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ec305867-b5e4-42d0-bd87-940bbeedb003.aspx
  
6709​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-LevelLaserTherapy07.00.14hMedicine (07)07.00.14h07.00.14ec305867-b5e4-42d0-bd87-940bbeedb003​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy
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5626Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62pPharmacy (08)08.00.62p08.00.623f223e2e-8b21-479a-bb77-5c350f2780f1Abatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use
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6157Acupuncture12.00.01hMiscellaneous (12)12.00.01h12.00.0151b33f90-efbb-44ea-81f0-df77ba8b4765AcupunctureAcupuncture
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6289AcuteCareFacilityInpatientTransfers12.04.04bMiscellaneous (12)12.04.04b12.04.04041a205f-0c15-47d8-b360-7e2ae95890a4Acute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers
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6624ADAMTS13,recombinant-krhn(Adzynma)08.02.21Pharmacy (08)08.02.2108.02.2148b73346-595a-453a-a012-7e53761de789ADAMTS13, recombinant-krhn (Adzynma)ADAMTS13, recombinant-krhn (Adzynma)
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6203Ado-TrastuzumabEmtansine(Kadcyla®)08.01.11iPharmacy (08)08.01.11i08.01.116376f7cc-44ba-4f5a-8572-660cfea3b4bbAdo-Trastuzumab Emtansine (Kadcyla®)Ado-Trastuzumab Emtansine (Kadcyla®)
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5163Agalsidasebeta(Fabrazyme®)08.00.69cPharmacy (08)08.00.69c08.00.69b8b27d69-62ab-4921-9ae8-f074ee40c9dcAgalsidase beta (Fabrazyme®)Agalsidase beta (Fabrazyme®)
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6522AirAmbulanceServices12.04.03cMiscellaneous (12)12.04.03c12.04.030c439ba9-9ae5-469b-9a3d-6b3059dd86adAir Ambulance ServicesAir Ambulance Services
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6313Alemtuzumab(Lemtrada®)08.01.22dPharmacy (08)08.01.22d08.01.22286fe526-ea7a-4849-be6c-90970e43a269Alemtuzumab (Lemtrada®)Alemtuzumab (Lemtrada®)
e5d1f91c-5781-472e-8a8f-aba999bdf8ee.aspx
  
6343Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)08.00.72lPharmacy (08)08.00.72l08.00.72e5d1f91c-5781-472e-8a8f-aba999bdf8eeAlglucosidase 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™ )
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6365AllergyImmunotherapy07.00.21jMedicine (07)07.00.21j07.00.21e97c8f42-c197-410b-a30b-751901494dc7Allergy ImmunotherapyAllergy Immunotherapy
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6175AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88Pharmacy (08)08.01.8808.01.887b6b45cc-a602-418b-80f7-d0d8796981ecAllogeneic Processed Thymus Tissue-agdc (Rethymic®)Allogeneic Processed Thymus Tissue-agdc (Rethymic®)
8e33c660-965c-4bdc-a6fd-f2d0999aac45.aspx
  
6154AlloMap™MolecularExpressionTestingforHeartTransplantRejection(AmeriHealthAdministrators)06.02.29dPathology and Laboratory (06)06.02.29d06.02.298e33c660-965c-4bdc-a6fd-f2d0999aac45AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)
a0803772-4e4f-4d53-950e-4ee17a5c49bb.aspx
  
6369Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C®,AralastNP®,Glassia®,Zemaira®)08.00.91ePharmacy (08)08.00.91e08.00.91a0803772-4e4f-4d53-950e-4ee17a5c49bbAlpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)
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6588AlwaysBundledProcedureCodes00.01.52vAdministrative (00)00.01.52v00.01.525348681e-acf9-41ba-a903-9daf3cb3fcd7Always Bundled Procedure CodesAlways Bundled Procedure Codes
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6179AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09iMedicine (07)07.02.09i07.02.094242bfce-640e-453e-9bf6-966b0382a8afAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) DevicesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
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6213AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21pMedicine (07)07.02.21p07.02.21d66f84ac-393e-421b-8ff5-e019a4e143abAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
d486df02-e380-4bbf-a9da-16d8462925fd.aspx
  
6427Amivantamab-vmjw(Rybrevant®)08.01.90aPharmacy (08)08.01.90a08.01.90d486df02-e380-4bbf-a9da-16d8462925fdAmivantamab-vmjw (Rybrevant®)Amivantamab-vmjw (Rybrevant®)
ca8760ac-cc70-4b9b-a52a-08223726910b.aspx
  
6474AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12bAnesthesia (01)01.00.12b01.00.12ca8760ac-cc70-4b9b-a52a-08223726910bAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint ManagementAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
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6492Anifrolumab-fnia(Saphnelo®)08.01.82cPharmacy (08)08.01.82c08.01.82e33cb071-de8f-4aad-aa56-740c78fa063aAnifrolumab-fnia (Saphnelo®)Anifrolumab-fnia (Saphnelo®)
f06f0d8e-9656-427c-a18a-4e290d8ca5f1.aspx
  
6260Ankle-Foot/Knee-Ankle-FootOrthoses05.00.39uDME (05)05.00.39u05.00.39f06f0d8e-9656-427c-a18a-4e290d8ca5f1Ankle-Foot/Knee-Ankle-Foot OrthosesAnkle-Foot/Knee-Ankle-Foot Orthoses
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5901ApheresisTherapy06.03.04nPathology and Laboratory (06)06.03.04n06.03.040d151aaf-53f7-4fc0-a0dc-540b0ed277a6Apheresis TherapyApheresis Therapy
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5963Apos®biomechanicalshoesystem05.00.84DME (05)05.00.8405.00.84ba410497-dc76-45a7-86d1-89fdcb6cc851Apos® biomechanical shoe systemApos® biomechanical shoe system
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6145ApplicationandRemovalofTattoos11.08.05gSurgery (11)11.08.05g11.08.058c8a85cf-d21e-4de9-8dba-2b996e35dbe4Application and Removal of TattoosApplication and Removal of Tattoos
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6705AppliedBehaviorAnalysis(ABA)fortheTreatmentofAutismSpectrumDisorders(ASD)14.00.03aBehavioral Health (14)14.00.03a14.00.036ce912d3-f485-4ddf-bcef-902616736b67Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)
3b29ff29-2825-4509-a933-5c95d4212c15.aspx
  
6434AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucoma11.05.16lSurgery (11)11.05.16l11.05.163b29ff29-2825-4509-a933-5c95d4212c15Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
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5311ArtificialIntervertebralCervicalDiscInsertion(AmerihealthAdministrators)11.14.19pSurgery (11)11.14.19p11.14.19bc52c9e0-2f80-4074-92f6-4627d2247b46Artificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators)Artificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators)
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5808ArtificialIntervertebralLumbarDiscInsertion11.15.31bSurgery (11)11.15.31b11.15.3114c6546f-9145-49d6-a22b-44f85ab32431Artificial Intervertebral Lumbar Disc InsertionArtificial Intervertebral Lumbar Disc Insertion
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5453AsparaginaseErwiniaChrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze®)08.01.35gPharmacy (08)08.01.35g08.01.3545eea1e5-d113-4c3c-a874-49b1e3d094b0Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®)
9df36788-e9f1-4d47-a9c2-21f112f4b6b4.aspx
  
5557AssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(AmeriHealthAdministrators)06.02.27nPathology and Laboratory (06)06.02.27n06.02.279df36788-e9f1-4d47-a9c2-21f112f4b6b4Assays 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)
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6631AssistedReproductiveTechnologyforInfertilityandOocyteCryopreservation07.10.06jMedicine (07)07.10.06j07.10.066f3e894a-05bc-4cd3-bdef-f6cbc845ef41Assisted Reproductive Technology for Infertility and Oocyte CryopreservationAssisted Reproductive Technology for Infertility and Oocyte Cryopreservation
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5120Atezolizumab(Tecentriq®)08.01.69cPharmacy (08)08.01.69c08.01.693692eb86-55ea-4cdd-a607-efd8374b8545Atezolizumab (Tecentriq®)Atezolizumab (Tecentriq®)
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6424AuricularProstheses05.00.82DME (05)05.00.8205.00.8248247e2c-24d2-47e5-abb3-f29984e2fd33Auricular ProsthesesAuricular Prostheses
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6707AutologousChondrocyteImplantation(ACI)andOtherCell-basedTreatmentsofFocalArticularCartilageLesions(AmerihealthAdministrators)11.14.06jSurgery (11)11.14.06j11.14.066b5bdbf5-f556-4583-aa70-78730a56890cAutologous 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)
a590a8dc-f63a-4148-bbaf-c1db550f4901.aspx
  
5683AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29oDME (05)05.00.29o05.00.29a590a8dc-f63a-4148-bbaf-c1db550f4901Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
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6305AutonomicNervousSystemTesting07.03.23fMedicine (07)07.03.23f07.03.23eb3c1ee7-737d-44c6-89df-27081fad358cAutonomic Nervous System TestingAutonomic Nervous System Testing
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6091Avelumab(Bavencio®)08.01.64cPharmacy (08)08.01.64c08.01.648634181f-e7ae-4971-83be-45e7b99e6c46Avelumab (Bavencio®)Avelumab (Bavencio®)
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5096BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitis11.16.06jSurgery (11)11.16.06j11.16.06e6e1f2fb-cb7d-4b62-b88c-93f6f4dbaaa6Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic RhinosinusitisBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
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2824BariatricSurgery11.03.02tSurgery (11)11.03.02t11.03.02deb6788b-9378-4634-bea1-f71971bb7026Bariatric SurgeryBariatric Surgery
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6415Belimumab(Benlysta®)forIntravenousUse08.00.99ePharmacy (08)08.00.99e08.00.9951a01731-c3c5-4aa9-95c8-83a2cf8e12d3Belimumab (Benlysta®) for Intravenous UseBelimumab (Benlysta®) for Intravenous Use
67bd6cc4-ddf0-488d-96d2-3475d10fba45.aspx
  
6625BeremageneGeperpavec(Vyjuvek™)08.02.10bPharmacy (08)08.02.10b08.02.1067bd6cc4-ddf0-488d-96d2-3475d10fba45Beremagene Geperpavec (Vyjuvek™)Beremagene Geperpavec (Vyjuvek™)
8cdc388e-ec5b-49de-a6f9-a2140f482cf9.aspx
  
6561BetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89aPharmacy (08)08.01.89a08.01.898cdc388e-ec5b-49de-a6f9-a2140f482cf9Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]
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5394Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66uPharmacy (08)08.00.66u08.00.665e39b1ae-f374-4b43-a5f0-9444ff939207Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
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5883BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39pAdministrative (00)00.10.39p00.10.3995f9b3c1-bad5-4370-9529-72d47935639aBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility CampusBilling for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
{"5884": {"Id":5884,"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":7908,"PolicyAttachmentPageName":"51655d25-e2d1-4a76-b79a-b81778bf424c"},}
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6405BillingRequirementsforMultipleBirthsforProfessionalProviders00.10.38aAdministrative (00)00.10.38a00.10.389be43eff-6b64-4e0b-a426-ef73f2537ec3Billing Requirements for Multiple Births for Professional ProvidersBilling 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"},}
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6623BiofeedbackTherapy07.00.01nMedicine (07)07.00.01n07.00.019bbfe306-c517-4311-9e0c-3992dede578bBiofeedback TherapyBiofeedback Therapy
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6708BioimpedancefortheDetectionofLymphedema07.06.03bMedicine (07)07.06.03b07.06.0330a57ce7-8380-4072-8656-3a9103506911Bioimpedance for the Detection of LymphedemaBioimpedance for the Detection of Lymphedema
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4845Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/Canthopexy11.05.02jSurgery (11)11.05.02j11.05.02b491f109-dc4e-41fb-906a-5eb04fe2602dBlepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/CanthopexyBlepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
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5114Blinatumomab(Blincyto®)08.01.21fPharmacy (08)08.01.21f08.01.21b306af6e-813e-493c-8a8b-b57d5995a5e4Blinatumomab (Blincyto®)Blinatumomab (Blincyto®)
3242af25-c531-415a-ae26-e24a7c42c39d.aspx
  
6338Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAids11.01.06iSurgery (11)11.01.06i11.01.063242af25-c531-415a-ae26-e24a7c42c39dBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
9ed7ef7a-4ae7-48d2-820b-208e2d183121.aspx
  
6372BoneMineralDensity(BMD)Testing09.00.04oRadiology (09)09.00.04o09.00.049ed7ef7a-4ae7-48d2-820b-208e2d183121Bone Mineral Density (BMD) TestingBone Mineral Density (BMD) Testing
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6390BotulinumToxinAgents08.00.26acPharmacy (08)08.00.26ac08.00.26ff919628-9d60-4949-a4b1-093a98efd8ffBotulinum Toxin AgentsBotulinum Toxin Agents
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6181BrachytherapyandAcceleratedWholeBreastIrradiationusingThree-DimensionalConformationRadiationTherapy09.00.10zRadiology (09)09.00.10z09.00.10ac7dfdb5-e79a-42d5-b6c3-681e9dcda63cBrachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation TherapyBrachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy
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5974BreastPumps05.00.76hDME (05)05.00.76h05.00.76e718aa9b-d3fc-4639-a5db-9da0f889ca0dBreast PumpsBreast Pumps
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6082BrentuximabVedotin(Adcetris®)08.01.13iPharmacy (08)08.01.13i08.01.138fb16725-fe22-41e8-a8fd-d52ed540ecf3Brentuximab Vedotin (Adcetris®)Brentuximab Vedotin (Adcetris®)
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6412BronchialValves11.16.09Surgery (11)11.16.0911.16.09ee437b97-bae6-428a-9307-6821eb6b1f46Bronchial ValvesBronchial Valves
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6366Burosumab-twza(Crysvita®)08.01.49bPharmacy (08)08.01.49b08.01.4926b0281d-ae9c-41dd-bd7b-ac0c4c9581baBurosumab-twza (Crysvita®)Burosumab-twza (Crysvita®)
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5367Canakinumab(Ilaris®)08.01.51bPharmacy (08)08.01.51b08.01.5138c73bef-e52a-4cb7-a01c-656e866406c9Canakinumab (Ilaris®)Canakinumab (Ilaris®)
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6201CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)Programs10.01.01rRehabilitation Services (10)10.01.01r10.01.014f05be45-fe22-4985-826c-1a29eeda3bd8Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
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6110CareManagementandCarePlanningServices00.01.59nAdministrative (00)00.01.59n00.01.59b07fe1e1-bece-4278-976c-ff96c6008f21Care Management and Care Planning ServicesCare Management and Care Planning Services
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5994Carfilzomib(Kyprolis®)08.01.05jPharmacy (08)08.01.05j08.01.05f6351ed6-683e-4623-83d6-5dee552f7b29Carfilzomib (Kyprolis®)Carfilzomib (Kyprolis®)
3d5103bb-27d5-4963-bd34-f6ba67f1076b.aspx
  
4360CastandSplintApplicationsandAssociatedSupplies00.10.15dAdministrative (00)00.10.15d00.10.153d5103bb-27d5-4963-bd34-f6ba67f1076bCast and Splint Applications and Associated SuppliesCast and Splint Applications and Associated Supplies
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6493CataractSurgery11.01.07gSurgery (11)11.01.07g11.01.07fec31763-44fc-4101-8f21-6605830732d7Cataract SurgeryCataract Surgery
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5689CatheterAblationofCardiacArrhythmias11.02.06qSurgery (11)11.02.06q11.02.069eccdc4b-79a3-4f95-8e04-651c93549127Catheter Ablation of Cardiac ArrhythmiasCatheter Ablation of Cardiac Arrhythmias
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5565Cemiplimab-rwlc(Libtayo®)08.01.66cPharmacy (08)08.01.66c08.01.66b06a7d38-c9e9-4610-916b-190365fe9fd8Cemiplimab-rwlc (Libtayo®)Cemiplimab-rwlc (Libtayo®)
c81b22ec-3ec7-4a91-85c1-70af8b7cf771.aspx
  
5344Cerliponasealfa(Brineura®)08.01.39cPharmacy (08)08.01.39c08.01.39c81b22ec-3ec7-4a91-85c1-70af8b7cf771Cerliponase alfa (Brineura®)Cerliponase alfa (Brineura®)
aff2b094-ca8b-410b-96e4-4a9c0c4fecbb.aspx
  
5183CervicalTractionDevicesforIn-homeUse05.00.61gDME (05)05.00.61g05.00.61aff2b094-ca8b-410b-96e4-4a9c0c4fecbbCervical Traction Devices for In-home UseCervical Traction Devices for In-home Use
2ba8dd03-1332-463a-bd4a-f6ad3e32ef5f.aspx
  
6170Cetuximab(Erbitux®)08.00.67oPharmacy (08)08.00.67o08.00.672ba8dd03-1332-463a-bd4a-f6ad3e32ef5fCetuximab (Erbitux®)Cetuximab (Erbitux®)
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5902ChemicalPeels11.08.08hSurgery (11)11.08.08h11.08.088aaecd67-1a97-4dba-8260-5b9df700036eChemical PeelsChemical Peels
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6567ChimericAntigenReceptor(CAR)Therapy08.01.43mPharmacy (08)08.01.43m08.01.43e04e6e00-4fcc-47f9-9eb4-a878ce14652dChimeric Antigen Receptor (CAR) TherapyChimeric Antigen Receptor (CAR) Therapy
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6544ChiropracticSpinalandExtraspinalManipulationTherapy10.02.02kRehabilitation Services (10)10.02.02k10.02.0203a1b92b-198a-466f-bdfb-61c4b8506e4dChiropractic Spinal and Extraspinal Manipulation TherapyChiropractic Spinal and Extraspinal Manipulation Therapy
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6081CoagulationFactors08.00.92agPharmacy (08)08.00.92ag08.00.92c40f3d9d-b80c-4073-a7b3-75b07f1d2132Coagulation FactorsCoagulation Factors
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6603Cobalamin(VitaminB12),FolicAcid,andHomocysteineTesting06.02.54cPathology and Laboratory (06)06.02.54c06.02.546b7ebced-bcd0-4114-8045-d3344f571457Cobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingCobalamin (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"},}
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6337CochlearImplantation11.01.02rSurgery (11)11.01.02r11.01.0285d7a94a-d5ad-4974-87f1-423bc92c9205Cochlear ImplantationCochlear Implantation
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6151Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)08.01.71Pharmacy (08)08.01.7108.01.71180e2231-db77-429e-a2a2-26e6b1665e64Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
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6651ColorectalCancerScreening11.03.12uSurgery (11)11.03.12u11.03.1207e946c3-ede9-491b-a58b-e8bd704ca61dColorectal Cancer ScreeningColorectal Cancer Screening
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6411ComplementaryandIntegrativeHealthServices12.00.03hMiscellaneous (12)12.00.03h12.00.03ba170083-35f9-4f1e-9e58-e68b05aa307aComplementary and Integrative Health ServicesComplementary and Integrative Health Services
2a646409-8ef0-4f1d-a82f-b8255abe7637.aspx
  
6648CompleteDecongestiveTherapy(CDT)07.06.01bMedicine (07)07.06.01b07.06.012a646409-8ef0-4f1d-a82f-b8255abe7637Complete Decongestive Therapy (CDT)Complete Decongestive Therapy (CDT)
9af50738-b876-485d-a1aa-ce59f7bc63bc.aspx
  
6250CompositeTissueAllotransplantationoftheHand(s)andFace11.14.30Surgery (11)11.14.3011.14.309af50738-b876-485d-a1aa-ce59f7bc63bcComposite Tissue Allotransplantation of the Hand(s) and FaceComposite Tissue Allotransplantation of the Hand(s) and Face
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6129CompressionGarments05.00.37iDME (05)05.00.37i05.00.37d26e483d-d440-4d8e-86ac-4bfd25e128d1Compression GarmentsCompression Garments
b9742429-a8a1-4644-8b1c-2d8a9c69cbbb.aspx
  
5106Computer-AidedDetection(CAD)SystemforUsewithChestRadiographs09.00.42cRadiology (09)09.00.42c09.00.42b9742429-a8a1-4644-8b1c-2d8a9c69cbbbComputer-Aided Detection (CAD) System for Use with Chest RadiographsComputer-Aided Detection (CAD) System for Use with Chest Radiographs
74e08be5-b94f-4be4-a25b-b91380825a8e.aspx
  
6178Computer-assistedMusculoskeletalSurgicalNavigationalOrthopedicProcedure11.14.17eSurgery (11)11.14.17e11.14.1774e08be5-b94f-4be4-a25b-b91380825a8eComputer-assisted Musculoskeletal Surgical Navigational Orthopedic ProcedureComputer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
1fc8159e-2b1f-42e2-975e-fe9ef1aae41b.aspx
  
6418ConsultationServices00.01.69bAdministrative (00)00.01.69b00.01.691fc8159e-2b1f-42e2-975e-fe9ef1aae41bConsultation ServicesConsultation Services
d6d7e319-5af2-4f69-8fc0-7a90f8d7d80b.aspx
  
6643ContactLensesfortheTreatmentofPersistent(Corneal)EpithelialDefects07.13.11kMedicine (07)07.13.11k07.13.11d6d7e319-5af2-4f69-8fc0-7a90f8d7d80bContact Lenses for the Treatment of Persistent (Corneal) Epithelial DefectsContact 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"},}
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5138ContrastAgentsUsedinConjunctionwithEchocardiography09.00.11eRadiology (09)09.00.11e09.00.1112ca4dc2-6f5b-4375-a86a-975789fb3469Contrast Agents Used in Conjunction with EchocardiographyContrast Agents Used in Conjunction with Echocardiography
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6525CornealPachymetryUsingUltrasound07.13.07lMedicine (07)07.13.07l07.13.07a1f7886c-2785-4dc7-bfaf-eb44b5577a4dCorneal Pachymetry Using UltrasoundCorneal Pachymetry Using Ultrasound
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6304CoronaryArteryCalcium(CAC)TestingUsingComputedTomography(AmeriHealthAdministrators)09.00.58Radiology (09)09.00.5809.00.5895fe317c-cc2c-4f35-be30-a227f8fcb371Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators)Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators)
a0296243-13b3-4c16-8081-8892cb295c25.aspx
  
6160CosmeticProcedures12.01.03bMiscellaneous (12)12.01.03b12.01.03a0296243-13b3-4c16-8081-8892cb295c25Cosmetic ProceduresCosmetic Procedures
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6542CoverageofAnticancerPrescriptionOralandInjectableDrugsandBiologicsandSupportiveAgents08.01.08qPharmacy (08)08.01.08q08.01.0855987d2d-c837-4f40-b716-6fea2ad1eb73Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive AgentsCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents
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3720CoverageofMedicalDevices05.00.04eDME (05)05.00.04e05.00.0414669bc5-097a-4a2c-bbf0-82a2e0da5a62Coverage of Medical DevicesCoverage of Medical Devices
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6482CranialElectrotherapyStimulation05.00.80dDME (05)05.00.80d05.00.80e6fa1ee9-b65c-4dc7-8cb6-4f43c749322bCranial Electrotherapy StimulationCranial Electrotherapy Stimulation
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6122CranialRemoldingOrthoses(Helmets)05.00.25jDME (05)05.00.25j05.00.25234626c7-025c-4f8c-bbe6-a1851c93420cCranial Remolding Orthoses (Helmets)Cranial Remolding Orthoses (Helmets)
cde76797-199e-4918-9e43-897124bfa2c4.aspx
  
5034CriteriaforReimbursementofEmergencyRoomServices00.10.03kAdministrative (00)00.10.03k00.10.03cde76797-199e-4918-9e43-897124bfa2c4Criteria for Reimbursement of Emergency Room ServicesCriteria for Reimbursement of Emergency Room Services
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6439crizanlizumab-tmca(Adakveo®)08.00.04aPharmacy (08)08.00.04a08.00.04b13eb749-bcbf-4a49-9865-64e96d61b947crizanlizumab-tmca (Adakveo®)crizanlizumab-tmca (Adakveo®)
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6635CryosurgicalAblationoftheProstateGland11.11.03dSurgery (11)11.11.03d11.11.037e3fde8b-e5b5-405b-8ce0-009e29458622Cryosurgical Ablation of the Prostate GlandCryosurgical Ablation of the Prostate Gland
34c27cb0-972d-4a80-b60b-1e81b353d8e9.aspx
  
6679Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)08.01.29lPharmacy (08)08.01.29l08.01.2934c27cb0-972d-4a80-b60b-1e81b353d8e9Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)
803d7702-4e64-481a-a856-89a699b735d9.aspx
  
5378DayRehabilitation10.00.02cRehabilitation Services (10)10.00.02c10.00.02803d7702-4e64-481a-a856-89a699b735d9Day RehabilitationDay Rehabilitation
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6358DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNails11.08.17kSurgery (11)11.08.17k11.08.1719d4f8f5-e16c-4aff-9f5a-2a9d99fc69d1Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
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6053DeepBrainStimulation(DBS)11.15.20tSurgery (11)11.15.20t11.15.20794efd54-5108-453a-99b1-67dde41a8a59Deep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)
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6535Delandistrogenemoxeparvovec(delandistrogenemoxeparvovec-rokl;Elevidys®)08.02.13Pharmacy (08)08.02.1308.02.137d904f73-b379-4e91-b6f4-5b3abb3239c4Delandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®) Delandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®)
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