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f9cd203a-79ff-4e2b-a528-de895e67a9d1.aspx
  
1330Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028jPharmacy (08)MA08.028jMA08.028f9cd203a-79ff-4e2b-a528-de895e67a9d1Abatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use
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1198AbortionMA11.010dSurgery (11)MA11.010dMA11.010cc1a6539-080b-46db-b903-d4804467b8faAbortionAbortion
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1704AcupunctureMA12.004eMiscellaneous (12)MA12.004eMA12.004ca5cf4f3-f26b-440a-9861-5d6da4e8efe2AcupunctureAcupuncture
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969AcuteCareFacilityInpatientTransfersMA12.003bMiscellaneous (12)MA12.003bMA12.00340a201d5-c72e-4858-8d07-5423c65af08dAcute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers
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1255ADAMTS13,recombinant-krhn(Adzynma)MA08.171Pharmacy (08)MA08.171MA08.17195b7c282-9261-42ad-8df3-2ab8f462523cADAMTS13, recombinant-krhn (Adzynma)ADAMTS13, recombinant-krhn (Adzynma)
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856Ado-TrastuzumabEmtansine(Kadcyla®)MA08.066gPharmacy (08)MA08.066gMA08.066c16fa0c8-7e0b-41bf-b18d-34c34971191fAdo-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"},}
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1302Agalsidasebeta(Fabrazyme)andpegunigalsidasealfa-iwxj(Elfabrio)MA08.033dPharmacy (08)MA08.033dMA08.0339bf1af05-ecaf-480f-a925-78a3aef533fdAgalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio)Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio)
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1148AirAmbulanceServicesMA12.007bMiscellaneous (12)MA12.007bMA12.00766c3e611-3717-4969-b891-61d21233a143Air Ambulance ServicesAir Ambulance Services
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977Alemtuzumab(Lemtrada®)MA08.015dPharmacy (08)MA08.015dMA08.015cd081d46-88c8-49fc-9358-495cc20afd4aAlemtuzumab (Lemtrada®)Alemtuzumab (Lemtrada®)
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993Alglucosidasealfa(e.g.,Lumizyme®),Avalglucosidasealfa-ngpt(Nexviazyme®),Cipaglucosidasealfa-atga(Pombiliti™)MA08.036gPharmacy (08)MA08.036gMA08.036ae9a96dd-7fcc-42dd-8131-748117e301e2Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )
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1024AllergyImmunotherapyMA07.055dMedicine (07)MA07.055dMA07.0557c1d9cf9-dd9c-4e19-924e-ad01a9b72bdaAllergy ImmunotherapyAllergy Immunotherapy
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1011Alpha1-AntitrypsinTherapy(e.g.,Prolastin-C,AralastNP,Glassia,Zemaira)MA08.050bPharmacy (08)MA08.050bMA08.05093d63acf-a8cc-41bc-a2c5-18238795ccfbAlpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)
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1708AlwaysBundledProcedureCodesMA00.026wAdministrative (00)MA00.026wMA00.0263ddbe79c-6739-4e25-8e95-871ee34e6801Always Bundled Procedure CodesAlways Bundled Procedure Codes
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829AmbulatoryBloodPressureMonitoring(ABPM)andHomeBloodPressureMonitoring(HBPM)DevicesMA07.005cMedicine (07)MA07.005cMA07.0050965b016-d0af-46b4-8b97-9e4f7af19146Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) DevicesAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
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1661AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026qMedicine (07)MA07.026qMA07.026d4dffffb-7db2-46a1-9bbf-5698edaed2d8Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
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1081Amivantamab-vmjw(Rybrevant®)MA08.148aPharmacy (08)MA08.148aMA08.14882bf3454-ff11-494a-82fc-4a277c9e2c6cAmivantamab-vmjw (Rybrevant®)Amivantamab-vmjw (Rybrevant®)
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1369AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008cAnesthesia (01)MA01.008cMA01.0085342b2c3-d175-483e-bbfd-63d920366304Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint ManagementAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management
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1137Anifrolumab-fnia(Saphnelo®)MA08.140cPharmacy (08)MA08.140cMA08.140ffb29139-c6b9-4389-9ceb-5670bc56e674Anifrolumab-fnia (Saphnelo®)Anifrolumab-fnia (Saphnelo®)
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928Ankle-Foot/Knee-Ankle-FootOrthosesMA05.010jDME (05)MA05.010jMA05.0103279c85b-4f6c-4134-87cb-1c314c3f60c0Ankle-Foot/Knee-Ankle-Foot OrthosesAnkle-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"},}
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165ApheresisTherapyMA06.001ePathology and Laboratory (06)MA06.001eMA06.00183351e2c-0a5c-49e3-bca7-f333d1078e85Apheresis TherapyApheresis Therapy
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1542Apos®biomechanicalshoesystemMA05.070DME (05)MA05.070MA05.070e3f4b785-821c-42a7-b608-7cfe7f542a0aApos® biomechanical shoe systemApos® biomechanical shoe system
c3542857-3c91-4a43-90c5-1f396b6d349e.aspx
  
798ApplicationandRemovalofTattoosMA11.072Surgery (11)MA11.072MA11.072c3542857-3c91-4a43-90c5-1f396b6d349eApplication and Removal of TattoosApplication and Removal of Tattoos
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1089AqueousShunts,Microstents,Viscocanalostomy,andCanaloplastyfortheTreatmentofGlaucomaMA11.105jSurgery (11)MA11.105jMA11.105e09477ca-37b6-4df8-949c-3203118199dbAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaAqueous 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"},}
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1673AsparaginaseErwiniaChrysanthemi(recombinant)-rywn(Rylaze®)MA08.085iPharmacy (08)MA08.085iMA08.08546d052a1-42e0-4afc-b47d-746e3ba72aa7Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)
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1671Atezolizumab(Tecentriq®)andAtezolizumabwithHyaluronidase-tqjs(TecentriqHybrezaTM)MA08.127dPharmacy (08)MA08.127dMA08.1275673ea03-86e3-4be3-a736-0a64f04760acAtezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)
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1078AuricularProsthesesMA05.068DME (05)MA05.068MA05.0681196f21f-3450-490c-852b-febc54f66776Auricular ProsthesesAuricular Prostheses
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1538AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)MA05.005gDME (05)MA05.005gMA05.0057bca59ad-97e6-4ed3-b236-0734deceedf7Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
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1382AutonomicNervousSystemTestingMA07.027gMedicine (07)MA07.027gMA07.027ccbfb000-08b5-4105-8b07-392f2718ff25Autonomic Nervous System TestingAutonomic Nervous System Testing
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1621Avelumab(Bavencio®)MA08.122dPharmacy (08)MA08.122dMA08.1226a987f55-f913-4da6-88e6-62b7b311252cAvelumab (Bavencio®)Avelumab (Bavencio®)
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1496BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisorRecurrentAcuteRhinosinusitisMA11.100fSurgery (11)MA11.100fMA11.10073bad694-cd52-4998-8556-2034b60e2675Balloon 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
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1069Belimumab(Benlysta®)forIntravenousUseMA08.057dPharmacy (08)MA08.057dMA08.057ea8f920a-fc0b-497b-ad5e-a25e4944e36fBelimumab (Benlysta®) for Intravenous UseBelimumab (Benlysta®) for Intravenous Use
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1603Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072oPharmacy (08)MA08.072oMA08.072e4ff28c3-83f1-406d-9641-86b5d2ff1b53Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
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35BillingforProfessionalOffice-BasedServicesPerformedinanOutpatientOffice-BasedSettingLocatedwithinaFacilityoronaFacilityCampusMA00.037lAdministrative (00)MA00.037lMA00.037a943aaee-c928-4c2c-beee-17218edad0c2Billing 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
{"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"},}
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1133BiofeedbackTherapyMA07.010cMedicine (07)MA07.010cMA07.0109092ab12-85f9-4db7-af18-4a5b65ba07f0Biofeedback TherapyBiofeedback Therapy
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1292BioimpedancefortheDetectionofLymphedemaMA07.052Medicine (07)MA07.052MA07.0527afcb7bb-2baf-4668-9a41-2b522051ffecBioimpedance for the Detection of LymphedemaBioimpedance for the Detection of Lymphedema
21145f4c-ee33-4aad-917a-30695c515a2d.aspx
  
1532Blinatumomab(Blincyto®)MA08.058gPharmacy (08)MA08.058gMA08.05821145f4c-ee33-4aad-917a-30695c515a2dBlinatumomab (Blincyto®) Blinatumomab (Blincyto®)
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989Bone-Anchored(Osseointegrated)HearingAidsandImplantableMiddleEarHearingAidsMA11.049gSurgery (11)MA11.049gMA11.0492098fab0-09bc-4325-aba2-2b77632a83b2Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
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1052BotulinumToxinAgentsMA08.017kPharmacy (08)MA08.017kMA08.017caa652b3-02e8-4521-bb10-d3acd06f60d9Botulinum Toxin AgentsBotulinum Toxin Agents
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1549BrentuximabVedotin(Adcetris®)MA08.068kPharmacy (08)MA08.068kMA08.068c104ca59-b0c0-4ba7-9b1c-853112eb5e7fBrentuximab Vedotin (Adcetris®)Brentuximab Vedotin (Adcetris®)
{"1550": {"Id":1550,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":9002,"PolicyAttachmentPageName":"dc4f21e7-0c13-4061-afec-f7eb829ab68e"},}
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1067BronchialValvesMA11.020Surgery (11)MA11.020MA11.02062a855de-c1ea-4d37-9b01-a8d408546250Bronchial ValvesBronchial Valves
cd48927f-ea18-4d21-a20f-fc64084e9fb2.aspx
  
1025Burosumab-twza(Crysvita®)MA08.099bPharmacy (08)MA08.099bMA08.099cd48927f-ea18-4d21-a20f-fc64084e9fb2Burosumab-twza (Crysvita®)Burosumab-twza (Crysvita®)
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1608Canakinumab(Ilaris®)MA08.101cPharmacy (08)MA08.101cMA08.10124718575-f0ad-4bb7-a298-4cf311b11f9bCanakinumab (Ilaris®)Canakinumab (Ilaris®)
{"1609": {"Id":1609,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":9271,"PolicyAttachmentPageName":"26c77500-4891-4873-9e46-706be27bdbd2"},}
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769CanesandCrutchesMA05.052bDME (05)MA05.052bMA05.05290be0df6-4917-4222-a90b-99f6461b61f8Canes and CrutchesCanes and Crutches
dabf0152-819f-40c4-8150-035de6fa9461.aspx
  
788CapsuleEndoscopyMA07.022eMedicine (07)MA07.022eMA07.022dabf0152-819f-40c4-8150-035de6fa9461Capsule EndoscopyCapsule Endoscopy
955aca1a-8275-47f3-9a8f-0f6d2682d8eb.aspx
  
851CardiacRehabilitation(CR)andIntensiveCardiacRehabilitation(ICR)ProgramsMA10.002fRehabilitation Services (10)MA10.002fMA10.002955aca1a-8275-47f3-9a8f-0f6d2682d8ebCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) ProgramsCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
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1707CareManagementandCarePlanningServicesMA00.006oAdministrative (00)MA00.006oMA00.006baf706da-50b3-4865-aaca-f619ddd95374Care Management and Care Planning ServicesCare Management and Care Planning Services
5a2dd532-c36f-483f-9348-8600916ede19.aspx
  
1548Carfilzomib(Kyprolis®)MA08.062jPharmacy (08)MA08.062jMA08.0625a2dd532-c36f-483f-9348-8600916ede19Carfilzomib (Kyprolis®)Carfilzomib (Kyprolis®)
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1321CastandSplintApplicationsandAssociatedSuppliesMA00.012cAdministrative (00)MA00.012cMA00.012baa5f89e-a39b-4277-bc0d-25cb3c212674Cast and Splint Applications and Associated SuppliesCast 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"},}
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1138CataractSurgeryMA11.054eSurgery (11)MA11.054eMA11.0546d9edd1a-96ab-4fe5-b196-e98b567febd4Cataract SurgeryCataract Surgery
{"1139": {"Id":1139,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8500,"PolicyAttachmentPageName":"2c59af64-e765-49f6-a784-b795ea526113"},}
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1652CatheterAblationofCardiacArrhythmiasMA11.060hSurgery (11)MA11.060hMA11.060f43f47dc-2ebc-4123-9180-843422b7186bCatheter Ablation of Cardiac ArrhythmiasCatheter Ablation of Cardiac Arrhythmias
96b211e5-6d32-4c5f-b8af-35d9af3bde2f.aspx
  
1553Cemiplimab-rwlc(Libtayo®)MA08.124dPharmacy (08)MA08.124dMA08.12496b211e5-6d32-4c5f-b8af-35d9af3bde2fCemiplimab-rwlc (Libtayo®)Cemiplimab-rwlc (Libtayo®)
8136c93c-9de8-4cec-be5d-15788042a569.aspx
  
1570Cerliponasealfa(Brineura®)MA08.089dPharmacy (08)MA08.089dMA08.0898136c93c-9de8-4cec-be5d-15788042a569Cerliponase 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"},}
8c9283e5-d136-42ad-9c04-beff05592e40.aspx
  
1611CervicalTractionDevicesforIn-homeUseMA05.009bDME (05)MA05.009bMA05.0098c9283e5-d136-42ad-9c04-beff05592e40Cervical Traction Devices for In-home UseCervical Traction Devices for In-home Use
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819Cetuximab(Erbitux®)MA08.031gPharmacy (08)MA08.031gMA08.031a1c42244-6455-4cc1-8f06-d27da3998595Cetuximab (Erbitux®)Cetuximab (Erbitux®)
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1427ChemicalPeelsMA11.103bSurgery (11)MA11.103bMA11.103867f33b5-7c1c-44d5-b3a7-7681208400e1Chemical PeelsChemical Peels
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1646ChimericAntigenReceptor(CAR)TherapyMA08.093oPharmacy (08)MA08.093oMA08.093a424c297-ea16-4d99-a1fc-abafe3958e6dChimeric Antigen Receptor (CAR) TherapyChimeric Antigen Receptor (CAR) Therapy
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1610CoagulationFactorsMA08.004wPharmacy (08)MA08.004wMA08.004ba5308b2-33de-4fef-b3be-67ac62a9b3c2Coagulation FactorsCoagulation Factors
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1212Cobalamin(VitaminB12),FolicAcid,andHomocysteineTestingMA06.032aPathology and Laboratory (06)MA06.032aMA06.032ad839354-6971-41a0-8d01-ad241d09fb08Cobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
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918CochlearImplantationMA11.039eSurgery (11)MA11.039eMA11.0394a37023a-9005-494a-b45d-e871483492b0Cochlear ImplantationCochlear Implantation
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800Collagenaseclostridiumhistolyticum(Xiaflex®),collagenaseclostridiumhistolyticum-aaes(Qwo®)MA08.128Pharmacy (08)MA08.128MA08.128fee78a0b-02d4-430c-b646-cfac446d41a4Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
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783CommodeChairsMA05.036bDME (05)MA05.036bMA05.03637a80c47-f90c-47ee-b58c-d4b25d90306dCommode ChairsCommode Chairs
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1065ComplementaryandIntegrativeHealthServicesMA12.001eMiscellaneous (12)MA12.001eMA12.0012b9ece34-5173-46a4-821e-fa55c65cd42aComplementary and Integrative Health ServicesComplementary and Integrative Health Services
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1245CompleteDecongestiveTherapy(CDT)MA07.042Medicine (07)MA07.042MA07.042432753c6-2f7e-4a74-9757-7fee1ebd8168Complete Decongestive Therapy (CDT)Complete Decongestive Therapy (CDT)
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920CompositeTissueAllotransplantationoftheHand(s)andFaceMA11.112Surgery (11)MA11.112MA11.1126c2c276e-9fa3-429e-bc58-9a5ee9545ebaComposite Tissue Allotransplantation of the Hand(s) and FaceComposite Tissue Allotransplantation of the Hand(s) and Face
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1119CompressionGarmentsMA05.045eDME (05)MA05.045eMA05.04516c95899-4a2d-4018-ae58-6808e5ab1663Compression GarmentsCompression Garments
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1300Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014bRadiology (09)MA09.014bMA09.014a3add4cc-055a-4e9d-9dfc-2b2c583f3862Computer-Aided Detection (CAD) System for Use with Chest RadiographsComputer-Aided Detection (CAD) System for Use with Chest Radiographs
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828Computer-AssistedMusculoskeletalSurgicalNavigationalOrthopedicProcedureMA11.088cSurgery (11)MA11.088cMA11.088f59aa164-15c2-44b7-bbf6-da50748c61ccComputer-Assisted Musculoskeletal Surgical Navigational Orthopedic ProcedureComputer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
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1072ConsultationServicesMA00.049bAdministrative (00)MA00.049bMA00.04981badbcb-c683-4b9d-a96f-79d468315497Consultation ServicesConsultation Services
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1634ContinuousGlucoseMonitorsandHomeBloodGlucoseMonitorsandSuppliesMA00.002qAdministrative (00)MA00.002qMA00.0024dea1ca1-1d9c-4591-bc3f-6f63bd34d8dbContinuous Glucose Monitors and Home Blood Glucose Monitors and SuppliesContinuous Glucose Monitors and Home Blood Glucose Monitors and Supplies
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43ContrastAgentsUsedinConjunctionwithEchocardiographyMA09.004cRadiology (09)MA09.004cMA09.0043f09acf7-614c-4f2a-8b31-3aeb51979ec9Contrast Agents Used in Conjunction with EchocardiographyContrast Agents Used in Conjunction with Echocardiography
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1163CornealPachymetryUsingUltrasoundMA07.046gMedicine (07)MA07.046gMA07.04634c18a0b-a842-405a-8e20-c6cadd85ed9eCorneal Pachymetry Using UltrasoundCorneal Pachymetry Using Ultrasound
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802CosmeticProceduresMA12.009aMiscellaneous (12)MA12.009aMA12.0092c6f102c-dd07-432d-8393-709313f4074fCosmetic ProceduresCosmetic Procedures
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1506CoverageofMedicalDevicesMA05.040bDME (05)MA05.040bMA05.0406c112be2-1a7e-41f5-904b-82a4223bec8bCoverage of Medical DevicesCoverage of Medical Devices
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1130CranialElectrotherapyStimulationMA05.066dDME (05)MA05.066dMA05.066e50b9ce8-e5d2-4d1b-8d9d-90ad574baf5dCranial Electrotherapy StimulationCranial Electrotherapy Stimulation
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1555CriteriaforReimbursementofEmergencyRoomServicesMA00.044dAdministrative (00)MA00.044dMA00.044cc15a385-6a4a-4ac8-9be9-35719baa321bCriteria for Reimbursement of Emergency Room ServicesCriteria for Reimbursement of Emergency Room Services
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1095crizanlizumab-tmca(Adakveo®) MA08.109bPharmacy (08)MA08.109bMA08.109ab27d4c8-099c-4c4c-80d4-c47744de1a1fcrizanlizumab-tmca (Adakveo®) crizanlizumab-tmca (Adakveo®)
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1602Crovalimab-akkz(PiaSky)MA08.178Pharmacy (08)MA08.178MA08.1787537366c-2749-4ef1-9800-d753b3903800Crovalimab-akkz (PiaSky) Crovalimab-akkz (PiaSky)
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1237CryosurgicalAblationoftheProstateGlandMA11.022aSurgery (11)MA11.022aMA11.022770940e9-38a5-45bf-b7fb-0210a5cbab36Cryosurgical Ablation of the Prostate GlandCryosurgical Ablation of the Prostate Gland
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1276Daratumumab(Darzalex®),DaratumumabandHyaluronidase-fihj(DarzalexFaspro®)MA08.079lPharmacy (08)MA08.079lMA08.079c59bbcae-3c42-4cb4-9f47-846763ab2714Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)Daratumumab (Darzalex®), Daratumumab and Hyaluronidase-fihj (Darzalex Faspro®)
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1478DayRehabilitationMA10.005bRehabilitation Services (10)MA10.005bMA10.005b77328f5-879d-4c4f-9440-7bf227a4df4eDay RehabilitationDay Rehabilitation
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1017DebridementofMycoticandSymptomaticNon-MycoticHypertrophicToeNailsMA11.014gSurgery (11)MA11.014gMA11.01425099058-e04b-498b-8894-0c8703c311acDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
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1030DeepBrainStimulation(DBS)MA11.005hSurgery (11)MA11.005hMA11.0059d327dba-7bcb-4d59-8996-78341f24833fDeep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)
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1396Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)MA08.052mPharmacy (08)MA08.052mMA08.052a438eb90-4c60-48ff-8f69-c9d64b3382abDenosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)
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1374DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099eSurgery (11)MA11.099eMA11.0996d686768-2451-450f-b5ff-39c3d07a51bdDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
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471DirectAccesstoObstetrics/Gynecology(OB/GYN)ServicesMA00.032fAdministrative (00)MA00.032fMA00.03274bdf09b-06a0-450c-9fc7-1faf0d609876Direct Access to Obstetrics/Gynecology (OB/GYN) ServicesDirect Access to Obstetrics/Gynecology (OB/GYN) Services
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1597DirectEndoscopicNecrosectomy(DEN)fortheTreatmentofPancreaticNecrosisMA11.115Surgery (11)MA11.115MA11.115bd96e219-dbb7-4a2d-8759-1897b4ce0ab6Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic NecrosisDirect Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis
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847Dofetilide(Tikosyn®)UseintheInpatientSettingMA08.021cPharmacy (08)MA08.021cMA08.021751d409f-6fce-4dab-82fb-40fc562dcc1aDofetilide (Tikosyn®) Use in the Inpatient SettingDofetilide (Tikosyn®) Use in the Inpatient Setting
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858Dostarlimab-gxly(Jemperli)MA08.136ePharmacy (08)MA08.136eMA08.13682beb3a6-44d4-4115-ad2a-e541d322be71Dostarlimab-gxly (Jemperli)Dostarlimab-gxly (Jemperli)
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1501Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesMA07.041cMedicine (07)MA07.041cMA07.0416313f185-3f19-4b75-9ec3-10abc52ba10aDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic MalignanciesDrug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
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1451DurableMedicalEquipment(DME)MA05.044rDME (05)MA05.044rMA05.0448c6e11cf-96e5-477c-ac28-403034852274Durable Medical Equipment (DME)Durable Medical Equipment (DME)
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1507DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028eDME (05)MA05.028eMA05.0287961a20b-70b6-4d08-a362-6da61ef8bc97Durable Medical Equipment (DME) Not Subject to a Rental to Purchase MaximumDurable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
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1058Durvalumab(Imfinzi®)andTremelimumab-actl(Imjudo®)MA08.123dPharmacy (08)MA08.123dMA08.123e60e2d1d-5090-4238-8d74-da8a5ec7603fDurvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)Durvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)
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1651Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)forintravenousadministrationMA08.044jPharmacy (08)MA08.044jMA08.044bab97c43-a2f5-461e-b1d8-09895c62c3a5Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous  administrationEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration
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1194Efbemalenograstimalfa-vuxw(Ryzneuta®),Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082mPharmacy (08)MA08.082mMA08.0822ae1a68f-6b24-4058-a7e5-752694e1bad9Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related BiosimilarsEfbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars
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796ElectricalStimulationandElectromagneticStimulationfortheTreatmentofWoundsMA07.013dMedicine (07)MA07.013dMA07.013a55b92be-6ad0-472a-8d6a-13d0781e56e9Electrical Stimulation and Electromagnetic Stimulation for the Treatment of WoundsElectrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
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1023ElectroconvulsiveTherapy(ECT)MA14.001aBehavioral Health (14)MA14.001aMA14.001f73a7df3-34fc-47eb-8984-ac387c1eddadElectroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)
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865Electromyography(EMG)Studies,NerveConductionStudies(NCS),andRelatedElectrodiagnosticStudiesMA07.050lMedicine (07)MA07.050lMA07.0505b2eb4f4-dae8-4896-8a84-fbbd7970c94cElectromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic StudiesElectromyography (EMG) Studies, Nerve Conduction Studies (NCS), and Related Electrodiagnostic Studies
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