| | | 1330 | Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028j | Pharmacy (08) | MA08.028j | MA08.028 | f9cd203a-79ff-4e2b-a528-de895e67a9d1 | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"1331": {"Id":1331,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8939,"PolicyAttachmentPageName":"4a383499-d68a-41de-adf6-497f157070a6"},} |
| | | 1198 | AbortionMA11.010d | Surgery (11) | MA11.010d | MA11.010 | cc1a6539-080b-46db-b903-d4804467b8fa | Abortion | Abortion | |
| | | 1704 | AcupunctureMA12.004e | Miscellaneous (12) | MA12.004e | MA12.004 | ca5cf4f3-f26b-440a-9861-5d6da4e8efe2 | Acupuncture | Acupuncture | {"1705": {"Id":1705,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":9336,"PolicyAttachmentPageName":"9510ffe2-ac98-4597-b49c-fd1cd86428f2"},} |
| | | 969 | AcuteCareFacilityInpatientTransfersMA12.003b | Miscellaneous (12) | MA12.003b | MA12.003 | 40a201d5-c72e-4858-8d07-5423c65af08d | Acute Care Facility Inpatient Transfers | Acute Care Facility Inpatient Transfers | |
| | | 1255 | ADAMTS13,recombinant-krhn(Adzynma)MA08.171 | Pharmacy (08) | MA08.171 | MA08.171 | 95b7c282-9261-42ad-8df3-2ab8f462523c | ADAMTS13, recombinant-krhn (Adzynma) | ADAMTS13, recombinant-krhn (Adzynma) | |
| | | 856 | Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066g | Pharmacy (08) | MA08.066g | MA08.066 | c16fa0c8-7e0b-41bf-b18d-34c34971191f | Ado-Trastuzumab Emtansine (Kadcyla®) | Ado-Trastuzumab Emtansine (Kadcyla®) | {"857": {"Id":857,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":8440,"PolicyAttachmentPageName":"62ca80d5-8705-423a-8dd1-972f9aa029b6"},} |
| | | 1302 | Agalsidasebeta(Fabrazyme)andpegunigalsidasealfa-iwxj(Elfabrio)MA08.033d | Pharmacy (08) | MA08.033d | MA08.033 | 9bf1af05-ecaf-480f-a925-78a3aef533fd | Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | |
| | | 1148 | AirAmbulanceServicesMA12.007b | Miscellaneous (12) | MA12.007b | MA12.007 | 66c3e611-3717-4969-b891-61d21233a143 | Air Ambulance Services | Air Ambulance Services | |
| | | 977 | Alemtuzumab(Lemtrada®)MA08.015d | Pharmacy (08) | MA08.015d | MA08.015 | cd081d46-88c8-49fc-9358-495cc20afd4a | Alemtuzumab (Lemtrada®) | Alemtuzumab (Lemtrada®) | |
| | | 993 | Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)MA08.036g | Pharmacy (08) | MA08.036g | MA08.036 | ae9a96dd-7fcc-42dd-8131-748117e301e2 | 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™ ) | |
| | | 1024 | AllergyImmunotherapyMA07.055d | Medicine (07) | MA07.055d | MA07.055 | 7c1d9cf9-dd9c-4e19-924e-ad01a9b72bda | Allergy Immunotherapy | Allergy Immunotherapy | |
| | | 1011 | Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050b | Pharmacy (08) | MA08.050b | MA08.050 | 93d63acf-a8cc-41bc-a2c5-18238795ccfb | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira) | |
| | | 1708 | AlwaysBundledProcedureCodesMA00.026w | Administrative (00) | MA00.026w | MA00.026 | 3ddbe79c-6739-4e25-8e95-871ee34e6801 | Always Bundled Procedure Codes | Always Bundled Procedure Codes | {"1709": {"Id":1709,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":9403,"PolicyAttachmentPageName":"5ef96895-5230-44ac-adf4-62f31184485b"},"1710": {"Id":1710,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (MPFSD Indicator B)","MPPolicyAttachmentInternalSourceId":9404,"PolicyAttachmentPageName":"f6de9ff6-d4ce-4691-aabc-aa8edd6b02d3"},"1711": {"Id":1711,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":9405,"PolicyAttachmentPageName":"6b882ed8-503d-42cd-aa82-b2986aab2f32"},} |
| | | 829 | AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005c | Medicine (07) | MA07.005c | MA07.005 | 0965b016-d0af-46b4-8b97-9e4f7af19146 | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices | |
| | | 1661 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026q | Medicine (07) | MA07.026q | MA07.026 | d4dffffb-7db2-46a1-9bbf-5698edaed2d8 | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring | |
| | | 1081 | Amivantamab-vmjw(Rybrevant®)MA08.148a | Pharmacy (08) | MA08.148a | MA08.148 | 82bf3454-ff11-494a-82fc-4a277c9e2c6c | Amivantamab-vmjw (Rybrevant®) | Amivantamab-vmjw (Rybrevant®) | |
| | | 1369 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008c | Anesthesia (01) | MA01.008c | MA01.008 | 5342b2c3-d175-483e-bbfd-63d920366304 | 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 | {} |
| | | 1137 | Anifrolumab-fnia(Saphnelo®)MA08.140c | Pharmacy (08) | MA08.140c | MA08.140 | ffb29139-c6b9-4389-9ceb-5670bc56e674 | Anifrolumab-fnia (Saphnelo®) | Anifrolumab-fnia (Saphnelo®) | |
| | | 928 | Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010j | DME (05) | MA05.010j | MA05.010 | 3279c85b-4f6c-4134-87cb-1c314c3f60c0 | Ankle-Foot/Knee-Ankle-Foot Orthoses | Ankle-Foot/Knee-Ankle-Foot Orthoses | {"929": {"Id":929,"MPAttachmentLetter":"A","Title":"HCPCS CODES FOR ANKLE-FOOT/ KNEE-ANKLE FOOT ORTHOSIS","MPPolicyAttachmentInternalSourceId":8451,"PolicyAttachmentPageName":"9fca7e50-d4e4-4ead-a708-5f649d046039"},} |
| | | 165 | ApheresisTherapyMA06.001e | Pathology and Laboratory (06) | MA06.001e | MA06.001 | 83351e2c-0a5c-49e3-bca7-f333d1078e85 | Apheresis Therapy | Apheresis Therapy | |
| | | 1542 | Apos®biomechanicalshoesystemMA05.070 | DME (05) | MA05.070 | MA05.070 | e3f4b785-821c-42a7-b608-7cfe7f542a0a | Apos® biomechanical shoe system | Apos® biomechanical shoe system | |
| | | 798 | ApplicationandRemovalofTattoosMA11.072 | Surgery (11) | MA11.072 | MA11.072 | c3542857-3c91-4a43-90c5-1f396b6d349e | Application and Removal of Tattoos | Application and Removal of Tattoos | |
| | | 1089 | AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105j | Surgery (11) | MA11.105j | MA11.105 | e09477ca-37b6-4df8-949c-3203118199db | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma | {"1090": {"Id":1090,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":8592,"PolicyAttachmentPageName":"c47da178-16d6-48ea-a433-139702744bf4"},} |
| | | 1673 | AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)MA08.085i | Pharmacy (08) | MA08.085i | MA08.085 | 46d052a1-42e0-4afc-b47d-746e3ba72aa7 | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®) | |
| | | 1671 | Atezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybrezaTM)MA08.127d | Pharmacy (08) | MA08.127d | MA08.127 | 5673ea03-86e3-4be3-a736-0a64f04760ac | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM) | {"1672": {"Id":1672,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9179,"PolicyAttachmentPageName":"2b3c9364-3beb-4628-9330-738c9a0568d4"},} |
| | | 1078 | AuricularProsthesesMA05.068 | DME (05) | MA05.068 | MA05.068 | 1196f21f-3450-490c-852b-febc54f66776 | Auricular Prostheses | Auricular Prostheses | |
| | | 1538 | AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)MA05.005g | DME (05) | MA05.005g | MA05.005 | 7bca59ad-97e6-4ed3-b236-0734deceedf7 | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"1539": {"Id":1539,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9243,"PolicyAttachmentPageName":"d72dfbd3-bbf6-4c8a-86b6-ee92332afa6d"},"1540": {"Id":1540,"MPAttachmentLetter":"A","Title":"ICD-10 codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":9244,"PolicyAttachmentPageName":"f77c87fe-25f6-4007-9f44-52fb84821a3d"},} |
| | | 1382 | AutonomicNervousSystemTestingMA07.027g | Medicine (07) | MA07.027g | MA07.027 | ccbfb000-08b5-4105-8b07-392f2718ff25 | Autonomic Nervous System Testing | Autonomic Nervous System Testing | |
| | | 1621 | Avelumab(Bavencio®)MA08.122d | Pharmacy (08) | MA08.122d | MA08.122 | 6a987f55-f913-4da6-88e6-62b7b311252c | Avelumab (Bavencio®) | Avelumab (Bavencio®) | {"1622": {"Id":1622,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9268,"PolicyAttachmentPageName":"90877462-36a1-41c2-ab95-3654a49366d5"},} |
| | | 1496 | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisorRecurrentAcuteRhinosinusitisMA11.100f | Surgery (11) | MA11.100f | MA11.100 | 73bad694-cd52-4998-8556-2034b60e2675 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis | |
| | | 1069 | Belimumab(Benlysta®)forIntravenousUseMA08.057d | Pharmacy (08) | MA08.057d | MA08.057 | ea8f920a-fc0b-497b-ad5e-a25e4944e36f | Belimumab (Benlysta®) for Intravenous Use | Belimumab (Benlysta®) for Intravenous Use | |
| | | 1603 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072o | Pharmacy (08) | MA08.072o | MA08.072 | e4ff28c3-83f1-406d-9641-86b5d2ff1b53 | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"1604": {"Id":1604,"MPAttachmentLetter":"A","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":9219,"PolicyAttachmentPageName":"de59b461-e300-469f-8fcd-afe265d2bc65"},} |
| | | 35 | BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037l | Administrative (00) | MA00.037l | MA00.037 | a943aaee-c928-4c2c-beee-17218edad0c2 | 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 | {"36": {"Id":36,"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 - CPT/HCPCS Codes","MPPolicyAttachmentInternalSourceId":7873,"PolicyAttachmentPageName":"a514181b-b263-4d9c-88cf-7d960f6de980"},} |
| | | 1133 | BiofeedbackTherapyMA07.010c | Medicine (07) | MA07.010c | MA07.010 | 9092ab12-85f9-4db7-af18-4a5b65ba07f0 | Biofeedback Therapy | Biofeedback Therapy | |
| | | 1292 | BioimpedancefortheDetectionofLymphedemaMA07.052 | Medicine (07) | MA07.052 | MA07.052 | 7afcb7bb-2baf-4668-9a41-2b522051ffec | Bioimpedance for the Detection of Lymphedema | Bioimpedance for the Detection of Lymphedema | |
| | | 1532 | Blinatumomab(Blincyto®)MA08.058g | Pharmacy (08) | MA08.058g | MA08.058 | 21145f4c-ee33-4aad-917a-30695c515a2d | Blinatumomab (Blincyto®) | Blinatumomab (Blincyto®) | |
| | | 989 | Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049g | Surgery (11) | MA11.049g | MA11.049 | 2098fab0-09bc-4325-aba2-2b77632a83b2 | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids | |
| | | 1052 | BotulinumToxinAgentsMA08.017k | Pharmacy (08) | MA08.017k | MA08.017 | caa652b3-02e8-4521-bb10-d3acd06f60d9 | Botulinum Toxin Agents | Botulinum Toxin Agents | {"1053": {"Id":1053,"MPAttachmentLetter":"A","Title":"ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":8526,"PolicyAttachmentPageName":"93fad3c1-b2d8-4e73-9603-77cfe0195b84"},} |
| | | 1549 | BrentuximabVedotin(Adcetris®)MA08.068k | Pharmacy (08) | MA08.068k | MA08.068 | c104ca59-b0c0-4ba7-9b1c-853112eb5e7f | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | {"1550": {"Id":1550,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":9002,"PolicyAttachmentPageName":"dc4f21e7-0c13-4061-afec-f7eb829ab68e"},} |
| | | 1067 | BronchialValvesMA11.020 | Surgery (11) | MA11.020 | MA11.020 | 62a855de-c1ea-4d37-9b01-a8d408546250 | Bronchial Valves | Bronchial Valves | |
| | | 1025 | Burosumab-twza(Crysvita®)MA08.099b | Pharmacy (08) | MA08.099b | MA08.099 | cd48927f-ea18-4d21-a20f-fc64084e9fb2 | Burosumab-twza (Crysvita®) | Burosumab-twza (Crysvita®) | |
| | | 1608 | Canakinumab(Ilaris®)MA08.101c | Pharmacy (08) | MA08.101c | MA08.101 | 24718575-f0ad-4bb7-a298-4cf311b11f9b | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | {"1609": {"Id":1609,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9271,"PolicyAttachmentPageName":"26c77500-4891-4873-9e46-706be27bdbd2"},} |
| | | 769 | CanesandCrutchesMA05.052b | DME (05) | MA05.052b | MA05.052 | 90be0df6-4917-4222-a90b-99f6461b61f8 | Canes and Crutches | Canes and Crutches | |
| | | 788 | CapsuleEndoscopyMA07.022e | Medicine (07) | MA07.022e | MA07.022 | dabf0152-819f-40c4-8150-035de6fa9461 | Capsule Endoscopy | Capsule Endoscopy | |
| | | 851 | CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002f | Rehabilitation Services (10) | MA10.002f | MA10.002 | 955aca1a-8275-47f3-9a8f-0f6d2682d8eb | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs | {"852": {"Id":852,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":8306,"PolicyAttachmentPageName":"4ede227c-bda6-49e3-b3b9-29b56415b1bf"},} |
| | | 1707 | CareManagementandCarePlanningServicesMA00.006o | Administrative (00) | MA00.006o | MA00.006 | baf706da-50b3-4865-aaca-f619ddd95374 | Care Management and Care Planning Services | Care Management and Care Planning Services | |
| | | 1548 | Carfilzomib(Kyprolis®)MA08.062j | Pharmacy (08) | MA08.062j | MA08.062 | 5a2dd532-c36f-483f-9348-8600916ede19 | Carfilzomib (Kyprolis®) | Carfilzomib (Kyprolis®) | |
| | | 1321 | CastandSplintApplicationsandAssociatedSuppliesMA00.012c | Administrative (00) | MA00.012c | MA00.012 | baa5f89e-a39b-4277-bc0d-25cb3c212674 | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"1322": {"Id":1322,"MPAttachmentLetter":"A","Title":"Procedures Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":8998,"PolicyAttachmentPageName":"f1396f83-4def-4eb7-b446-324bb3d5d1dd"},} |
| | | 1138 | CataractSurgeryMA11.054e | Surgery (11) | MA11.054e | MA11.054 | 6d9edd1a-96ab-4fe5-b196-e98b567febd4 | Cataract Surgery | Cataract Surgery | {"1139": {"Id":1139,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8500,"PolicyAttachmentPageName":"2c59af64-e765-49f6-a784-b795ea526113"},} |
| | | 1652 | CatheterAblationofCardiacArrhythmiasMA11.060h | Surgery (11) | MA11.060h | MA11.060 | f43f47dc-2ebc-4123-9180-843422b7186b | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | |
| | | 1553 | Cemiplimab-rwlc(Libtayo®)MA08.124d | Pharmacy (08) | MA08.124d | MA08.124 | 96b211e5-6d32-4c5f-b8af-35d9af3bde2f | Cemiplimab-rwlc (Libtayo®) | Cemiplimab-rwlc (Libtayo®) | |
| | | 1570 | Cerliponasealfa(Brineura®)MA08.089d | Pharmacy (08) | MA08.089d | MA08.089 | 8136c93c-9de8-4cec-be5d-15788042a569 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | {"1571": {"Id":1571,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Cerliponase alfa (Brineura®)","MPPolicyAttachmentInternalSourceId":9270,"PolicyAttachmentPageName":"e68f969d-b0be-41fc-812a-b94d6ef808bc"},} |
| | | 1611 | CervicalTractionDevicesforIn-homeUseMA05.009b | DME (05) | MA05.009b | MA05.009 | 8c9283e5-d136-42ad-9c04-beff05592e40 | Cervical Traction Devices for In-home Use | Cervical Traction Devices for In-home Use | |
| | | 819 | Cetuximab(Erbitux®)MA08.031g | Pharmacy (08) | MA08.031g | MA08.031 | a1c42244-6455-4cc1-8f06-d27da3998595 | Cetuximab (Erbitux®) | Cetuximab (Erbitux®) | {"820": {"Id":820,"MPAttachmentLetter":"B","Title":"ICD-10 Codes for Cetuximab (Erbitux®)","MPPolicyAttachmentInternalSourceId":8348,"PolicyAttachmentPageName":"4bf0f992-d194-4a0c-b3e0-a79e4c2dee09"},"821": {"Id":821,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":8349,"PolicyAttachmentPageName":"1d86ffe4-e62b-444e-b83b-8e7083c04732"},} |
| | | 1427 | ChemicalPeelsMA11.103b | Surgery (11) | MA11.103b | MA11.103 | 867f33b5-7c1c-44d5-b3a7-7681208400e1 | Chemical Peels | Chemical Peels | |
| | | 1646 | ChimericAntigenReceptor(CAR)TherapyMA08.093o | Pharmacy (08) | MA08.093o | MA08.093 | a424c297-ea16-4d99-a1fc-abafe3958e6d | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | {"1647": {"Id":1647,"MPAttachmentLetter":"A","Title":"ICD 10 codes","MPPolicyAttachmentInternalSourceId":9355,"PolicyAttachmentPageName":"d85427bb-eb6c-49e7-9e19-bc1d9ae7ea57"},} |
| | | 964 | ChiropracticServicesMA10.004i | Rehabilitation Services (10) | MA10.004i | MA10.004 | 1bf4f989-e8fe-478c-92dc-271df20e0080 | Chiropractic Services | Chiropractic Services | |
| | | 1610 | CoagulationFactorsMA08.004w | Pharmacy (08) | MA08.004w | MA08.004 | ba5308b2-33de-4fef-b3be-67ac62a9b3c2 | Coagulation Factors | Coagulation Factors | |
| | | 1212 | Cobalamin(VitaminB12),FolicAcid,andHomocysteineTestingMA06.032a | Pathology and Laboratory (06) | MA06.032a | MA06.032 | ad839354-6971-41a0-8d01-ad241d09fb08 | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing | {"1213": {"Id":1213,"MPAttachmentLetter":"A","Title":"ICD 10 CODES FOR MEDICALLY NECESSARY COBALAMIN (VITAMIN B12), FOLIC ACID, AND/OR HOMOCYSTEINE TESTING (CPT CODES 82607, 82746, AND 83090)","MPPolicyAttachmentInternalSourceId":8881,"PolicyAttachmentPageName":"431da55a-4535-4af0-8bec-654d3a0b6a0b"},} |
| | | 918 | CochlearImplantationMA11.039e | Surgery (11) | MA11.039e | MA11.039 | 4a37023a-9005-494a-b45d-e871483492b0 | Cochlear Implantation | Cochlear Implantation | |
| | | 800 | Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)MA08.128 | Pharmacy (08) | MA08.128 | MA08.128 | fee78a0b-02d4-430c-b646-cfac446d41a4 | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®) | |
| | | 783 | CommodeChairsMA05.036b | DME (05) | MA05.036b | MA05.036 | 37a80c47-f90c-47ee-b58c-d4b25d90306d | Commode Chairs | Commode Chairs | |
| | | 1065 | ComplementaryandIntegrativeHealthServicesMA12.001e | Miscellaneous (12) | MA12.001e | MA12.001 | 2b9ece34-5173-46a4-821e-fa55c65cd42a | Complementary and Integrative Health Services | Complementary and Integrative Health Services | |
| | | 1245 | CompleteDecongestiveTherapy(CDT)MA07.042 | Medicine (07) | MA07.042 | MA07.042 | 432753c6-2f7e-4a74-9757-7fee1ebd8168 | Complete Decongestive Therapy (CDT) | Complete Decongestive Therapy (CDT) | |
| | | 920 | CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112 | Surgery (11) | MA11.112 | MA11.112 | 6c2c276e-9fa3-429e-bc58-9a5ee9545eba | Composite Tissue Allotransplantation of the Hand(s) and Face | Composite Tissue Allotransplantation of the Hand(s) and Face | |
| | | 1119 | CompressionGarmentsMA05.045e | DME (05) | MA05.045e | MA05.045 | 16c95899-4a2d-4018-ae58-6808e5ab1663 | Compression Garments | Compression Garments | |
| | | 1300 | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014b | Radiology (09) | MA09.014b | MA09.014 | a3add4cc-055a-4e9d-9dfc-2b2c583f3862 | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | Computer-Aided Detection (CAD) System for Use with Chest Radiographs | |
| | | 828 | Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088c | Surgery (11) | MA11.088c | MA11.088 | f59aa164-15c2-44b7-bbf6-da50748c61cc | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure | |
| | | 1072 | ConsultationServicesMA00.049b | Administrative (00) | MA00.049b | MA00.049 | 81badbcb-c683-4b9d-a96f-79d468315497 | Consultation Services | Consultation Services | |
| | | 1634 | ContinuousGlucoseMonitorsandHomeBloodGlucoseMonitorsandSuppliesMA00.002q | Administrative (00) | MA00.002q | MA00.002 | 4dea1ca1-1d9c-4591-bc3f-6f63bd34d8db | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | {"1635": {"Id":1635,"MPAttachmentLetter":"B","Title":"Implantable Continuous Glucose Monitors (I-CGM)","MPPolicyAttachmentInternalSourceId":9369,"PolicyAttachmentPageName":"bf432957-35b7-4151-a1b0-94f2b8787e4e"},"1636": {"Id":1636,"MPAttachmentLetter":"A","Title":"ICD10: Long-Term Interstitial CGMS (Non-Implantable)","MPPolicyAttachmentInternalSourceId":9370,"PolicyAttachmentPageName":"9ccad97f-5010-44b5-a1e1-395df8bf63e1"},} |
| | | 43 | ContrastAgentsUsedinConjunctionwithEchocardiographyMA09.004c | Radiology (09) | MA09.004c | MA09.004 | 3f09acf7-614c-4f2a-8b31-3aeb51979ec9 | Contrast Agents Used in Conjunction with Echocardiography | Contrast Agents Used in Conjunction with Echocardiography | |
| | | 1163 | CornealPachymetryUsingUltrasoundMA07.046g | Medicine (07) | MA07.046g | MA07.046 | 34c18a0b-a842-405a-8e20-c6cadd85ed9e | Corneal Pachymetry Using Ultrasound | Corneal Pachymetry Using Ultrasound | {"1164": {"Id":1164,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes Eligible to be Reported for Corneal Pachymetry Using Ultrasound","MPPolicyAttachmentInternalSourceId":8840,"PolicyAttachmentPageName":"93a2eb6e-392e-4fb6-ac7c-b826ebf7060b"},} |
| | | 802 | CosmeticProceduresMA12.009a | Miscellaneous (12) | MA12.009a | MA12.009 | 2c6f102c-dd07-432d-8393-709313f4074f | Cosmetic Procedures | Cosmetic Procedures | |
| | | 1506 | CoverageofMedicalDevicesMA05.040b | DME (05) | MA05.040b | MA05.040 | 6c112be2-1a7e-41f5-904b-82a4223bec8b | Coverage of Medical Devices | Coverage of Medical Devices | |
| | | 1130 | CranialElectrotherapyStimulationMA05.066d | DME (05) | MA05.066d | MA05.066 | e50b9ce8-e5d2-4d1b-8d9d-90ad574baf5d | Cranial Electrotherapy Stimulation | Cranial Electrotherapy Stimulation | |
| | | 1555 | CriteriaforReimbursementofEmergencyRoomServicesMA00.044d | Administrative (00) | MA00.044d | MA00.044 | cc15a385-6a4a-4ac8-9be9-35719baa321b | Criteria for Reimbursement of Emergency Room Services | Criteria for Reimbursement of Emergency Room Services | |
| | | 1095 | crizanlizumab-tmca(Adakveo®) MA08.109b | Pharmacy (08) | MA08.109b | MA08.109 | ab27d4c8-099c-4c4c-80d4-c47744de1a1f | crizanlizumab-tmca (Adakveo®) | crizanlizumab-tmca (Adakveo®) | |
| | | 1602 | Crovalimab-akkz(PiaSky)MA08.178 | Pharmacy (08) | MA08.178 | MA08.178 | 7537366c-2749-4ef1-9800-d753b3903800 | Crovalimab-akkz (PiaSky) | Crovalimab-akkz (PiaSky) | |
| | | 1237 | CryosurgicalAblationoftheProstateGlandMA11.022a | Surgery (11) | MA11.022a | MA11.022 | 770940e9-38a5-45bf-b7fb-0210a5cbab36 | Cryosurgical Ablation of the Prostate Gland | Cryosurgical Ablation of the Prostate Gland | |
| | | 1276 | Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)MA08.079l | Pharmacy (08) | MA08.079l | MA08.079 | c59bbcae-3c42-4cb4-9f47-846763ab2714 | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®) | |
| | | 1478 | DayRehabilitationMA10.005b | Rehabilitation Services (10) | MA10.005b | MA10.005 | b77328f5-879d-4c4f-9440-7bf227a4df4e | Day Rehabilitation | Day Rehabilitation | |
| | | 1017 | DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014g | Surgery (11) | MA11.014g | MA11.014 | 25099058-e04b-498b-8894-0c8703c311ac | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails | {"1018": {"Id":1018,"MPAttachmentLetter":"E","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (S86.892A - Z79.01), Continued","MPPolicyAttachmentInternalSourceId":8635,"PolicyAttachmentPageName":"1656fe9e-ad44-4804-a38a-6c0444891118"},"1019": {"Id":1019,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (A30.0 -E10.21)","MPPolicyAttachmentInternalSourceId":8636,"PolicyAttachmentPageName":"11bb7228-845a-4176-9455-1dd5fc1b782c"},"1020": {"Id":1020,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E10.22 - E13.3512), Continued","MPPolicyAttachmentInternalSourceId":8639,"PolicyAttachmentPageName":"65dbcfc4-9105-4242-8674-884de088cef1"},"1021": {"Id":1021,"MPAttachmentLetter":"D","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (I87.099 - S86.891S), Continued","MPPolicyAttachmentInternalSourceId":8641,"PolicyAttachmentPageName":"f2e03f20-1120-41a2-b54e-83ea9e582a3f"},"1022": {"Id":1022,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Debridement of mycotic hypertrophic toe nails (E13.3513 - I87.093), Continued","MPPolicyAttachmentInternalSourceId":8644,"PolicyAttachmentPageName":"de9304a6-7103-4a83-9b32-5be6c2db4733"},} |
| | | 1030 | DeepBrainStimulation(DBS)MA11.005h | Surgery (11) | MA11.005h | MA11.005 | 9d327dba-7bcb-4d59-8996-78341f24833f | Deep Brain Stimulation (DBS) | Deep Brain Stimulation (DBS) | |
| | | 1396 | Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)MA08.052m | Pharmacy (08) | MA08.052m | MA08.052 | a438eb90-4c60-48ff-8f69-c9d64b3382ab | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | {"1397": {"Id":1397,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":9057,"PolicyAttachmentPageName":"e8aa76fc-1dcd-4cc5-8b84-2d33304c5098"},} |
| | | 1374 | DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099e | Surgery (11) | MA11.099e | MA11.099 | 6d686768-2451-450f-b5ff-39c3d07a51bd | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty | |
| | | 471 | DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032f | Administrative (00) | MA00.032f | MA00.032 | 74bdf09b-06a0-450c-9fc7-1faf0d609876 | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | Direct Access to Obstetrics/Gynecology (OB/GYN) Services | |
| | | 1597 | DirectEndoscopicNecrosectomy(DEN)fortheTreatmentofPancreaticNecrosisMA11.115 | Surgery (11) | MA11.115 | MA11.115 | bd96e219-dbb7-4a2d-8759-1897b4ce0ab6 | Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis | Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis | |
| | | 847 | Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021c | Pharmacy (08) | MA08.021c | MA08.021 | 751d409f-6fce-4dab-82fb-40fc562dcc1a | Dofetilide (Tikosyn®) Use in the Inpatient Setting | Dofetilide (Tikosyn®) Use in the Inpatient Setting | |
| | | 858 | Dostarlimab-gxly(Jemperli)MA08.136e | Pharmacy (08) | MA08.136e | MA08.136 | 82beb3a6-44d4-4115-ad2a-e541d322be71 | Dostarlimab-gxly (Jemperli) | Dostarlimab-gxly (Jemperli) | |
| | | 1501 | Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041c | Medicine (07) | MA07.041c | MA07.041 | 6313f185-3f19-4b75-9ec3-10abc52ba10a | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies | |
| | | 1451 | DurableMedicalEquipment(DME)MA05.044r | DME (05) | MA05.044r | MA05.044 | 8c6e11cf-96e5-477c-ac28-403034852274 | Durable Medical Equipment (DME) | Durable Medical Equipment (DME) | {"1452": {"Id":1452,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":9181,"PolicyAttachmentPageName":"aa814621-43aa-40ee-9a23-640d161db3a1"},"1453": {"Id":1453,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":9182,"PolicyAttachmentPageName":"a24f78ca-61c0-45ab-b2c3-e16e5d113e0c"},"1454": {"Id":1454,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":9183,"PolicyAttachmentPageName":"442b9bc9-daac-4b5a-99c0-53417f0d4bca"},} |
| | | 1507 | DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028e | DME (05) | MA05.028e | MA05.028 | 7961a20b-70b6-4d08-a362-6da61ef8bc97 | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum | |
| | | 1058 | Durvalumab(Imfinzi®)andTremelimumab-actl(Imjudo®)MA08.123d | Pharmacy (08) | MA08.123d | MA08.123 | e60e2d1d-5090-4238-8d74-da8a5ec7603f | Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) | Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®) | {"1059": {"Id":1059,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":8515,"PolicyAttachmentPageName":"5c48cad9-d592-4d35-b216-c5392eebd130"},} |
| | | 1651 | Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)forintravenousadministrationMA08.044j | Pharmacy (08) | MA08.044j | MA08.044 | bab97c43-a2f5-461e-b1d8-09895c62c3a5 | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration | Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration | |
| | | 1194 | Efbemalenograstimalfa-vuxw(Ryzneuta®),Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082m | Pharmacy (08) | MA08.082m | MA08.082 | 2ae1a68f-6b24-4058-a7e5-752694e1bad9 | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars | {"1195": {"Id":1195,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":8752,"PolicyAttachmentPageName":"4bdddc59-fc86-407e-be6c-910d24083c4e"},} |
| | | 1439 | Efgartigimodalfa-fcab(Vyvgart)andefgartigimodalfaandhyaluronidase-qvfc(VyvgartHytrulo)MA08.142d | Pharmacy (08) | MA08.142d | MA08.142 | 7989c8e0-524a-45f4-8de4-0a624fa1dd92 | Efgartigimod alfa - fcab (Vyvgart) and efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo) | Efgartigimod alfa - fcab (Vyvgart) and efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo) | |
| | | 796 | ElectricalStimulationandElectromagneticStimulationfortheTreatmentofWoundsMA07.013d | Medicine (07) | MA07.013d | MA07.013 | a55b92be-6ad0-472a-8d6a-13d0781e56e9 | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds | {"797": {"Id":797,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":8448,"PolicyAttachmentPageName":"bc9d5cd2-215e-49a4-a8fd-39aea25bfe5b"},} |
| | | 1023 | ElectroconvulsiveTherapy(ECT)MA14.001a | Behavioral Health (14) | MA14.001a | MA14.001 | f73a7df3-34fc-47eb-8984-ac387c1eddad | Electroconvulsive Therapy (ECT) | Electroconvulsive Therapy (ECT) | |
| | | 865 | Electromyography(EMG)Studies,NerveConductionStudies(NCS),andRelatedElectrodiagnosticStudiesMA07.050l | Medicine (07) | MA07.050l | MA07.050 | 5b2eb4f4-dae8-4896-8a84-fbbd7970c94c | Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies | Electromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies | {"866": {"Id":866,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic Studies","MPPolicyAttachmentInternalSourceId":8120,"PolicyAttachmentPageName":"38375e9f-5b33-4cc7-a30e-fa5853aed7fb"},"867": {"Id":867,"MPAttachmentLetter":"D","Title":"ICD-10 Codes - Needle Electromyography for Guidance in Conjunction with Chemodenervation","MPPolicyAttachmentInternalSourceId":8436,"PolicyAttachmentPageName":"551e073c-1c77-42d7-93f9-b88c29738efc"},"868": {"Id":868,"MPAttachmentLetter":"B","Title":"ICD10 Codes - Needle Electromyography and Nerve Conduction Studies","MPPolicyAttachmentInternalSourceId":8441,"PolicyAttachmentPageName":"23be52a8-9a0e-4d4a-861b-f9d1aa616df1"},"869": {"Id":869,"MPAttachmentLetter":"C","Title":"ICD10 Codes - Electromyography of Anal or Urethral Sphincter","MPPolicyAttachmentInternalSourceId":8498,"PolicyAttachmentPageName":"8f609a7a-c5a2-4912-b97a-58215fff334e"},"870": {"Id":870,"MPAttachmentLetter":"E","Title":"ICD10 Codes - Neuromuscular Junction Testing","MPPolicyAttachmentInternalSourceId":8499,"PolicyAttachmentPageName":"965d952f-a21a-4976-9f65-1ac04edb8f9d"},"871": {"Id":871,"MPAttachmentLetter":"F","Title":"ICD10 Codes - Somatosensory Evoked Potentials (SSEPs)","MPPolicyAttachmentInternalSourceId":8502,"PolicyAttachmentPageName":"b5527a94-6a17-4515-888a-c6a7ce1f7273"},} |
| | | 994 | Elranatamab-bcmm(Elrexfio™)MA08.168 | Pharmacy (08) | MA08.168 | MA08.168 | 01b304c6-6552-45f6-bac9-4c42a623f121 | Elranatamab-bcmm (Elrexfio™) | Elranatamab-bcmm (Elrexfio™) | |