedance for the Detection of Lymphedema | Bioimpedance for the Detection of Lymphedema | |
| | | 6961 | Blinatumomab(Blincyto®)08.01.21g | Pharmacy (08) | 08.01.21g | 08.01.21 | 0640cf4b-eb1e-42ae-b6a8-4ef24369748a | Blinatumomab (Blincyto®) | Blinatumomab (Blincyto®) | |
| | | 6338 | Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAids11.01.06i | Surgery (11) | 11.01.06i | 11.01.06 | 3242af25-c531-415a-ae26-e24a7c42c39d | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | |
| | | 6372 | BoneMineralDensity(BMD)Testing09.00.04o | Radiology (09) | 09.00.04o | 09.00.04 | 9ed7ef7a-4ae7-48d2-820b-208e2d183121 | Bone Mineral Density (BMD) Testing | Bone Mineral Density (BMD) Testing | |
| | | 7426 | BotulinumToxinAgents08.00.26ad | Pharmacy (08) | 08.00.26ad | 08.00.26 | 32d1d1bc-8945-46bd-9e4b-eda32540d8ed | Botulinum Toxin Agents | Botulinum Toxin Agents | {"7427": {"Id":7427,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":9474,"PolicyAttachmentPageName":"e2782a1e-bbab-4fa6-8ddc-2fcd92977745"},} |
| | | 6181 | BrachytherapyandAcceleratedWholeBreastIrradiationusingThree-DimensionalConformationRadiationTherapy09.00.10z | Radiology (09) | 09.00.10z | 09.00.10 | ac7dfdb5-e79a-42d5-b6c3-681e9dcda63c | Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy | Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy | |
| | | 7468 | BreastPumps05.00.76h | DME (05) | 05.00.76h | 05.00.76 | 7561b3b3-04e8-49c2-b106-ad882f141b89 | Breast Pumps | Breast Pumps | |
| | | 6984 | BrentuximabVedotin(Adcetris®)08.01.13k | Pharmacy (08) | 08.01.13k | 08.01.13 | f13b61bd-5d57-4443-907a-9a119560f26c | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | {"6985": {"Id":6985,"MPAttachmentLetter":"A","Title":"ICD CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8995,"PolicyAttachmentPageName":"09923d4d-3e7e-4ff8-9b03-f2cf9738f0b1"},} |
| | | 7245 | BronchialValves11.16.09 | Surgery (11) | 11.16.09 | 11.16.09 | 74655048-5c3b-4911-803c-fc91117b568f | Bronchial Valves | Bronchial Valves | |
| | | 6366 | Burosumab-twza(Crysvita®)08.01.49b | Pharmacy (08) | 08.01.49b | 08.01.49 | 26b0281d-ae9c-41dd-bd7b-ac0c4c9581ba | Burosumab-twza (Crysvita®) | Burosumab-twza (Crysvita®) | |
| | | 7062 | Canakinumab(Ilaris®)08.01.51c | Pharmacy (08) | 08.01.51c | 08.01.51 | 7cf3300c-8d20-4eb5-b3b6-d9f1a5afbe1f | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | {"7063": {"Id":7063,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9272,"PolicyAttachmentPageName":"2f8981a3-741c-42f9-a5df-e92d42f5d52f"},} |
| | | 7230 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)Programs10.01.01r | Rehabilitation Services (10) | 10.01.01r | 10.01.01 | 1b9d1d59-b7c0-4838-8a17-2a18cc6c02e8 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"7231": {"Id":7231,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":9418,"PolicyAttachmentPageName":"c908d72d-f970-4483-a067-3b95ada2093b"},} |
| | | 7165 | CareManagementandCarePlanningServices00.01.59o | Administrative (00) | 00.01.59o | 00.01.59 | 6242f17c-6a75-4b31-8484-d56cbcb54923 | Care Management and Care Planning Services | Care Management and Care Planning Services | |
| | | 6983 | Carfilzomib(Kyprolis®)08.01.05l | Pharmacy (08) | 08.01.05l | 08.01.05 | dd05173e-58df-4139-834a-a1e830d3b3e8 | Carfilzomib (Kyprolis®) | Carfilzomib (Kyprolis®) | |
| | | 7021 | Casgevy™(exagamglogeneautotemcel)08.02.14 | Pharmacy (08) | 08.02.14 | 08.02.14 | 1bb6839b-1e1b-4642-bddf-6aa6ade77ae4 | Casgevy™ (exagamglogene autotemcel) | Casgevy™ (exagamglogene autotemcel) | |
| | | 6738 | CastandSplintApplicationsandAssociatedSupplies00.10.15d | Administrative (00) | 00.10.15d | 00.10.15 | ff41fdec-319e-4608-be2d-eee15f3bec86 | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"6739": {"Id":6739,"MPAttachmentLetter":"A","Title":"Procedure Codes Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":8996,"PolicyAttachmentPageName":"e57f2559-9175-4c80-b8ea-259381682441"},} |
| | | 6493 | CataractSurgery11.01.07g | Surgery (11) | 11.01.07g | 11.01.07 | fec31763-44fc-4101-8f21-6605830732d7 | Cataract Surgery | Cataract Surgery | {"6494": {"Id":6494,"MPAttachmentLetter":"A","Title":"ICD 10 codes for Cataract Surgery","MPPolicyAttachmentInternalSourceId":8501,"PolicyAttachmentPageName":"246ef7a5-9f53-44fa-8148-e1d9ed3d62b1"},} |
| | | 7096 | CatheterAblationofCardiacArrhythmias11.02.06r | Surgery (11) | 11.02.06r | 11.02.06 | 9df2f9df-0706-42e3-a35e-1d9bd498052c | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | |
| | | 6988 | Cemiplimab-rwlc(Libtayo®)08.01.66d | Pharmacy (08) | 08.01.66d | 08.01.66 | a78797d7-fe01-4323-b932-9f3f27ddc346 | Cemiplimab-rwlc (Libtayo®) | Cemiplimab-rwlc (Libtayo®) | |
| | | 7007 | Cerliponasealfa(Brineura®)08.01.39d | Pharmacy (08) | 08.01.39d | 08.01.39 | 5c89e0d7-8b1b-48bf-848d-445f4c9ddec5 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | {"7008": {"Id":7008,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Cerliponase alfa (Brineura®)","MPPolicyAttachmentInternalSourceId":9269,"PolicyAttachmentPageName":"5c4b9376-fdc2-4510-8dd6-440ed91b080e"},} |
| | | 7153 | CervicalTractionDevicesforIn-homeUse05.00.61h | DME (05) | 05.00.61h | 05.00.61 | caf1a6dd-71ab-4537-a5f3-4aadda6bcb45 | Cervical Traction Devices for In-home Use | Cervical Traction Devices for In-home Use | |
| | | 6170 | Cetuximab(Erbitux®)08.00.67o | Pharmacy (08) | 08.00.67o | 08.00.67 | 2ba8dd03-1332-463a-bd4a-f6ad3e32ef5f | Cetuximab (Erbitux®) | Cetuximab (Erbitux®) | {"6171": {"Id":6171,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":8346,"PolicyAttachmentPageName":"50d17395-3ac0-4802-becf-8c6726798808"},"6172": {"Id":6172,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":8347,"PolicyAttachmentPageName":"eeddeafc-ed0b-4978-9f90-a0ee678d7d2e"},} |
| | | 6853 | ChemicalPeels11.08.08h | Surgery (11) | 11.08.08h | 11.08.08 | 21a99081-eb8e-4ea4-93f5-62db83cc6161 | Chemical Peels | Chemical Peels | |
| | | 7236 | ChimericAntigenReceptor(CAR)Therapy08.01.43p | Pharmacy (08) | 08.01.43p | 08.01.43 | d66f88f5-09aa-45c4-9442-23d8d42fd20d | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | |
| | | 6544 | ChiropracticSpinalandExtraspinalManipulationTherapy10.02.02k | Rehabilitation Services (10) | 10.02.02k | 10.02.02 | 03a1b92b-198a-466f-bdfb-61c4b8506e4d | Chiropractic Spinal and Extraspinal Manipulation Therapy | Chiropractic Spinal and Extraspinal Manipulation Therapy | |
| | | 7318 | CoagulationFactors08.00.92ai | Pharmacy (08) | 08.00.92ai | 08.00.92 | b4d94f12-7942-4473-a9b5-df08e694ea3c | Coagulation Factors | Coagulation Factors | |
| | | 6603 | Cobalamin(VitaminB12),FolicAcid,andHomocysteineTesting06.02.54c | Pathology and Laboratory (06) | 06.02.54c | 06.02.54 | 6b7ebced-bcd0-4114-8045-d3344f571457 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | {"6604": {"Id":6604,"MPAttachmentLetter":"A","Title":"MEDICALLY NECESSARY ICD 10 CODES FOR COBALAMIN (VITAMIN B12) AND/OR FOLIC ACID TESTING (CPT CODES 82607, 82608, 82746, AND 82747)","MPPolicyAttachmentInternalSourceId":8879,"PolicyAttachmentPageName":"8dfa2395-5829-45da-8e2b-8f9ba6540478"},} |
| | | 6337 | CochlearImplantation11.01.02r | Surgery (11) | 11.01.02r | 11.01.02 | 85d7a94a-d5ad-4974-87f1-423bc92c9205 | Cochlear Implantation | Cochlear Implantation | |
| | | 6151 | Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)08.01.71 | Pharmacy (08) | 08.01.71 | 08.01.71 | 180e2231-db77-429e-a2a2-26e6b1665e64 | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | |
| | | 6651 | ColorectalCancerScreening11.03.12u | Surgery (11) | 11.03.12u | 11.03.12 | 07e946c3-ede9-491b-a58b-e8bd704ca61d | Colorectal Cancer Screening | Colorectal Cancer Screening | |
| | | 6411 | ComplementaryandIntegrativeHealthServices12.00.03h | Miscellaneous (12) | 12.00.03h | 12.00.03 | ba170083-35f9-4f1e-9e58-e68b05aa307a | Complementary and Integrative Health Services | Complementary and Integrative Health Services | |
| | | 6648 | CompleteDecongestiveTherapy(CDT)07.06.01b | Medicine (07) | 07.06.01b | 07.06.01 | 2a646409-8ef0-4f1d-a82f-b8255abe7637 | Complete Decongestive Therapy (CDT) | Complete Decongestive Therapy (CDT) | |
| | | 6250 | CompositeTissueAllotransplantationoftheHand(s)andFace11.14.30 | Surgery (11) | 11.14.30 | 11.14.30 | 9af50738-b876-485d-a1aa-ce59f7bc63bc | Composite Tissue Allotransplantation of the Hand(s) and Face | Composite Tissue Allotransplantation of the Hand(s) and Face | |
| | | 7394 | CompressionGarments05.00.37j | DME (05) | 05.00.37j | 05.00.37 | fa0fc9af-6ebc-47d0-b5d5-663df7a7d554 | Compression Garments | Compression Garments | |
| | | 6723 | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographs09.00.42d | Radiology (09) | 09.00.42d | 09.00.42 | 808d9177-9c6a-4134-9a81-abe8964f00a0 | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | |
| | | 6178 | Computer-assistedMusculoskeletalSurgicalNavigationalOrthopedicProcedure11.14.17e | Surgery (11) | 11.14.17e | 11.14.17 | 74e08be5-b94f-4be4-a25b-b91380825a8e | Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | |
| | | 6418 | ConsultationServices00.01.69b | Administrative (00) | 00.01.69b | 00.01.69 | 1fc8159e-2b1f-42e2-975e-fe9ef1aae41b | Consultation Services | Consultation Services | |
| | | 6643 | ContactLensesfortheTreatmentofPersistent(Corneal)EpithelialDefects07.13.11k | Medicine (07) | 07.13.11k | 07.13.11 | d6d7e319-5af2-4f69-8fc0-7a90f8d7d80b | Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects | Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects | {"6644": {"Id":6644,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":8891,"PolicyAttachmentPageName":"51c8189f-6947-49e0-832f-e6d8f8b88e6a"},} |
| | | 7259 | ContrastAgentsUsedinConjunctionwithEchocardiography09.00.11e | Radiology (09) | 09.00.11e | 09.00.11 | c5fd2062-89b8-4c22-a99b-47e4398d8af6 | Contrast Agents Used in Conjunction with Echocardiography | Contrast Agents Used in Conjunction with Echocardiography | |
| | | 6525 | CornealPachymetryUsingUltrasound07.13.07l | Medicine (07) | 07.13.07l | 07.13.07 | a1f7886c-2785-4dc7-bfaf-eb44b5577a4d | Corneal Pachymetry Using Ultrasound | Corneal Pachymetry Using Ultrasound | {"6526": {"Id":6526,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":8841,"PolicyAttachmentPageName":"c03ac400-a1a8-4964-b017-c80070fe0395"},} |
| | | 7451 | CoronaryArteryCalcium(CAC)TestingUsingComputedTomography(AmeriHealthAdministrators)09.00.58 | Radiology (09) | 09.00.58 | 09.00.58 | 4d7b57ba-e67d-45c3-9bf9-2f320a4ffa84 | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators) | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators) | |
| | | 7171 | CosmeticProcedures12.01.03b | Miscellaneous (12) | 12.01.03b | 12.01.03 | 1b0c4dbc-22e1-4cf2-a8bd-43a74b3675fb | Cosmetic Procedures | Cosmetic Procedures | |
| | | 7462 | CoverageofAnticancerPrescriptionOralandInjectableDrugsandBiologicsandSupportiveAgents08.01.08t | Pharmacy (08) | 08.01.08t | 08.01.08 | 8f24fd6e-4417-436f-b2c9-e552bea7bacd | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents | {} |
| | | 6936 | CoverageofMedicalDevices05.00.04e | DME (05) | 05.00.04e | 05.00.04 | 21580a78-eec4-4b84-a973-1315467a0db9 | Coverage of Medical Devices | Coverage of Medical Devices | |
| | | 6482 | CranialElectrotherapyStimulation05.00.80d | DME (05) | 05.00.80d | 05.00.80 | e6fa1ee9-b65c-4dc7-8cb6-4f43c749322b | Cranial Electrotherapy Stimulation | Cranial Electrotherapy Stimulation | |
| | | 7172 | CranialRemoldingOrthoses(Helmets)05.00.25j | DME (05) | 05.00.25j | 05.00.25 | aa7f72f9-fa25-4e14-a3e5-5688e717d10a | Cranial Remolding Orthoses (Helmets) | Cranial Remolding Orthoses (Helmets) | |
| | | 6989 | CriteriaforReimbursementofEmergencyRoomServices00.10.03l | Administrative (00) | 00.10.03l | 00.10.03 | 185338ad-41d3-418a-8747-c8d402f4c6ff | Criteria for Reimbursement of Emergency Room Services | Criteria for Reimbursement of Emergency Room Services | |
| | | 6439 | crizanlizumab-tmca(Adakveo®)08.00.04a | Pharmacy (08) | 08.00.04a | 08.00.04 | b13eb749-bcbf-4a49-9865-64e96d61b947 | crizanlizumab-tmca (Adakveo®) | crizanlizumab-tmca (Adakveo®) | |
| | | 7061 | Crovalimab-akkz(Piasky)08.02.31 | Pharmacy (08) | 08.02.31 | 08.02.31 | aabae9b6-4fc1-47d0-bfdb-a233c71259c4 | Crovalimab-akkz (Piasky) | Crovalimab-akkz (Piasky) | |
| | | 7375 | CryosurgicalAblationoftheProstateGland11.11.03d | Surgery (11) | 11.11.03d | 11.11.03 | dbc8ae22-ad7a-483f-8a0b-c6d0c833dd11 | Cryosurgical Ablation of the Prostate Gland | Cryosurgical Ablation of the Prostate Gland | |
| | | 6679 | Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)08.01.29l | Pharmacy (08) | 08.01.29l | 08.01.29 | 34c27cb0-972d-4a80-b60b-1e81b353d8e9 | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | |
| | | 6906 | DayRehabilitation10.00.02c | Rehabilitation Services (10) | 10.00.02c | 10.00.02 | f51fc115-617f-4fda-adec-b8413749d2b9 | Day Rehabilitation | Day Rehabilitation | |
| | | 7350 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToenails11.08.17k | Surgery (11) | 11.08.17k | 11.08.17 | 7cd14dae-3d32-4cab-8f46-de18d2f1714b | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails | {"7351": {"Id":7351,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":9486,"PolicyAttachmentPageName":"ba004a1f-d19f-45f9-92cd-fce3a8bee751"},"7352": {"Id":7352,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":9487,"PolicyAttachmentPageName":"2f94821a-fc57-4d52-adfa-298645557909"},"7353": {"Id":7353,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":9488,"PolicyAttachmentPageName":"d0b78c62-4f83-4132-a457-a68ab57257f8"},"7354": {"Id":7354,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":9489,"PolicyAttachmentPageName":"5ac808a6-a052-45bc-8f8e-0ed6f2de1f9b"},"7355": {"Id":7355,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":9490,"PolicyAttachmentPageName":"145fc8e3-d65b-4ae1-a52b-c5beab064fa7"},} |
