| | | 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 | |
| | | 5626 | Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62p | Pharmacy (08) | 08.00.62p | 08.00.62 | 3f223e2e-8b21-479a-bb77-5c350f2780f1 | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"5627": {"Id":5627,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7512,"PolicyAttachmentPageName":"49fc5dbf-d8fb-4372-874b-0d7bf976dcf2"},} |
| | | 6157 | Acupuncture12.00.01h | Miscellaneous (12) | 12.00.01h | 12.00.01 | 51b33f90-efbb-44ea-81f0-df77ba8b4765 | Acupuncture | Acupuncture | {"6158": {"Id":6158,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":8417,"PolicyAttachmentPageName":"9152bc08-603b-4aac-896d-7e466c32a8dc"},} |
| | | 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"},} |
| | | 5163 | Agalsidasebeta(Fabrazyme®)08.00.69c | Pharmacy (08) | 08.00.69c | 08.00.69 | b8b27d69-62ab-4921-9ae8-f074ee40c9dc | Agalsidase beta (Fabrazyme®) | Agalsidase beta (Fabrazyme®) | |
| | | 6522 | AirAmbulanceServices12.04.03c | Miscellaneous (12) | 12.04.03c | 12.04.03 | 0c439ba9-9ae5-469b-9a3d-6b3059dd86ad | Air Ambulance Services | Air Ambulance Services | |
| | | 6313 | Alemtuzumab(Lemtrada®)08.01.22d | Pharmacy (08) | 08.01.22d | 08.01.22 | 286fe526-ea7a-4849-be6c-90970e43a269 | 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 | |
| | | 6175 | AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88 | Pharmacy (08) | 08.01.88 | 08.01.88 | 7b6b45cc-a602-418b-80f7-d0d8796981ec | Allogeneic Processed Thymus Tissue-agdc (Rethymic®) | Allogeneic Processed Thymus Tissue-agdc (Rethymic®) | |
| | | 6154 | AlloMap™MolecularExpressionTestingforHeartTransplantRejection(AmeriHealthAdministrators)06.02.29d | Pathology and Laboratory (06) | 06.02.29d | 06.02.29 | 8e33c660-965c-4bdc-a6fd-f2d0999aac45 | 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®) | |
| | | 6588 | AlwaysBundledProcedureCodes00.01.52v | Administrative (00) | 00.01.52v | 00.01.52 | 5348681e-acf9-41ba-a903-9daf3cb3fcd7 | Always Bundled Procedure Codes | Always Bundled Procedure Codes | {"6589": {"Id":6589,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":8882,"PolicyAttachmentPageName":"ea46ce9b-948a-45e6-ac85-3be27203bf83"},"6590": {"Id":6590,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (Indicator B)","MPPolicyAttachmentInternalSourceId":8883,"PolicyAttachmentPageName":"02b4d060-30c7-45c1-a97b-71398831bc65"},"6591": {"Id":6591,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":8884,"PolicyAttachmentPageName":"821041cf-e71b-4d6e-b47f-52d628094870"},} |
| | | 6179 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09i | Medicine (07) | 07.02.09i | 07.02.09 | 4242bfce-640e-453e-9bf6-966b0382a8af | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | |
| | | 6213 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21p | Medicine (07) | 07.02.21p | 07.02.21 | d66f84ac-393e-421b-8ff5-e019a4e143ab | 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®) | |
| | | 6474 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12b | Anesthesia (01) | 01.00.12b | 01.00.12 | ca8760ac-cc70-4b9b-a52a-08223726910b | 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 | {"6475": {"Id":6475,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":8709,"PolicyAttachmentPageName":"dc1a176f-a1bc-4450-b3cc-a2fbcc2b5c4e"},} |
| | | 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®) | |
| | | 6260 | Ankle-Foot/Knee-Ankle-FootOrthoses05.00.39u | DME (05) | 05.00.39u | 05.00.39 | f06f0d8e-9656-427c-a18a-4e290d8ca5f1 | Ankle-Foot/Knee-Ankle-Foot Orthoses | Ankle-Foot/Knee-Ankle-Foot Orthoses | {"6261": {"Id":6261,"MPAttachmentLetter":"A","Title":"HCPCS Codes","MPPolicyAttachmentInternalSourceId":8450,"PolicyAttachmentPageName":"3f67a3e8-aa0d-4b25-b163-ae0dc66386bb"},} |
| | | 5901 | ApheresisTherapy06.03.04n | Pathology and Laboratory (06) | 06.03.04n | 06.03.04 | 0d151aaf-53f7-4fc0-a0dc-540b0ed277a6 | Apheresis Therapy | Apheresis Therapy | |
| | | 5963 | Apos®biomechanicalshoesystem05.00.84 | DME (05) | 05.00.84 | 05.00.84 | ba410497-dc76-45a7-86d1-89fdcb6cc851 | 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"},} |
| | | 5311 | ArtificialIntervertebralCervicalDiscInsertion(AmerihealthAdministrators)11.14.19p | Surgery (11) | 11.14.19p | 11.14.19 | bc52c9e0-2f80-4074-92f6-4627d2247b46 | Artificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators) | Artificial Intervertebral Cervical Disc Insertion (Amerihealth Administrators) | |
| | | 5808 | ArtificialIntervertebralLumbarDiscInsertion11.15.31b | Surgery (11) | 11.15.31b | 11.15.31 | 14c6546f-9145-49d6-a22b-44f85ab32431 | Artificial Intervertebral Lumbar Disc Insertion | Artificial Intervertebral Lumbar Disc Insertion | |
| | | 5453 | AsparaginaseErwiniaChrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze®)08.01.35g | Pharmacy (08) | 08.01.35g | 08.01.35 | 45eea1e5-d113-4c3c-a874-49b1e3d094b0 | Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®) | Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®) | |
| | | 5557 | AssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(AmeriHealthAdministrators)06.02.27n | Pathology and Laboratory (06) | 06.02.27n | 06.02.27 | 9df36788-e9f1-4d47-a9c2-21f112f4b6b4 | 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 | |
| | | 5120 | Atezolizumab(Tecentriq®)08.01.69c | Pharmacy (08) | 08.01.69c | 08.01.69 | 3692eb86-55ea-4cdd-a607-efd8374b8545 | Atezolizumab (Tecentriq®) | Atezolizumab (Tecentriq®) | {"5121": {"Id":5121,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7179,"PolicyAttachmentPageName":"d42f2057-342f-4f9c-848b-430f95990f97"},} |
| | | 6424 | AuricularProstheses05.00.82 | DME (05) | 05.00.82 | 05.00.82 | 48247e2c-24d2-47e5-abb3-f29984e2fd33 | Auricular Prostheses | Auricular Prostheses | |
| | | 6707 | AutologousChondrocyteImplantation(ACI)andOtherCell-basedTreatmentsofFocalArticularCartilageLesions(AmerihealthAdministrators)11.14.06j | Surgery (11) | 11.14.06j | 11.14.06 | 6b5bdbf5-f556-4583-aa70-78730a56890c | 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) | |
| | | 5683 | AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29o | DME (05) | 05.00.29o | 05.00.29 | a590a8dc-f63a-4148-bbaf-c1db550f4901 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"5684": {"Id":5684,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":7702,"PolicyAttachmentPageName":"72e465f4-a6d8-47da-947d-a60610ca93bc"},"5685": {"Id":5685,"MPAttachmentLetter":"A","Title":"ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":7703,"PolicyAttachmentPageName":"2d28e7c9-989c-4508-ad0f-ead9d9e10f0a"},} |
| | | 6305 | AutonomicNervousSystemTesting07.03.23f | Medicine (07) | 07.03.23f | 07.03.23 | eb3c1ee7-737d-44c6-89df-27081fad358c | Autonomic Nervous System Testing | Autonomic Nervous System Testing | |
| | | 6091 | Avelumab(Bavencio®)08.01.64c | Pharmacy (08) | 08.01.64c | 08.01.64 | 8634181f-e7ae-4971-83be-45e7b99e6c46 | Avelumab (Bavencio®) | Avelumab (Bavencio®) | {"6092": {"Id":6092,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":8159,"PolicyAttachmentPageName":"67e0efb5-3938-48ad-9c9c-e712d139041b"},} |
| | | 5096 | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitis11.16.06j | Surgery (11) | 11.16.06j | 11.16.06 | e6e1f2fb-cb7d-4b62-b88c-93f6f4dbaaa6 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | |
| | | 2824 | BariatricSurgery11.03.02t | Surgery (11) | 11.03.02t | 11.03.02 | deb6788b-9378-4634-bea1-f71971bb7026 | Bariatric Surgery | Bariatric Surgery | {"2825": {"Id":2825,"MPAttachmentLetter":"A","Title":"Body Mass Index (BMI) Charts","MPPolicyAttachmentInternalSourceId":4907,"PolicyAttachmentPageName":"1ae6209c-f0da-459c-adb3-cace9e40b535"},"2826": {"Id":2826,"MPAttachmentLetter":"B","Title":"Tanner Staging System Criteria for Adolescents","MPPolicyAttachmentInternalSourceId":4908,"PolicyAttachmentPageName":"3fc8cbfa-375e-4a3f-a769-c3bd36fe1065"},"2827": {"Id":2827,"MPAttachmentLetter":"C","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":4909,"PolicyAttachmentPageName":"778a747c-2dd7-41ec-a720-71eec3fa4351"},} |
| | | 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®)] | |
| | | 5394 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUse08.00.66u | Pharmacy (08) | 08.00.66u | 08.00.66 | 5e39b1ae-f374-4b43-a5f0-9444ff939207 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"5395": {"Id":5395,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":7256,"PolicyAttachmentPageName":"ae2016c2-03bb-4ed9-986e-15e23b1bcb87"},"5396": {"Id":5396,"MPAttachmentLetter":"B","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":7322,"PolicyAttachmentPageName":"c3be9297-30ef-4a4c-a768-0bcb23746e8f"},} |
| | | 5883 | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39p | Administrative (00) | 00.10.39p | 00.10.39 | 95f9b3c1-bad5-4370-9529-72d47935639a | 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 | {"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"},} |
| | | 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"},} |
| | | 6623 | BiofeedbackTherapy07.00.01n | Medicine (07) | 07.00.01n | 07.00.01 | 9bbfe306-c517-4311-9e0c-3992dede578b | 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 | |
| | | 4845 | Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/Canthopexy11.05.02j | Surgery (11) | 11.05.02j | 11.05.02 | b491f109-dc4e-41fb-906a-5eb04fe2602d | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | {"4846": {"Id":4846,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6997,"PolicyAttachmentPageName":"665d1d9d-23ab-4d5d-9822-e83db0e70d80"},} |
| | | 5114 | Blinatumomab(Blincyto®)08.01.21f | Pharmacy (08) | 08.01.21f | 08.01.21 | b306af6e-813e-493c-8a8b-b57d5995a5e4 | 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 | |
| | | 6390 | BotulinumToxinAgents08.00.26ac | Pharmacy (08) | 08.00.26ac | 08.00.26 | ff919628-9d60-4949-a4b1-093a98efd8ff | Botulinum Toxin Agents | Botulinum Toxin Agents | {"6391": {"Id":6391,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":8524,"PolicyAttachmentPageName":"53a541a3-934e-4eca-bc33-e19fe1a03605"},} |
| | | 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 | |
| | | 5974 | BreastPumps05.00.76h | DME (05) | 05.00.76h | 05.00.76 | e718aa9b-d3fc-4639-a5db-9da0f889ca0d | Breast Pumps | Breast Pumps | |
| | | 6082 | BrentuximabVedotin(Adcetris®)08.01.13i | Pharmacy (08) | 08.01.13i | 08.01.13 | 8fb16725-fe22-41e8-a8fd-d52ed540ecf3 | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | {"6083": {"Id":6083,"MPAttachmentLetter":"A","Title":"ICD CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7784,"PolicyAttachmentPageName":"f2f311e1-b1da-4680-9a0c-3ceaba5fa574"},} |
| | | 6412 | BronchialValves11.16.09 | Surgery (11) | 11.16.09 | 11.16.09 | ee437b97-bae6-428a-9307-6821eb6b1f46 | 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®) | |
| | | 5367 | Canakinumab(Ilaris®)08.01.51b | Pharmacy (08) | 08.01.51b | 08.01.51 | 38c73bef-e52a-4cb7-a01c-656e866406c9 | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | |
| | | 6201 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)Programs10.01.01r | Rehabilitation Services (10) | 10.01.01r | 10.01.01 | 4f05be45-fe22-4985-826c-1a29eeda3bd8 | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"6202": {"Id":6202,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":8328,"PolicyAttachmentPageName":"d886555d-fed0-496e-be26-b5a45e431370"},} |
| | | 6110 | CareManagementandCarePlanningServices00.01.59n | Administrative (00) | 00.01.59n | 00.01.59 | b07fe1e1-bece-4278-976c-ff96c6008f21 | Care Management and Care Planning Services | Care Management and Care Planning Services | |
| | | 5994 | Carfilzomib(Kyprolis®)08.01.05j | Pharmacy (08) | 08.01.05j | 08.01.05 | f6351ed6-683e-4623-83d6-5dee552f7b29 | Carfilzomib (Kyprolis®) | Carfilzomib (Kyprolis®) | |
| | | 4360 | CastandSplintApplicationsandAssociatedSupplies00.10.15d | Administrative (00) | 00.10.15d | 00.10.15 | 3d5103bb-27d5-4963-bd34-f6ba67f1076b | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"4361": {"Id":4361,"MPAttachmentLetter":"A","Title":"Procedure Codes Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":6421,"PolicyAttachmentPageName":"4af8b16b-794b-4533-a048-5413712cbe65"},} |
| | | 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"},} |
| | | 5689 | CatheterAblationofCardiacArrhythmias11.02.06q | Surgery (11) | 11.02.06q | 11.02.06 | 9eccdc4b-79a3-4f95-8e04-651c93549127 | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | |
| | | 5565 | Cemiplimab-rwlc(Libtayo®)08.01.66c | Pharmacy (08) | 08.01.66c | 08.01.66 | b06a7d38-c9e9-4610-916b-190365fe9fd8 | Cemiplimab-rwlc (Libtayo®) | Cemiplimab-rwlc (Libtayo®) | |
| | | 5344 | Cerliponasealfa(Brineura®)08.01.39c | Pharmacy (08) | 08.01.39c | 08.01.39 | c81b22ec-3ec7-4a91-85c1-70af8b7cf771 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | |
| | | 5183 | CervicalTractionDevicesforIn-homeUse05.00.61g | DME (05) | 05.00.61g | 05.00.61 | aff2b094-ca8b-410b-96e4-4a9c0c4fecbb | 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"},} |
| | | 5902 | ChemicalPeels11.08.08h | Surgery (11) | 11.08.08h | 11.08.08 | 8aaecd67-1a97-4dba-8260-5b9df700036e | Chemical Peels | Chemical Peels | |
| | | 6567 | ChimericAntigenReceptor(CAR)Therapy08.01.43m | Pharmacy (08) | 08.01.43m | 08.01.43 | e04e6e00-4fcc-47f9-9eb4-a878ce14652d | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | {"6568": {"Id":6568,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8757,"PolicyAttachmentPageName":"01b66863-7b61-4475-adae-0e66f183f82e"},} |
| | | 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 | |
| | | 6081 | CoagulationFactors08.00.92ag | Pharmacy (08) | 08.00.92ag | 08.00.92 | c40f3d9d-b80c-4073-a7b3-75b07f1d2132 | 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 | |
| | | 6129 | CompressionGarments05.00.37i | DME (05) | 05.00.37i | 05.00.37 | d26e483d-d440-4d8e-86ac-4bfd25e128d1 | Compression Garments | Compression Garments | |
| | | 5106 | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographs09.00.42c | Radiology (09) | 09.00.42c | 09.00.42 | b9742429-a8a1-4644-8b1c-2d8a9c69cbbb | 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"},} |
| | | 5138 | ContrastAgentsUsedinConjunctionwithEchocardiography09.00.11e | Radiology (09) | 09.00.11e | 09.00.11 | 12ca4dc2-6f5b-4375-a86a-975789fb3469 | 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"},} |
| | | 6304 | CoronaryArteryCalcium(CAC)TestingUsingComputedTomography(AmeriHealthAdministrators)09.00.58 | Radiology (09) | 09.00.58 | 09.00.58 | 95fe317c-cc2c-4f35-be30-a227f8fcb371 | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators) | Coronary Artery Calcium (CAC) Testing Using Computed Tomography (AmeriHealth Administrators) | |
| | | 6160 | CosmeticProcedures12.01.03b | Miscellaneous (12) | 12.01.03b | 12.01.03 | a0296243-13b3-4c16-8081-8892cb295c25 | Cosmetic Procedures | Cosmetic Procedures | |
| | | 6542 | CoverageofAnticancerPrescriptionOralandInjectableDrugsandBiologicsandSupportiveAgents08.01.08q | Pharmacy (08) | 08.01.08q | 08.01.08 | 55987d2d-c837-4f40-b716-6fea2ad1eb73 | 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 | {} |
| | | 3720 | CoverageofMedicalDevices05.00.04e | DME (05) | 05.00.04e | 05.00.04 | 14669bc5-097a-4a2c-bbf0-82a2e0da5a62 | 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 | |
| | | 6122 | CranialRemoldingOrthoses(Helmets)05.00.25j | DME (05) | 05.00.25j | 05.00.25 | 234626c7-025c-4f8c-bbe6-a1851c93420c | Cranial Remolding Orthoses (Helmets) | Cranial Remolding Orthoses (Helmets) | |
| | | 5034 | CriteriaforReimbursementofEmergencyRoomServices00.10.03k | Administrative (00) | 00.10.03k | 00.10.03 | cde76797-199e-4918-9e43-897124bfa2c4 | 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®) | |
| | | 6635 | CryosurgicalAblationoftheProstateGland11.11.03d | Surgery (11) | 11.11.03d | 11.11.03 | 7e3fde8b-e5b5-405b-8ce0-009e29458622 | 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®) | |
| | | 5378 | DayRehabilitation10.00.02c | Rehabilitation Services (10) | 10.00.02c | 10.00.02 | 803d7702-4e64-481a-a856-89a699b735d9 | Day Rehabilitation | Day Rehabilitation | |
| | | 6358 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNails11.08.17k | Surgery (11) | 11.08.17k | 11.08.17 | 19d4f8f5-e16c-4aff-9f5a-2a9d99fc69d1 | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"6359": {"Id":6359,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":8630,"PolicyAttachmentPageName":"a8d1525d-88b8-4635-b527-662fb44f789c"},"6360": {"Id":6360,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":8631,"PolicyAttachmentPageName":"3851fb91-242c-4994-8719-37246bf52429"},"6361": {"Id":6361,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":8632,"PolicyAttachmentPageName":"208ae26d-8e54-4a27-a0a4-5ac4458f3d4e"},"6362": {"Id":6362,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":8633,"PolicyAttachmentPageName":"2879a1c3-2274-412e-8015-9bfa89f0005a"},"6363": {"Id":6363,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":8634,"PolicyAttachmentPageName":"a1f4ac3d-791c-4cb3-b475-8b71a190bb43"},} |
| | | 6053 | DeepBrainStimulation(DBS)11.15.20t | Surgery (11) | 11.15.20t | 11.15.20 | 794efd54-5108-453a-99b1-67dde41a8a59 | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | |
| | | 6535 | Delandistrogenemoxeparvovec(delandistrogenemoxeparvovec-rokl;Elevidys®)08.02.13 | Pharmacy (08) | 08.02.13 | 08.02.13 | 7d904f73-b379-4e91-b6f4-5b3abb3239c4 | Delandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®) | Delandistrogene moxeparvovec (delandistrogene moxeparvovec-rokl; Elevidys®) | |