Commercial
Advanced Search
  
  
  
  
  
  
  
  
  
  
MPattachmentdataPub
b59cae2d-57f8-4cdb-b9af-b182573fa7a3.aspx
  
4316Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62nPharmacy (08)08.00.62n08.00.62b59cae2d-57f8-4cdb-b9af-b182573fa7a3Abatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use
{"4317": {"Id":4317,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6281,"PolicyAttachmentPageName":"23995e7c-07d0-4f56-b252-d44d8d3ae0c0"},}
b37a9b0a-0f3f-4a3e-b80b-4c4adb5e358b.aspx
  
5388Acupuncture12.00.01gMiscellaneous (12)12.00.01g12.00.01b37a9b0a-0f3f-4a3e-b80b-4c4adb5e358bAcupunctureAcupuncture
{"5389": {"Id":5389,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":7393,"PolicyAttachmentPageName":"6aea3518-fc32-4d28-9afb-544467f4fa73"},}
e30315a0-0657-4f6d-888a-2fa4b0aa46fd.aspx
  
4767AcuteCareFacilityInpatientTransfers12.04.04bMiscellaneous (12)12.04.04b12.04.04e30315a0-0657-4f6d-888a-2fa4b0aa46fdAcute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers
38d8a45c-488c-48e3-988a-04ec71fc747f.aspx
  
4949Ado-TrastuzumabEmtansine(Kadcyla®)08.01.11hPharmacy (08)08.01.11h08.01.1138d8a45c-488c-48e3-988a-04ec71fc747fAdo-Trastuzumab Emtansine (Kadcyla®)Ado-Trastuzumab Emtansine (Kadcyla®)
{"4950": {"Id":4950,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes and Narratives","MPPolicyAttachmentInternalSourceId":6792,"PolicyAttachmentPageName":"22019f47-888f-4ab7-b554-9fe0c2c91809"},}
d9e41786-d397-4077-99ef-24e9b3106343.aspx
  
4427Aducanumab(Aduhelm)forAlzheimerDisease08.01.93Pharmacy (08)08.01.9308.01.93d9e41786-d397-4077-99ef-24e9b3106343Aducanumab (Aduhelm) for Alzheimer DiseaseAducanumab (Aduhelm) for Alzheimer Disease
b8b27d69-62ab-4921-9ae8-f074ee40c9dc.aspx
  
5163Agalsidasebeta(Fabrazyme®)08.00.69cPharmacy (08)08.00.69c08.00.69b8b27d69-62ab-4921-9ae8-f074ee40c9dcAgalsidase beta (Fabrazyme®)Agalsidase beta (Fabrazyme®)
14f5591d-8f79-4b62-a760-2e53f042f272.aspx
  
5043AirAmbulanceServices12.04.03cMiscellaneous (12)12.04.03c12.04.0314f5591d-8f79-4b62-a760-2e53f042f272Air Ambulance ServicesAir Ambulance Services
253c8671-81ff-425d-9d8e-309011c90aa0.aspx
  
5305Alemtuzumab(Lemtrada®)08.01.22dPharmacy (08)08.01.22d08.01.22253c8671-81ff-425d-9d8e-309011c90aa0Alemtuzumab (Lemtrada®)Alemtuzumab (Lemtrada®)
8efb377e-0527-4def-a962-5f79e0b36912.aspx
  
5359Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®)08.00.72kPharmacy (08)08.00.72k08.00.728efb377e-0527-4def-a962-5f79e0b36912Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® )
a1de565a-4780-477e-8f16-1cbce906084c.aspx
  
4820AllergyImmunotherapy07.00.21jMedicine (07)07.00.21j07.00.21a1de565a-4780-477e-8f16-1cbce906084cAllergy ImmunotherapyAllergy Immunotherapy
b94000e7-dd84-4ae8-b8f9-3712a52d80da.aspx
  
5178AllogeneicProcessedThymusTissue-agdc(Rethymic®)08.01.88Pharmacy (08)08.01.8808.01.88b94000e7-dd84-4ae8-b8f9-3712a52d80daAllogeneic Processed Thymus Tissue-agdc (Rethymic®)Allogeneic Processed Thymus Tissue-agdc (Rethymic®)
79251573-4f96-4f72-96e8-6488e1cc8797.aspx
  
5224AlloMap™MolecularExpressionTestingforHeartTransplantRejection(AmeriHealthAdministrators)06.02.29dPathology and Laboratory (06)06.02.29d06.02.2979251573-4f96-4f72-96e8-6488e1cc8797AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (AmeriHealth Administrators)
89deaeea-96aa-4381-9a71-4bc587fb08c9.aspx
  
5230Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C®,AralastNP®,Glassia®,Zemaira®)08.00.91ePharmacy (08)08.00.91e08.00.9189deaeea-96aa-4381-9a71-4bc587fb08c9Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)
b4c1fd43-8110-4431-8ec1-5eb58bfa6786.aspx
  
5049AlwaysBundledProcedureCodes00.01.52rAdministrative (00)00.01.52r00.01.52b4c1fd43-8110-4431-8ec1-5eb58bfa6786Always Bundled Procedure CodesAlways Bundled Procedure Codes
{"5050": {"Id":5050,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":7148,"PolicyAttachmentPageName":"16222f74-7a66-426c-bf28-9763c1e649a4"},"5051": {"Id":5051,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (Indicator B)","MPPolicyAttachmentInternalSourceId":7149,"PolicyAttachmentPageName":"80a66e18-60d9-41ab-ab4b-9c6c620224f4"},"5052": {"Id":5052,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":7150,"PolicyAttachmentPageName":"6ce8129c-60f2-4a1e-8923-6e9e664192e0"},}
48fdbbc0-05ed-4ff5-a173-261459ff7c09.aspx
  
4873AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)Devices07.02.09hMedicine (07)07.02.09h07.02.0948fdbbc0-05ed-4ff5-a173-261459ff7c09Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) DevicesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
8bd51df3-472e-4025-9b4e-12c5110a60fa.aspx
  
4980AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)Monitoring07.02.21kMedicine (07)07.02.21k07.02.218bd51df3-472e-4025-9b4e-12c5110a60faAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
c99adc14-4d87-446c-8013-d814bd771bee.aspx
  
5385AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagement01.00.12aAnesthesia (01)01.00.12a01.00.12c99adc14-4d87-446c-8013-d814bd771beeAnesthesia 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
{"5386": {"Id":5386,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7396,"PolicyAttachmentPageName":"96c7ef41-0f51-4b0a-8b5e-4a1ae55b5715"},}
7f881bbb-9ecf-4690-b6b8-6f5cb234c8f7.aspx
  
5431Anifrolumab-fnia(Saphnelo®)08.01.82bPharmacy (08)08.01.82b08.01.827f881bbb-9ecf-4690-b6b8-6f5cb234c8f7Anifrolumab-fnia (Saphnelo®)Anifrolumab-fnia (Saphnelo®)
9fe524ee-227c-45ca-894a-d481fa0fef99.aspx
  
5159Ankle-Foot/Knee-Ankle-FootOrthoses05.00.39sDME (05)05.00.39s05.00.399fe524ee-227c-45ca-894a-d481fa0fef99Ankle-Foot/Knee-Ankle-Foot OrthosesAnkle-Foot/Knee-Ankle-Foot Orthoses
{"5160": {"Id":5160,"MPAttachmentLetter":"A","Title":"HCPCS Codes","MPPolicyAttachmentInternalSourceId":7044,"PolicyAttachmentPageName":"7d58f450-832e-4572-9279-da5bf832159f"},}
b395fd09-303a-4b18-a74c-04bb56dc9226.aspx
  
2807ApheresisTherapy06.03.04nPathology and Laboratory (06)06.03.04n06.03.04b395fd09-303a-4b18-a74c-04bb56dc9226Apheresis TherapyApheresis Therapy
40adc8e6-69c1-4b04-9492-4dde285906f2.aspx
  
5107ApplicationandRemovalofTattoos11.08.05gSurgery (11)11.08.05g11.08.0540adc8e6-69c1-4b04-9492-4dde285906f2Application and Removal of TattoosApplication and Removal of Tattoos
5ab4e14d-6b67-4846-85eb-07d9a15c7819.aspx
  
5039AppliedBehaviorAnalysis(ABA)fortheTreatmentofAutismSpectrumDisorders(ASD)14.00.03Behavioral Health (14)14.00.0314.00.035ab4e14d-6b67-4846-85eb-07d9a15c7819Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)Applied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)
b59e539f-57fe-4c9e-97c1-f32cbacecfd4.aspx
  
4993Aprepitant(Cinvanti™),FosaprepitantDimeglumine(Emend®),Granisetron(Sustol®),andRolapitant(Varubi®)08.01.41ePharmacy (08)08.01.41e08.01.41b59e539f-57fe-4c9e-97c1-f32cbacecfd4Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
{"4994": {"Id":4994,"MPAttachmentLetter":"A","Title":"Risk of Emesis Without Prophylaxis: Intravenous and Oral Antineoplastic Agents","MPPolicyAttachmentInternalSourceId":7122,"PolicyAttachmentPageName":"3ba22a0e-77fb-40a0-b6ac-db0a5f7a1f4d"},}
b55c31d5-eb8d-4517-bf3c-eeeb6c9b79a1.aspx
  
4998AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucoma11.05.16lSurgery (11)11.05.16l11.05.16b55c31d5-eb8d-4517-bf3c-eeeb6c9b79a1Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
{"4999": {"Id":4999,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":7061,"PolicyAttachmentPageName":"fdf22af8-1f6d-44a3-bf8f-874a014f596a"},}
bc52c9e0-2f80-4074-92f6-4627d2247b46.aspx
  
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)
afb41ec7-458d-467b-b4e7-e59d90e2de3d.aspx
  
4989ArtificialIntervertebralLumbarDiscInsertion11.15.31bSurgery (11)11.15.31b11.15.31afb41ec7-458d-467b-b4e7-e59d90e2de3dArtificial Intervertebral Lumbar Disc InsertionArtificial Intervertebral Lumbar Disc Insertion
84cbb299-b398-41f9-8fca-e8636350d26e.aspx
  
4552AsparaginaseErwiniaChrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze™)08.01.35fPharmacy (08)08.01.35f08.01.3584cbb299-b398-41f9-8fca-e8636350d26eAsparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze™)
409b7171-d1a6-4ae0-9438-21770a53e0fb.aspx
  
4489AssaysofGeneticExpressioninTumorTissueforBreastCancerPrognosis(AmeriHealthAdministrators)06.02.27nPathology and Laboratory (06)06.02.27n06.02.27409b7171-d1a6-4ae0-9438-21770a53e0fbAssays 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)
1957f95b-a5e6-40c1-befd-604f31a47e21.aspx
  
4861AssistedReproductiveTechnologyforInfertilityandOocyteCryopreservation07.10.06iMedicine (07)07.10.06i07.10.061957f95b-a5e6-40c1-befd-604f31a47e21Assisted Reproductive Technology for Infertility and Oocyte CryopreservationAssisted Reproductive Technology for Infertility and Oocyte Cryopreservation
3692eb86-55ea-4cdd-a607-efd8374b8545.aspx
  
5120Atezolizumab(Tecentriq®)08.01.69cPharmacy (08)08.01.69c08.01.693692eb86-55ea-4cdd-a607-efd8374b8545Atezolizumab (Tecentriq®)Atezolizumab (Tecentriq®)
{"5121": {"Id":5121,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7179,"PolicyAttachmentPageName":"d42f2057-342f-4f9c-848b-430f95990f97"},}
2128d5d8-b7a4-4ff5-9a1a-9608698cc0eb.aspx
  
5239AutologousChondrocyteImplantation(ACI)andOtherCell-basedTreatmentsofFocalArticularCartilageLesions(AmerihealthAdministrators)11.14.06jSurgery (11)11.14.06j11.14.062128d5d8-b7a4-4ff5-9a1a-9608698cc0ebAutologous 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)
3b574e00-b30e-4b42-87e3-f17689845506.aspx
  
4870AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)05.00.29nDME (05)05.00.29n05.00.293b574e00-b30e-4b42-87e3-f17689845506Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
{"4871": {"Id":4871,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":6577,"PolicyAttachmentPageName":"81b1b9fa-986a-4325-9c78-a3175d3f4dc5"},"4872": {"Id":4872,"MPAttachmentLetter":"A","Title":"ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":6578,"PolicyAttachmentPageName":"141a3a4c-2bc8-4fba-bc8d-d9a8b564a2ef"},}
b393d397-a419-44af-9b52-d0c610c1ee8c.aspx
  
5340AutonomicNervousSystemTesting07.03.23fMedicine (07)07.03.23f07.03.23b393d397-a419-44af-9b52-d0c610c1ee8cAutonomic Nervous System TestingAutonomic Nervous System Testing
f20a2a02-1ded-4005-9bf4-693e1c2fd092.aspx
  
4958Avelumab(Bavencio®)08.01.64bPharmacy (08)08.01.64b08.01.64f20a2a02-1ded-4005-9bf4-693e1c2fd092Avelumab (Bavencio®)Avelumab (Bavencio®)
{"4959": {"Id":4959,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7008,"PolicyAttachmentPageName":"f9d6f03c-2dca-4ee9-b5d8-afcceee6e029"},}
e6e1f2fb-cb7d-4b62-b88c-93f6f4dbaaa6.aspx
  
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
deb6788b-9378-4634-bea1-f71971bb7026.aspx
  
2824BariatricSurgery11.03.02tSurgery (11)11.03.02t11.03.02deb6788b-9378-4634-bea1-f71971bb7026Bariatric SurgeryBariatric 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"},}
246806c0-46da-409c-b330-cdc5192c284a.aspx
  
4276Belantamabmafodotin-blmf(Blenrep)08.01.70bPharmacy (08)08.01.70b08.01.70246806c0-46da-409c-b330-cdc5192c284aBelantamab mafodotin-blmf (Blenrep)Belantamab mafodotin-blmf (Blenrep)
48faca03-d3ad-4abd-af51-f1fdd06652c8.aspx
  
5303Belimumab(Benlysta®)forIntravenousUse08.00.99ePharmacy (08)08.00.99e08.00.9948faca03-d3ad-4abd-af51-f1fdd06652c8Belimumab (Benlysta®) for Intravenous UseBelimumab (Benlysta®) for Intravenous Use
f4038900-116f-45a9-a1d0-49644aa0544d.aspx
  
4970BetibeglogeneAutotemcel[Beti-Cel(ZYNTEGLO®)]08.01.89Pharmacy (08)08.01.8908.01.89f4038900-116f-45a9-a1d0-49644aa0544dBetibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]Betibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]
5e39b1ae-f374-4b43-a5f0-9444ff939207.aspx
  
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
{"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"},}
974307f4-0c12-4fca-a95c-49747a501e32.aspx
  
5080BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampus00.10.39pAdministrative (00)00.10.39p00.10.39974307f4-0c12-4fca-a95c-49747a501e32Billing 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
{"5081": {"Id":5081,"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":7191,"PolicyAttachmentPageName":"381f14d3-4b02-400b-92cd-7ab75b59686a"},}
e862bc0b-0289-4661-bf0a-950e2efca6ee.aspx
  
3087BillingRequirementsforMultipleBirthsforProfessionalProviders00.10.38aAdministrative (00)00.10.38a00.10.38e862bc0b-0289-4661-bf0a-950e2efca6eeBilling Requirements for Multiple Births for Professional ProvidersBilling Requirements for Multiple Births for Professional Providers
{"3088": {"Id":3088,"MPAttachmentLetter":"A","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ROUTINE OBSTETRIC (GLOBALE MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED","MPPolicyAttachmentInternalSourceId":5340,"PolicyAttachmentPageName":"ba5b6730-4f52-4c93-97c1-4ca8f4766879"},"3089": {"Id":3089,"MPAttachmentLetter":"B","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ANETEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":5341,"PolicyAttachmentPageName":"494d41d3-1fd0-4df8-b729-ad76b6fc2723"},"3090": {"Id":3090,"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":5342,"PolicyAttachmentPageName":"1232f148-ec02-4366-a47a-8917edfa3d73"},"3091": {"Id":3091,"MPAttachmentLetter":"D","Title":"MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES WHEN ANTEPARTUM CARE IS NOT PROVIDED","MPPolicyAttachmentInternalSourceId":5343,"PolicyAttachmentPageName":"dee47969-1193-42f8-9cc1-4dabfcc50995"},}
0670e429-5237-4d7d-9b9a-ed6b3741461b.aspx
  
5123BiofeedbackTherapy07.00.01jMedicine (07)07.00.01j07.00.010670e429-5237-4d7d-9b9a-ed6b3741461bBiofeedback TherapyBiofeedback Therapy
4f6901b4-8f19-4b3f-97f5-802d005c75cf.aspx
  
4368BioimpedencefortheDetectionofLymphedema07.06.03bMedicine (07)07.06.03b07.06.034f6901b4-8f19-4b3f-97f5-802d005c75cfBioimpedence for the Detection of LymphedemaBioimpedence for the Detection of Lymphedema
b491f109-dc4e-41fb-906a-5eb04fe2602d.aspx
  
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
{"4846": {"Id":4846,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6997,"PolicyAttachmentPageName":"665d1d9d-23ab-4d5d-9822-e83db0e70d80"},}
b306af6e-813e-493c-8a8b-b57d5995a5e4.aspx
  
5114Blinatumomab(Blincyto®)08.01.21fPharmacy (08)08.01.21f08.01.21b306af6e-813e-493c-8a8b-b57d5995a5e4Blinatumomab (Blincyto®)Blinatumomab (Blincyto®)
e1490bfd-d6ac-4b00-a8c1-314c46c78d8f.aspx
  
5030Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAids11.01.06gSurgery (11)11.01.06g11.01.06e1490bfd-d6ac-4b00-a8c1-314c46c78d8fBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
f7005cd1-2e6a-4135-bcfe-9b67820a0fab.aspx
  
4981BoneMineralDensity(BMD)Testing09.00.04mRadiology (09)09.00.04m09.00.04f7005cd1-2e6a-4135-bcfe-9b67820a0fabBone Mineral Density (BMD) TestingBone Mineral Density (BMD) Testing
ec8ad7b9-59e3-4bd1-b521-dc205fe47298.aspx
  
5023Bortezomib(BortezomibforInjection,Velcade®)08.00.73oPharmacy (08)08.00.73o08.00.73ec8ad7b9-59e3-4bd1-b521-dc205fe47298Bortezomib (Bortezomib for Injection, Velcade®)Bortezomib (Bortezomib for Injection, Velcade®)
{"5024": {"Id":5024,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7118,"PolicyAttachmentPageName":"123cd11e-0384-4510-9e89-891f066beb77"},}
b503e71b-b106-42f3-bf61-3ce0cf03e7cf.aspx
  
5254BotulinumToxinAgents08.00.26aaPharmacy (08)08.00.26aa08.00.26b503e71b-b106-42f3-bf61-3ce0cf03e7cfBotulinum Toxin AgentsBotulinum Toxin Agents
{"5255": {"Id":5255,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":7183,"PolicyAttachmentPageName":"d1f466a1-455f-4cbb-b3a2-dfcfaeb616b0"},}
f581558f-daff-4a3d-8a3f-4a5256e1bf06.aspx
  
4495BrachytherapyandAcceleratedWholeBreastIrradiationusingThree-DimensionalConformationRadiationTherapy09.00.10zRadiology (09)09.00.10z09.00.10f581558f-daff-4a3d-8a3f-4a5256e1bf06Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation TherapyBrachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy
7e4c86e0-e560-421c-8463-60b4239e18fa.aspx
  
5033BreastPumps05.00.76gDME (05)05.00.76g05.00.767e4c86e0-e560-421c-8463-60b4239e18faBreast PumpsBreast Pumps
2f4b8bc7-824b-4bd1-bffe-bc24075eb16a.aspx
  
4607BrentuximabVedotin(Adcetris®)08.01.13hPharmacy (08)08.01.13h08.01.132f4b8bc7-824b-4bd1-bffe-bc24075eb16aBrentuximab Vedotin (Adcetris®)Brentuximab Vedotin (Adcetris®)
{"4608": {"Id":4608,"MPAttachmentLetter":"A","Title":"ICD CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6762,"PolicyAttachmentPageName":"4ef59e2f-b124-4e39-bc83-d921fc98d944"},}
52cbba4a-1c34-44f4-852c-2aa2af748210.aspx
  
4141BronchialValves11.16.09Surgery (11)11.16.0911.16.0952cbba4a-1c34-44f4-852c-2aa2af748210Bronchial ValvesBronchial Valves
7086f118-eb42-44a3-8a89-e86e5c88d9cd.aspx
  
5360Burosumab-twza(Crysvita®)08.01.49bPharmacy (08)08.01.49b08.01.497086f118-eb42-44a3-8a89-e86e5c88d9cdBurosumab-twza (Crysvita®)Burosumab-twza (Crysvita®)
38c73bef-e52a-4cb7-a01c-656e866406c9.aspx
  
5367Canakinumab(Ilaris®)08.01.51bPharmacy (08)08.01.51b08.01.5138c73bef-e52a-4cb7-a01c-656e866406c9Canakinumab (Ilaris®)Canakinumab (Ilaris®)
cabc1c75-7431-49cc-9530-91eb57207d0f.aspx
  
4619CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)Programs10.01.01oRehabilitation Services (10)10.01.01o10.01.01cabc1c75-7431-49cc-9530-91eb57207d0fCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
{"4620": {"Id":4620,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6701,"PolicyAttachmentPageName":"494bab88-d0fd-4cf6-8e31-f39da209b9f6"},}
1a75e5b2-239b-4d8f-ba0c-f6af7246660e.aspx
  
5082CareManagementandCarePlanningServices00.01.59mAdministrative (00)00.01.59m00.01.591a75e5b2-239b-4d8f-ba0c-f6af7246660eCare Management and Care Planning ServicesCare Management and Care Planning Services
154ae50d-be6c-4132-ac0e-cd0daae0016c.aspx
  
4813Carfilzomib(Kyprolis®)08.01.05iPharmacy (08)08.01.05i08.01.05154ae50d-be6c-4132-ac0e-cd0daae0016cCarfilzomib (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
{"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"},}
999dab46-d26f-4042-bdec-44679dace028.aspx
  
4854CataractSurgery11.01.07fSurgery (11)11.01.07f11.01.07999dab46-d26f-4042-bdec-44679dace028Cataract SurgeryCataract Surgery
{"4855": {"Id":4855,"MPAttachmentLetter":"A","Title":"ICD 10 codes for policy 11.01.07d, Cataract Surgery","MPPolicyAttachmentInternalSourceId":6668,"PolicyAttachmentPageName":"705428a5-5a31-40d0-a0d2-354e451b3896"},}
8adec0f3-a1ab-492b-af21-07ab6d6aae6a.aspx
  
4621CatheterAblationofCardiacArrhythmias11.02.06oSurgery (11)11.02.06o11.02.068adec0f3-a1ab-492b-af21-07ab6d6aae6aCatheter Ablation of Cardiac ArrhythmiasCatheter Ablation of Cardiac Arrhythmias
5376605a-e682-418c-82d3-0e7b9a0df081.aspx
  
4956Cemiplimab-rwlc(Libtayo®)08.01.66bPharmacy (08)08.01.66b08.01.665376605a-e682-418c-82d3-0e7b9a0df081Cemiplimab-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
7a91e8d9-4bfe-4deb-978d-8f088449f615.aspx
  
5019Cetuximab(Erbitux®)08.00.67nPharmacy (08)08.00.67n08.00.677a91e8d9-4bfe-4deb-978d-8f088449f615Cetuximab (Erbitux®)Cetuximab (Erbitux®)
{"5020": {"Id":5020,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":7025,"PolicyAttachmentPageName":"9d4dd3a8-871d-43d3-8ff6-7f310fde867d"},"5021": {"Id":5021,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":7026,"PolicyAttachmentPageName":"aaa3078f-4999-485c-8564-30acef316ee7"},}
db5a3ccb-3f8a-411e-b545-f3ba973de1c5.aspx
  
4602ChemicalPeels11.08.08hSurgery (11)11.08.08h11.08.08db5a3ccb-3f8a-411e-b545-f3ba973de1c5Chemical PeelsChemical Peels
828baa5b-e049-4764-b88b-528d65afed34.aspx
  
4605ChimericAntigenReceptor(CAR)Therapy08.01.43kPharmacy (08)08.01.43k08.01.43828baa5b-e049-4764-b88b-528d65afed34Chimeric Antigen Receptor (CAR) TherapyChimeric Antigen Receptor (CAR) Therapy
{"4606": {"Id":4606,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6560,"PolicyAttachmentPageName":"c3da6cc6-10d3-42cd-afb6-fd746f9885a5"},}
41b59432-3402-4af7-aced-f58e3d7ff391.aspx
  
4819ChiropracticSpinalandExtraspinalManipulationTherapy10.02.02jRehabilitation Services (10)10.02.02j10.02.0241b59432-3402-4af7-aced-f58e3d7ff391Chiropractic Spinal and Extraspinal Manipulation TherapyChiropractic Spinal and Extraspinal Manipulation Therapy
5f61fef5-37e8-456e-bf9c-5b59e89362c1.aspx
  
4803CoagulationFactors08.00.92aePharmacy (08)08.00.92ae08.00.925f61fef5-37e8-456e-bf9c-5b59e89362c1Coagulation FactorsCoagulation Factors
359a2377-9b04-4dee-a8be-027bdc97c9b8.aspx
  
5066Cobalamin(VitaminB12),FolicAcid,andHomocysteineTesting06.02.54cPathology and Laboratory (06)06.02.54c06.02.54359a2377-9b04-4dee-a8be-027bdc97c9b8Cobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
{"5067": {"Id":5067,"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":7156,"PolicyAttachmentPageName":"9555cfd8-5d27-439f-98b9-f8ac99996c49"},}
0a678ec2-d067-438a-9c09-59c605e62ee8.aspx
  
4807CochlearImplantation11.01.02qSurgery (11)11.01.02q11.01.020a678ec2-d067-438a-9c09-59c605e62ee8Cochlear ImplantationCochlear Implantation
52fa70dc-94af-4f67-8cb5-471700f2dbd4.aspx
  
5144Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo™)08.01.71Pharmacy (08)08.01.7108.01.7152fa70dc-94af-4f67-8cb5-471700f2dbd4Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo™)
0290a952-ce69-44dd-b858-8c2d138066db.aspx
  
4879ColorectalCancerScreening11.03.12tSurgery (11)11.03.12t11.03.120290a952-ce69-44dd-b858-8c2d138066dbColorectal Cancer ScreeningColorectal Cancer Screening
78256c85-c80a-49b2-a307-d5efd4b20b60.aspx
  
4362ComplementaryandIntegrativeHealthServices12.00.03gMiscellaneous (12)12.00.03g12.00.0378256c85-c80a-49b2-a307-d5efd4b20b60Complementary and Integrative Health ServicesComplementary and Integrative Health Services
548dc3c9-5890-41ab-9876-91c5c8624a2a.aspx
  
4367CompleteDecongestiveTherapy(CDT)07.06.01bMedicine (07)07.06.01b07.06.01548dc3c9-5890-41ab-9876-91c5c8624a2aComplete Decongestive Therapy (CDT)Complete Decongestive Therapy (CDT)
6c8a40e6-70ca-4754-af6a-14bd7b400f2a.aspx
  
5093CompositeTissueAllotransplantationoftheHand(s)andFace11.14.30Surgery (11)11.14.3011.14.306c8a40e6-70ca-4754-af6a-14bd7b400f2aComposite Tissue Allotransplantation of the Hand(s) and FaceComposite Tissue Allotransplantation of the Hand(s) and Face
0b35e902-f311-4dd7-8f3b-a7219d7413c3.aspx
  
5249CompressionGarments05.00.37gDME (05)05.00.37g05.00.370b35e902-f311-4dd7-8f3b-a7219d7413c3Compression 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
55481cd2-1b4b-4a4f-abf8-325c47863fc0.aspx
  
5076Computer-assistedMusculoskeletalSurgicalNavigationalOrthopedicProcedure11.14.17eSurgery (11)11.14.17e11.14.1755481cd2-1b4b-4a4f-abf8-325c47863fc0Computer-assisted Musculoskeletal Surgical Navigational Orthopedic ProcedureComputer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
fa3b31f7-c0c1-46d2-9619-2f49ae0825f7.aspx
  
5083ConsultationServices00.01.69bAdministrative (00)00.01.69b00.01.69fa3b31f7-c0c1-46d2-9619-2f49ae0825f7Consultation ServicesConsultation Services
59bf419b-18ab-4008-accf-9b541d9bdb26.aspx
  
5140ContactLensesfortheTreatmentofPersistent(Corneal)EpithelialDefects07.13.11kMedicine (07)07.13.11k07.13.1159bf419b-18ab-4008-accf-9b541d9bdb26Contact Lenses for the Treatment of Persistent (Corneal) Epithelial DefectsContact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
{"5141": {"Id":5141,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7217,"PolicyAttachmentPageName":"8be86c4f-061e-4c60-8520-fdeb5207de44"},}
12ca4dc2-6f5b-4375-a86a-975789fb3469.aspx
  
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
abc9baf4-9e1b-4c13-bb6f-f5f65d443558.aspx
  
4382CornealPachymetryUsingUltrasound07.13.07lMedicine (07)07.13.07l07.13.07abc9baf4-9e1b-4c13-bb6f-f5f65d443558Corneal Pachymetry Using UltrasoundCorneal Pachymetry Using Ultrasound
{"4383": {"Id":4383,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":6351,"PolicyAttachmentPageName":"d6fb930e-4bdf-47c7-afb2-9a67e3a91d0b"},}
b9702be8-f4d4-41a6-bbe6-b60213ba8e7d.aspx
  
4858CosmeticProcedures12.01.03aMiscellaneous (12)12.01.03a12.01.03b9702be8-f4d4-41a6-bbe6-b60213ba8e7dCosmetic ProceduresCosmetic Procedures
072a0de7-2e59-41ad-89a2-b7782f792901.aspx
  
5256CoverageofAnticancerPrescriptionOralandInjectableDrugsandBiologicsandSupportiveAgents08.01.08lPharmacy (08)08.01.08l08.01.08072a0de7-2e59-41ad-89a2-b7782f792901Coverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive AgentsCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents
{}
14669bc5-097a-4a2c-bbf0-82a2e0da5a62.aspx
  
3720CoverageofMedicalDevices05.00.04eDME (05)05.00.04e05.00.0414669bc5-097a-4a2c-bbf0-82a2e0da5a62Coverage of Medical DevicesCoverage of Medical Devices
8a359129-cc17-465a-8d22-11ea6180520f.aspx
  
4764CranialElectrotherapyStimulation05.00.80cDME (05)05.00.80c05.00.808a359129-cc17-465a-8d22-11ea6180520fCranial Electrotherapy StimulationCranial Electrotherapy Stimulation
7e785865-c0c4-4961-9889-fb84775ccd4b.aspx
  
5172CranialRemoldingOrthoses(Helmets)05.00.25iDME (05)05.00.25i05.00.257e785865-c0c4-4961-9889-fb84775ccd4bCranial 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
f423a983-9d7b-4fc7-ae6a-2af4409adf66.aspx
  
5079crizanlizumab-tmca(Adakveo®)08.00.04Pharmacy (08)08.00.0408.00.04f423a983-9d7b-4fc7-ae6a-2af4409adf66crizanlizumab-tmca (Adakveo®)crizanlizumab-tmca (Adakveo®)
f1cff10d-b7bc-40e7-b5db-a6fe5f3bf3f2.aspx
  
4370CryosurgicalAblationoftheProstateGland11.11.03dSurgery (11)11.11.03d11.11.03f1cff10d-b7bc-40e7-b5db-a6fe5f3bf3f2Cryosurgical Ablation of the Prostate GlandCryosurgical Ablation of the Prostate Gland
bac83114-7a60-4245-84f3-bd19dc5948d3.aspx
  
4558Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro®)08.01.29jPharmacy (08)08.01.29j08.01.29bac83114-7a60-4245-84f3-bd19dc5948d3Daratumumab (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
d42f70a6-a972-422f-9fc4-142aa04bdff1.aspx
  
5125DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNails11.08.17kSurgery (11)11.08.17k11.08.17d42f70a6-a972-422f-9fc4-142aa04bdff1Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
{"5126": {"Id":5126,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":7200,"PolicyAttachmentPageName":"56d13ffe-d9ac-4d35-ab1d-18449a04914d"},"5127": {"Id":5127,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":7201,"PolicyAttachmentPageName":"f0919ea2-26c8-4fde-8f96-fb6302d2c684"},"5128": {"Id":5128,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":7202,"PolicyAttachmentPageName":"1e791c22-0b98-449d-9e3a-71ca1ac1b1a6"},"5129": {"Id":5129,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":7203,"PolicyAttachmentPageName":"6d4c7c59-658d-475a-8e9c-eb7c4300c94b"},"5130": {"Id":5130,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":7204,"PolicyAttachmentPageName":"d0339e3b-5a2e-4ff9-ac14-fe15ec87bc41"},}
afe27d48-50e6-4968-855d-e0fab6fa9e13.aspx
  
5200DeepBrainStimulation(DBS)11.15.20rSurgery (11)11.15.20r11.15.20afe27d48-50e6-4968-855d-e0fab6fa9e13Deep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)
7ad193a1-4356-4c00-8be7-6d555ca8dcee.aspx
  
5240DenervationoftheSpinalNervesforChronicPain(AmerihealthAdministrators)11.15.09pSurgery (11)11.15.09p11.15.097ad193a1-4356-4c00-8be7-6d555ca8dceeDenervation of the Spinal Nerves for Chronic Pain (Amerihealth Administrators)Denervation of the Spinal Nerves for Chronic Pain (Amerihealth Administrators)
a59431fc-4e4a-4555-bd20-86abeafad4c3.aspx
  
4262Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)08.00.94pPharmacy (08)08.00.94p08.00.94a59431fc-4e4a-4555-bd20-86abeafad4c3Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)
{"4263": {"Id":4263,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":6188,"PolicyAttachmentPageName":"0aaab259-024d-41d0-8f45-e4c2db3936e2"},}
2952bd67-7274-4c9d-adf0-b1cfb5131637.aspx
  
5000DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplasty11.16.01jSurgery (11)11.16.01j11.16.012952bd67-7274-4c9d-adf0-b1cfb5131637Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
34cffd2e-5f5c-447d-95c6-4f2546aea666.aspx
  
5005DiagnosticRadiologyServicesIncludedinCapitation00.03.02adAdministrative (00)00.03.02ad00.03.0234cffd2e-5f5c-447d-95c6-4f2546aea666Diagnostic Radiology Services Included in CapitationDiagnostic Radiology Services Included in Capitation
{"5006": {"Id":5006,"MPAttachmentLetter":"A","Title":"Diagnostic Radiology Procedure Codes Included in Capitation for Pennsylvania (PA) Health Maintenance Organization (HMO) Members","MPPolicyAttachmentInternalSourceId":7126,"PolicyAttachmentPageName":"41cccf03-47bb-4b9f-85ec-a3da4e01e20e"},}
1 - 100Next