Commercial
Advanced Search
Type
  
Name
  
ID
  
MPDispTitle
  
Policy Category
  
MPPolicyNumber
  
MPPolicyNumberwithoutversion
  
MPPolicyPageName
  
MPTitle
  
Title
  
MPattachmentdataPub
ff54db2a-d4c9-4bc1-9852-bd476768943a.aspx
  
8200​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-LevelLaserTherapy07.00.14iMedicine (07)07.00.14i07.00.14ff54db2a-d4c9-4bc1-9852-bd476768943a​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Low-Level Laser Therapy
0cdfa197-861f-4507-8f37-a8d7b9435ffb.aspx
  
7909Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62rPharmacy (08)08.00.62r08.00.620cdfa197-861f-4507-8f37-a8d7b9435ffbAbatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use
{"7910": {"Id":7910,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":9995,"PolicyAttachmentPageName":"04494cf2-18a7-4138-a8b8-3c3bcd4092b9"},}
7de3201d-5976-4ebb-bc43-f8ec9ed61633.aspx
  
8193AblationofLungTumors11.00.16kSurgery (11)11.00.16k11.00.167de3201d-5976-4ebb-bc43-f8ec9ed61633Ablation of Lung TumorsAblation of Lung Tumors
4548e4c6-d93b-45e5-af3e-9b97720605c6.aspx
  
7257Acupuncture12.00.01iMiscellaneous (12)12.00.01i12.00.014548e4c6-d93b-45e5-af3e-9b97720605c6AcupunctureAcupuncture
{"7258": {"Id":7258,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":9445,"PolicyAttachmentPageName":"a1e3fcaf-e5fb-4838-ad8b-20dab6e12848"},}
9d5c2f34-6177-4cbe-967c-fc6c80eb5810.aspx
  
7781AcuteCareFacilityInpatientTransfers12.04.04bMiscellaneous (12)12.04.04b12.04.049d5c2f34-6177-4cbe-967c-fc6c80eb5810Acute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers
fd008533-34c4-4ed3-ba7e-e3a4ac663f0f.aspx
  
7519ADAMTS13,recombinant-krhn(Adzynma)08.02.21Pharmacy (08)08.02.2108.02.21fd008533-34c4-4ed3-ba7e-e3a4ac663f0fADAMTS13, recombinant-krhn (Adzynma)ADAMTS13, recombinant-krhn (Adzynma)
1ede2684-4822-4a03-b66b-ed1000fcf81f.aspx
  
7991Ado-TrastuzumabEmtansine(Kadcyla®)08.01.11jPharmacy (08)08.01.11j08.01.111ede2684-4822-4a03-b66b-ed1000fcf81fAdo-Trastuzumab Emtansine (Kadcyla®)Ado-Trastuzumab Emtansine (Kadcyla®)
90dfd292-8f6d-4abe-a80d-dcd2eaa00eda.aspx
  
7393Afamitresgeneautoleucel(Tecelra®)08.02.32aPharmacy (08)08.02.32a08.02.3290dfd292-8f6d-4abe-a80d-dcd2eaa00edaAfamitresgene autoleucel (Tecelra®)Afamitresgene autoleucel (Tecelra®)
2fd0b60c-7395-4259-aed9-b2c4f32434bd.aspx
  
7525Agalsidasebeta(Fabrazyme®)andpegunigalsidasealfa-iwxj(Elfabrio)08.00.69dPharmacy (08)08.00.69d08.00.692fd0b60c-7395-4259-aed9-b2c4f32434bdAgalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio) Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio)
e1ea2509-f318-4875-b48b-fc16bb7c5517.aspx
  
7879AirAmbulanceServices12.04.03dMiscellaneous (12)12.04.03d12.04.03e1ea2509-f318-4875-b48b-fc16bb7c5517Air Ambulance ServicesAir Ambulance Services
f38164fa-91fd-4e3b-a62a-4a24cdfa2a60.aspx
  
7838Alemtuzumab(Lemtrada®)08.01.22ePharmacy (08)08.01.22e08.01.22f38164fa-91fd-4e3b-a62a-4a24cdfa2a60Alemtuzumab (Lemtrada®)Alemtuzumab (Lemtrada®)
f3b39736-c0d9-4504-b477-744d3dca2576.aspx
  
8021Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)08.00.72lPharmacy (08)08.00.72l08.00.72f3b39736-c0d9-4504-b477-744d3dca2576Alglucosidase 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™ )
ae552767-8477-4e39-bb98-4ed678fb2c66.aspx
  
7943AllergyImmunotherapy07.00.21kMedicine (07)07.00.21k07.00.21ae552767-8477-4e39-bb98-4ed678fb2c66Allergy ImmunotherapyAllergy Immunotherapy
17ddf8e3-6dac-4ce9-a1db-3fdd0321bb98.aspx
  
7992AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88bPharmacy (08)08.01.88b08.01.8817ddf8e3-6dac-4ce9-a1db-3fdd0321bb98Allogeneic Processed Thymus Tissue-agdc (Rethymic®)Allogeneic Processed Thymus Tissue-agdc (Rethymic®)
587903d8-b256-4658-8e19-ae9c4dd9ac2e.aspx
  
7251AlloMap™MolecularExpressionTestingforHeartTransplantRejection(AmeriHealthAdministrators)06.02.29gPathology and Laboratory (06)06.02.29g06.02.29587903d8-b256-4658-8e19-ae9c4dd9ac2eAlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)
bb06925b-fee6-4694-b5c0-0c5f1917c0fc.aspx
  
7570Alpha-1AntitrypsinTherapy(e.g.,Prolastin-C®,AralastNP®,Glassia®,Zemaira®)08.00.91fPharmacy (08)08.00.91f08.00.91bb06925b-fee6-4694-b5c0-0c5f1917c0fcAlpha-1 Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)Alpha-1 Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)
27dc232b-fa0b-4b59-b2f4-f196d1b68930.aspx
  
7425AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09kMedicine (07)07.02.09k07.02.0927dc232b-fa0b-4b59-b2f4-f196d1b68930Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) DevicesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
35fceaf1-d266-4754-a84a-202a950d29a8.aspx
  
7441AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21rMedicine (07)07.02.21r07.02.2135fceaf1-d266-4754-a84a-202a950d29a8Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
7bba4a84-2540-42ad-9cb2-6b0bb0121fbd.aspx
  
7661Amivantamab-vmjw(Rybrevant®)08.01.90bPharmacy (08)08.01.90b08.01.907bba4a84-2540-42ad-9cb2-6b0bb0121fbdAmivantamab-vmjw (Rybrevant®)Amivantamab-vmjw (Rybrevant®)
571edab5-03a3-4723-a4a3-8ec3d6d8faef.aspx
  
7870AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12dAnesthesia (01)01.00.12d01.00.12571edab5-03a3-4723-a4a3-8ec3d6d8faefAnesthesia 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
{"7871": {"Id":7871,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9986,"PolicyAttachmentPageName":"7d4b2030-7e2b-4c8b-a672-15aa73b071c5"},}
7f07890a-073d-4740-b9c9-de0c443f5020.aspx
  
7513Anifrolumab-fnia(Saphnelo®)08.01.82cPharmacy (08)08.01.82c08.01.827f07890a-073d-4740-b9c9-de0c443f5020Anifrolumab-fnia (Saphnelo®)Anifrolumab-fnia (Saphnelo®)
966bd452-6338-41a9-92af-732491b02dc4.aspx
  
7778Ankle-Foot/Knee-Ankle-FootOrthoses05.00.39vDME (05)05.00.39v05.00.39966bd452-6338-41a9-92af-732491b02dc4Ankle-Foot/Knee-Ankle-Foot OrthosesAnkle-Foot/Knee-Ankle-Foot Orthoses
{"7779": {"Id":7779,"MPAttachmentLetter":"A","Title":"HCPCS Codes","MPPolicyAttachmentInternalSourceId":10050,"PolicyAttachmentPageName":"a9a20411-76a0-4e64-939d-66d5b2da8b70"},}
b4847e80-c125-4c84-9580-eb40608a7287.aspx
  
7626ApheresisTherapy06.03.04oPathology and Laboratory (06)06.03.04o06.03.04b4847e80-c125-4c84-9580-eb40608a7287Apheresis TherapyApheresis Therapy
67425cc3-07be-4535-8f98-aa782aed6207.aspx
  
8082Apos®biomechanicalshoesystem05.00.84DME (05)05.00.8405.00.8467425cc3-07be-4535-8f98-aa782aed6207Apos® biomechanical shoe systemApos® biomechanical shoe system
85860950-db57-4c1e-8cf0-6ce8588a2f5c.aspx
  
7800ApplicationandRemovalofTattoos11.08.05gSurgery (11)11.08.05g11.08.0585860950-db57-4c1e-8cf0-6ce8588a2f5cApplication and Removal of TattoosApplication and Removal of Tattoos
df5a4d4b-0bc7-4458-844b-0a350f6cb8b0.aspx
  
8121AppliedBehaviorAnalysis(ABA)fortheTreatmentofAutismSpectrumDisorder(ASD)14.00.03bBehavioral Health (14)14.00.03b14.00.03df5a4d4b-0bc7-4458-844b-0a350f6cb8b0Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorder (ASD)Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorder (ASD)
27d52305-5f49-4a7a-9192-b9f44905dbd6.aspx
  
7785AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucoma11.05.16mSurgery (11)11.05.16m11.05.1627d52305-5f49-4a7a-9192-b9f44905dbd6Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
{"7786": {"Id":7786,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":9964,"PolicyAttachmentPageName":"15735e06-1e8c-4776-aee0-d7ce2e3e06a9"},}
35245b24-5bf6-4802-9442-902d406c9e67.aspx
  
7479ArtificialIntervertebralCervicalDiscInsertion(AmeriHealthAdministrators)11.14.19pSurgery (11)11.14.19p11.14.1935245b24-5bf6-4802-9442-902d406c9e67Artificial Intervertebral Cervical Disc Insertion (AmeriHealth Administrators)Artificial Intervertebral Cervical Disc Insertion (AmeriHealth Administrators)
3d7e89c6-fe10-495d-9e00-e50de95402b7.aspx
  
8219AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)08.01.35kPharmacy (08)08.01.35k08.01.353d7e89c6-fe10-495d-9e00-e50de95402b7Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)
56cacc55-1d7c-498d-927b-8a69cac0aca7.aspx
  
7261AssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(AmeriHealthAdministrators)06.02.27pPathology and Laboratory (06)06.02.27p06.02.2756cacc55-1d7c-498d-927b-8a69cac0aca7Assays 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)
6f3e894a-05bc-4cd3-bdef-f6cbc845ef41.aspx
  
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
992f3189-6d0f-4926-9bac-58206601cacc.aspx
  
7701Atezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybreza™)08.01.69fPharmacy (08)08.01.69f08.01.69992f3189-6d0f-4926-9bac-58206601caccAtezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™)Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™)
2b1b1765-a231-4988-a244-9ccb24ccbfcf.aspx
  
7534Atidarsageneautotemcel(Lenmeldy)08.02.24Pharmacy (08)08.02.2408.02.242b1b1765-a231-4988-a244-9ccb24ccbfcfAtidarsagene autotemcel (Lenmeldy)Atidarsagene autotemcel (Lenmeldy)
7286f746-1a47-421e-9e13-f0f434661f6e.aspx
  
7712AuricularProstheses05.00.82DME (05)05.00.8205.00.827286f746-1a47-421e-9e13-f0f434661f6eAuricular ProsthesesAuricular Prostheses
6ad85a47-647a-42a9-8246-484c14154169.aspx
  
7408AutologousChondrocyteImplantation(ACI)andOtherCell-basedTreatmentsofFocalArticularCartilageLesions(AmerihealthAdministrators)11.14.06jSurgery (11)11.14.06j11.14.066ad85a47-647a-42a9-8246-484c14154169Autologous 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)
b070d704-cac3-4d95-a688-af44923ad4c7.aspx
  
7358AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29oDME (05)05.00.29o05.00.29b070d704-cac3-4d95-a688-af44923ad4c7Automatic 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"},}
df03f3d3-755f-4e0b-8d07-5d54fefad0bb.aspx
  
7550AutonomicNervousSystemTesting07.03.23hMedicine (07)07.03.23h07.03.23df03f3d3-755f-4e0b-8d07-5d54fefad0bbAutonomic Nervous System TestingAutonomic Nervous System Testing
2424724c-1f94-42dd-ad72-c1bf210b7b93.aspx
  
8113Avelumab(Bavencio®)08.01.64ePharmacy (08)08.01.64e08.01.642424724c-1f94-42dd-ad72-c1bf210b7b93Avelumab (Bavencio®)Avelumab (Bavencio®)
bba13c5b-9170-4d2b-b794-c72911843dde.aspx
  
7669Axatilimab-csfr(Niktimvo™)forIntravenousUse08.02.34Pharmacy (08)08.02.3408.02.34bba13c5b-9170-4d2b-b794-c72911843ddeAxatilimab-csfr (Niktimvo™) for Intravenous UseAxatilimab-csfr (Niktimvo™) for Intravenous Use
9999fe02-c4cf-48bc-82cc-4ce3045f0ad8.aspx
  
7335BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisorRecurrentAcuteRhinosinusitis11.16.06kSurgery (11)11.16.06k11.16.069999fe02-c4cf-48bc-82cc-4ce3045f0ad8Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute RhinosinusitisBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis
f6f49074-f8b9-4452-ac18-a5b47dc32eec.aspx
  
8194BariatricSurgery11.03.02wSurgery (11)11.03.02w11.03.02f6f49074-f8b9-4452-ac18-a5b47dc32eecBariatric SurgeryBariatric Surgery
{"8195": {"Id":8195,"MPAttachmentLetter":"A","Title":"Body Mass Index (BMI) Charts","MPPolicyAttachmentInternalSourceId":10223,"PolicyAttachmentPageName":"df5a6631-342b-4fab-af74-6077f867f445"},"8196": {"Id":8196,"MPAttachmentLetter":"B","Title":"Tanner Staging System Criteria for Adolescents","MPPolicyAttachmentInternalSourceId":10224,"PolicyAttachmentPageName":"f5413920-a1f5-47ab-b09b-58b9fc567c19"},}
b2ee0b0f-5fe4-4e5e-8728-9b6ea3d508dd.aspx
  
7531Belimumab(Benlysta®)forIntravenousUse08.00.99ePharmacy (08)08.00.99e08.00.99b2ee0b0f-5fe4-4e5e-8728-9b6ea3d508ddBelimumab (Benlysta®) for Intravenous UseBelimumab (Benlysta®) for Intravenous Use
e4dc72b0-021c-45ca-8da8-946b4b5692fc.aspx
  
8095BeremageneGeperpavec(Vyjuvek™)08.02.10bPharmacy (08)08.02.10b08.02.10e4dc72b0-021c-45ca-8da8-946b4b5692fcBeremagene Geperpavec (Vyjuvek™)Beremagene Geperpavec (Vyjuvek™)
fc30b8b9-db7c-4141-a327-57e532d8259c.aspx
  
7518BetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89aPharmacy (08)08.01.89a08.01.89fc30b8b9-db7c-4141-a327-57e532d8259cBetibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]
1aea00b8-e8c1-4f57-850f-5b6915c1a76a.aspx
  
8030Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66wPharmacy (08)08.00.66w08.00.661aea00b8-e8c1-4f57-850f-5b6915c1a76aBevacizumab (Avastin®) and Related Biosimilars For Oncologic UseBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
{"8031": {"Id":8031,"MPAttachmentLetter":"A","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":10175,"PolicyAttachmentPageName":"34cf189a-9982-4718-891c-e73656f1ff0a"},}
9c766e44-e195-4f55-8f8a-df1e202967cc.aspx
  
8233BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39rAdministrative (00)00.10.39r00.10.399c766e44-e195-4f55-8f8a-df1e202967ccBilling 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
{"8234": {"Id":8234,"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":10318,"PolicyAttachmentPageName":"7100a278-181d-40b1-88e4-0cf1d3e576d0"},}
9be43eff-6b64-4e0b-a426-ef73f2537ec3.aspx
  
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"},}
f73f4ca0-79b2-4c0e-879a-389b1145f640.aspx
  
7229BiofeedbackTherapy07.00.01nMedicine (07)07.00.01n07.00.01f73f4ca0-79b2-4c0e-879a-389b1145f640Biofeedback TherapyBiofeedback Therapy
53dd50f9-76e1-4658-9cb7-47d83a8f3a09.aspx
  
8006BioimpedancefortheDetectionofLymphedema07.06.03cMedicine (07)07.06.03c07.06.0353dd50f9-76e1-4658-9cb7-47d83a8f3a09Bioimpedance for the Detection of LymphedemaBioimpedance for the Detection of Lymphedema
7177f741-41cb-4ce0-851b-6c9601b97a5c.aspx
  
7944Blinatumomab(Blincyto®)08.01.21hPharmacy (08)08.01.21h08.01.217177f741-41cb-4ce0-851b-6c9601b97a5cBlinatumomab (Blincyto®)Blinatumomab (Blincyto®)
b4550d74-0194-432a-85a8-2722d5d50595.aspx
  
7572Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAids11.01.06jSurgery (11)11.01.06j11.01.06b4550d74-0194-432a-85a8-2722d5d50595Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
bac92077-945c-4085-ac85-67db90995184.aspx
  
7719BoneMineralDensity(BMD)Testing09.00.04oRadiology (09)09.00.04o09.00.04bac92077-945c-4085-ac85-67db90995184Bone Mineral Density (BMD) TestingBone Mineral Density (BMD) Testing
cfa61371-54dc-46c2-8906-306bcd492f8c.aspx
  
8016BotulinumToxinAgents08.00.26aePharmacy (08)08.00.26ae08.00.26cfa61371-54dc-46c2-8906-306bcd492f8cBotulinum Toxin AgentsBotulinum Toxin Agents
{"8017": {"Id":8017,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":9954,"PolicyAttachmentPageName":"dbc81970-0297-44d2-8050-066edb615a5c"},}
b199e787-e2c4-49cc-9a14-ba0e3251fce1.aspx
  
8162BrachytherapyandAcceleratedWholeBreastIrradiationusingThree-DimensionalConformationRadiationTherapy09.00.10aaRadiology (09)09.00.10aa09.00.10b199e787-e2c4-49cc-9a14-ba0e3251fce1Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation TherapyBrachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy
e70095f6-c867-4c3b-9f96-707c3d28eb89.aspx
  
7745BreastPumps05.00.76iDME (05)05.00.76i05.00.76e70095f6-c867-4c3b-9f96-707c3d28eb89Breast PumpsBreast Pumps
1009c2d5-c204-493e-add9-09b73e59a058.aspx
  
7949BrentuximabVedotin(Adcetris®)08.01.13lPharmacy (08)08.01.13l08.01.131009c2d5-c204-493e-add9-09b73e59a058Brentuximab Vedotin (Adcetris®)Brentuximab Vedotin (Adcetris®)
74655048-5c3b-4911-803c-fc91117b568f.aspx
  
7245BronchialValves11.16.09Surgery (11)11.16.0911.16.0974655048-5c3b-4911-803c-fc91117b568fBronchial ValvesBronchial Valves
5c7664e8-beec-499d-bb46-36274a82dfe6.aspx
  
8241BundledProcedureCodes00.01.52zAdministrative (00)00.01.52z00.01.525c7664e8-beec-499d-bb46-36274a82dfe6Bundled Procedure CodesBundled Procedure Codes
{"8242": {"Id":8242,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":10320,"PolicyAttachmentPageName":"0c7dcad9-4ce9-4615-a629-282b7d8b98e8"},"8243": {"Id":8243,"MPAttachmentLetter":"A","Title":"Always Bundled and Bundled Procedures/Services (MPFSDB Indicators B and T)","MPPolicyAttachmentInternalSourceId":10321,"PolicyAttachmentPageName":"d0eb0a19-5173-468a-afc3-0eccfa38f606"},"8244": {"Id":8244,"MPAttachmentLetter":"D","Title":"Procedures/Services Not Eligible for Separate Reimbursement​ when reported with another specific Procedure/Service​","MPPolicyAttachmentInternalSourceId":10322,"PolicyAttachmentPageName":"c5836cc1-d032-4714-baf5-5d9d72a65fbf"},"8245": {"Id":8245,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":10323,"PolicyAttachmentPageName":"5c47117c-27b4-4693-aa60-f5c64c95a380"},}
90bde7e8-8725-49ce-b0b6-0d9746fc6827.aspx
  
7522Burosumab-twza(Crysvita®)08.01.49bPharmacy (08)08.01.49b08.01.4990bde7e8-8725-49ce-b0b6-0d9746fc6827Burosumab-twza (Crysvita®)Burosumab-twza (Crysvita®)
f256b980-3aff-428f-bc76-77eb472ed635.aspx
  
7510Canakinumab(Ilaris®)08.01.51cPharmacy (08)08.01.51c08.01.51f256b980-3aff-428f-bc76-77eb472ed635Canakinumab (Ilaris®)Canakinumab (Ilaris®)
{"7511": {"Id":7511,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9689,"PolicyAttachmentPageName":"afa88eed-46ec-4c67-a37f-4e048ec24c30"},}
1b9d1d59-b7c0-4838-8a17-2a18cc6c02e8.aspx
  
7230CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)Programs10.01.01rRehabilitation Services (10)10.01.01r10.01.011b9d1d59-b7c0-4838-8a17-2a18cc6c02e8Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsCardiac 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"},}
3b542224-8db8-4cad-84ea-ee0cb5482fa6.aspx
  
8239CareManagementandCarePlanningServices00.01.59pAdministrative (00)00.01.59p00.01.593b542224-8db8-4cad-84ea-ee0cb5482fa6Care Management and Care Planning ServicesCare Management and Care Planning Services
b6aef6df-ce54-40c9-8e78-94170c6dc59f.aspx
  
8004Carfilzomib(Kyprolis®)08.01.05mPharmacy (08)08.01.05m08.01.05b6aef6df-ce54-40c9-8e78-94170c6dc59fCarfilzomib (Kyprolis®)Carfilzomib (Kyprolis®)
08d5f01a-d563-4098-8e5d-3e4d7ee7c9a9.aspx
  
8104Casgevy™(exagamglogeneautotemcel)08.02.14aPharmacy (08)08.02.14a08.02.1408d5f01a-d563-4098-8e5d-3e4d7ee7c9a9Casgevy™ (exagamglogene autotemcel)Casgevy™ (exagamglogene autotemcel)
ff41fdec-319e-4608-be2d-eee15f3bec86.aspx
  
6738CastandSplintApplicationsandAssociatedSupplies00.10.15dAdministrative (00)00.10.15d00.10.15ff41fdec-319e-4608-be2d-eee15f3bec86Cast and Splint Applications and Associated SuppliesCast 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"},}
ef470463-d7eb-4225-aaa6-f0136325ce07.aspx
  
8077CataractSurgery11.01.07gSurgery (11)11.01.07g11.01.07ef470463-d7eb-4225-aaa6-f0136325ce07Cataract SurgeryCataract Surgery
{"8078": {"Id":8078,"MPAttachmentLetter":"A","Title":"ICD 10 codes for Cataract Surgery","MPPolicyAttachmentInternalSourceId":10188,"PolicyAttachmentPageName":"72967ae3-98fe-4915-8ef3-759719d4d65a"},}
72cd4f96-5b86-45c5-8b67-1fafdab6c096.aspx
  
7718CatheterAblationofCardiacArrhythmias11.02.06rSurgery (11)11.02.06r11.02.0672cd4f96-5b86-45c5-8b67-1fafdab6c096Catheter Ablation of Cardiac ArrhythmiasCatheter Ablation of Cardiac Arrhythmias
11d7da82-48d4-4e14-8cc6-7c28d229e130.aspx
  
8141Cemiplimab-rwlc(Libtayo®)08.01.66ePharmacy (08)08.01.66e08.01.6611d7da82-48d4-4e14-8cc6-7c28d229e130Cemiplimab-rwlc (Libtayo®)Cemiplimab-rwlc (Libtayo®)
90b30eda-a568-415f-bb16-b6b07bb92be1.aspx
  
8084Cerliponasealfa(Brineura®)08.01.39dPharmacy (08)08.01.39d08.01.3990b30eda-a568-415f-bb16-b6b07bb92be1Cerliponase alfa (Brineura®)Cerliponase alfa (Brineura®)
{"8085": {"Id":8085,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Cerliponase alfa (Brineura®)","MPPolicyAttachmentInternalSourceId":10163,"PolicyAttachmentPageName":"6ba2a414-3aa7-4d52-8180-cb44354bd4c1"},}
b9ddf003-4f8f-42e7-9fc6-76de1f37b76d.aspx
  
8083CervicalTractionDevicesforIn-homeUse05.00.61hDME (05)05.00.61h05.00.61b9ddf003-4f8f-42e7-9fc6-76de1f37b76dCervical Traction Devices for In-home UseCervical Traction Devices for In-home Use
e1ea1dc2-be97-47c4-82b3-2c44d2cbd6fc.aspx
  
7954Cetuximab(Erbitux®)08.00.67oPharmacy (08)08.00.67o08.00.67e1ea1dc2-be97-47c4-82b3-2c44d2cbd6fcCetuximab (Erbitux®)Cetuximab (Erbitux®)
{"7955": {"Id":7955,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":9909,"PolicyAttachmentPageName":"83817ed0-6e11-4d2e-af6f-cbc52c32c165"},"7956": {"Id":7956,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":9910,"PolicyAttachmentPageName":"1409a241-43f7-4201-a484-e1757f6b915e"},}
c3e66bb7-46d6-4df2-8e22-2af7f0d7035f.aspx
  
8065ChemicalPeels11.08.08hSurgery (11)11.08.08h11.08.08c3e66bb7-46d6-4df2-8e22-2af7f0d7035fChemical PeelsChemical Peels
d66f88f5-09aa-45c4-9442-23d8d42fd20d.aspx
  
7236ChimericAntigenReceptor(CAR)Therapy08.01.43pPharmacy (08)08.01.43p08.01.43d66f88f5-09aa-45c4-9442-23d8d42fd20dChimeric Antigen Receptor (CAR) TherapyChimeric Antigen Receptor (CAR) Therapy
a61acc7b-d9b3-46f0-a7bc-ad7ac57c0075.aspx
  
7689ChiropracticSpinalandExtraspinalManipulationTherapy10.02.02kRehabilitation Services (10)10.02.02k10.02.02a61acc7b-d9b3-46f0-a7bc-ad7ac57c0075Chiropractic Spinal and Extraspinal Manipulation TherapyChiropractic Spinal and Extraspinal Manipulation Therapy
bd646084-b825-424c-893e-93c594321e15.aspx
  
8203CoagulationFactors08.00.92akPharmacy (08)08.00.92ak08.00.92bd646084-b825-424c-893e-93c594321e15Coagulation FactorsCoagulation Factors
53adf5d8-86bb-4c20-9ace-bfa03628c82e.aspx
  
8105Cobalamin(VitaminB12),FolicAcid,andHomocysteineTesting06.02.54dPathology and Laboratory (06)06.02.54d06.02.5453adf5d8-86bb-4c20-9ace-bfa03628c82eCobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
{"8106": {"Id":8106,"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":10212,"PolicyAttachmentPageName":"ec2c2d38-1ed4-491f-a1c8-f55d1a5b7892"},}
4a4a8e41-7be2-4291-8d12-3b5b1577ef57.aspx
  
7725CochlearImplantation11.01.02sSurgery (11)11.01.02s11.01.024a4a8e41-7be2-4291-8d12-3b5b1577ef57Cochlear ImplantationCochlear Implantation
757a5c90-a2ba-46a4-8874-38c9ccf90021.aspx
  
7529Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)08.01.71Pharmacy (08)08.01.7108.01.71757a5c90-a2ba-46a4-8874-38c9ccf90021Collagenase clostridium histolyticum (Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)Collagenase clostridium histolyticum (Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
7129422f-5e96-42a8-bca2-bbfca91f1053.aspx
  
7573ColorectalCancerScreening11.03.12vSurgery (11)11.03.12v11.03.127129422f-5e96-42a8-bca2-bbfca91f1053Colorectal Cancer ScreeningColorectal Cancer Screening
ba170083-35f9-4f1e-9e58-e68b05aa307a.aspx
  
6411ComplementaryandIntegrativeHealthServices12.00.03hMiscellaneous (12)12.00.03h12.00.03ba170083-35f9-4f1e-9e58-e68b05aa307aComplementary and Integrative Health ServicesComplementary and Integrative Health Services
ac863e9b-e227-4276-a9bc-1969996c53ab.aspx
  
7681CompositeTissueAllotransplantationoftheHand(s)andFace11.14.30Surgery (11)11.14.3011.14.30ac863e9b-e227-4276-a9bc-1969996c53abComposite Tissue Allotransplantation of the Hand(s) and FaceComposite Tissue Allotransplantation of the Hand(s) and Face
fa0fc9af-6ebc-47d0-b5d5-663df7a7d554.aspx
  
7394CompressionGarments05.00.37jDME (05)05.00.37j05.00.37fa0fc9af-6ebc-47d0-b5d5-663df7a7d554Compression GarmentsCompression Garments
b1fa1dff-ec77-46cc-82ba-6cbc54778492.aspx
  
7959Computer-AidedDetection(CAD)SystemforUsewithChestRadiographs09.00.42dRadiology (09)09.00.42d09.00.42b1fa1dff-ec77-46cc-82ba-6cbc54778492Computer-Aided Detection (CAD) System for Use with Chest RadiographsComputer-Aided Detection (CAD) System for Use with Chest Radiographs
88b02a21-f437-48f0-9e6e-3fbd5d859180.aspx
  
7624Computer-assistedMusculoskeletalSurgicalNavigationalOrthopedicProcedure11.14.17eSurgery (11)11.14.17e11.14.1788b02a21-f437-48f0-9e6e-3fbd5d859180Computer-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
dca4af06-9e87-4c02-85b8-c4538b873975.aspx
  
8070ContactLensesfortheTreatmentofPersistent(Corneal)EpithelialDefects07.13.11kMedicine (07)07.13.11k07.13.11dca4af06-9e87-4c02-85b8-c4538b873975Contact Lenses for the Treatment of Persistent (Corneal) Epithelial DefectsContact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
{"8071": {"Id":8071,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":10160,"PolicyAttachmentPageName":"aed30e55-83dc-4747-9f3c-fa881b5f4fab"},}
c5fd2062-89b8-4c22-a99b-47e4398d8af6.aspx
  
7259ContrastAgentsUsedinConjunctionwithEchocardiography09.00.11eRadiology (09)09.00.11e09.00.11c5fd2062-89b8-4c22-a99b-47e4398d8af6Contrast Agents Used in Conjunction with EchocardiographyContrast Agents Used in Conjunction with Echocardiography
4db2bfde-0860-4406-bcd3-e3dabdf21d02.aspx
  
7859CornealPachymetryUsingUltrasound07.13.07mMedicine (07)07.13.07m07.13.074db2bfde-0860-4406-bcd3-e3dabdf21d02Corneal Pachymetry Using UltrasoundCorneal Pachymetry Using Ultrasound
{"7860": {"Id":7860,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":9933,"PolicyAttachmentPageName":"f7b9d42c-b23a-47bb-a26c-a889cde6af69"},}
534ecc67-d1e0-45be-b1ca-a5d9b61f83de.aspx
  
7803CoronaryArteryCalcium(CAC)TestingUsingComputedTomography(AmeriHealthAdministrators)09.00.58aRadiology (09)09.00.58a09.00.58534ecc67-d1e0-45be-b1ca-a5d9b61f83deCoronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators)Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators)
5498c2c4-4ab8-419d-8a2e-60f4813a9f0a.aspx
  
7672Cosibelimab-ipdl(Unloxcyt™)08.02.40Pharmacy (08)08.02.4008.02.405498c2c4-4ab8-419d-8a2e-60f4813a9f0aCosibelimab-ipdl (Unloxcyt™)Cosibelimab-ipdl (Unloxcyt™)
1b0c4dbc-22e1-4cf2-a8bd-43a74b3675fb.aspx
  
7171CosmeticProcedures12.01.03bMiscellaneous (12)12.01.03b12.01.031b0c4dbc-22e1-4cf2-a8bd-43a74b3675fbCosmetic ProceduresCosmetic Procedures
901403c5-1f07-40cf-8a9b-91b77219cd04.aspx
  
8254CoverageofAnticancerPrescriptionOralandInjectableDrugsandBiologicsandSupportiveAgents08.01.08vPharmacy (08)08.01.08v08.01.08901403c5-1f07-40cf-8a9b-91b77219cd04Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive AgentsCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents
{}
21580a78-eec4-4b84-a973-1315467a0db9.aspx
  
6936CoverageofMedicalDevices05.00.04eDME (05)05.00.04e05.00.0421580a78-eec4-4b84-a973-1315467a0db9Coverage of Medical DevicesCoverage of Medical Devices
d49f3a0d-b1b8-4bfc-a38f-820b6574df5e.aspx
  
8091CranialElectrotherapyStimulation05.00.80dDME (05)05.00.80d05.00.80d49f3a0d-b1b8-4bfc-a38f-820b6574df5eCranial Electrotherapy StimulationCranial Electrotherapy Stimulation
d701f3a5-de15-47bd-857c-9d53e7f8b51f.aspx
  
7742CranialRemoldingOrthoses(Helmets)05.00.25kDME (05)05.00.25k05.00.25d701f3a5-de15-47bd-857c-9d53e7f8b51fCranial Remolding Orthoses (Helmets)Cranial Remolding Orthoses (Helmets)
218e477c-e785-44d2-b69d-cce973f7e4c8.aspx
  
7666crizanlizumab-tmca(Adakveo®)08.00.04bPharmacy (08)08.00.04b08.00.04218e477c-e785-44d2-b69d-cce973f7e4c8crizanlizumab-tmca (Adakveo®)crizanlizumab-tmca (Adakveo®)
1279e64b-5553-4dd7-aba9-1b5050638555.aspx
  
7491Crovalimab-akkz(Piasky)08.02.31Pharmacy (08)08.02.3108.02.311279e64b-5553-4dd7-aba9-1b5050638555Crovalimab-akkz (Piasky)Crovalimab-akkz (Piasky)
dbc8ae22-ad7a-483f-8a0b-c6d0c833dd11.aspx
  
7375CryosurgicalAblationoftheProstateGland11.11.03dSurgery (11)11.11.03d11.11.03dbc8ae22-ad7a-483f-8a0b-c6d0c833dd11Cryosurgical Ablation of the Prostate GlandCryosurgical Ablation of the Prostate Gland
4cdc8ed3-6af8-4e8f-8cb6-e5420b00b644.aspx
  
7737Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)08.01.29mPharmacy (08)08.01.29m08.01.294cdc8ed3-6af8-4e8f-8cb6-e5420b00b644Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)
b610e117-80b5-45db-8f5a-c3ce712c6f55.aspx
  
7979Datopotamabderuxtecan(Datroway®)08.02.41Pharmacy (08)08.02.4108.02.41b610e117-80b5-45db-8f5a-c3ce712c6f55Datopotamab deruxtecan (Datroway®)Datopotamab deruxtecan (Datroway®)
1 - 100Next