|  | | 145 | Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028i | Pharmacy (08) | MA08.028i | MA08.028 | c78d0ed5-4c6d-433d-9d8b-657b147bdc85 | Abatacept (Orencia®) for Injection for Intravenous Use | Abatacept (Orencia®) for Injection for Intravenous Use | {"146": {"Id":146,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":8069,"PolicyAttachmentPageName":"705b0f4d-bdae-4d04-b698-60c380139510"},} |
| | | 1198 | AbortionMA11.010d | Surgery (11) | MA11.010d | MA11.010 | cc1a6539-080b-46db-b903-d4804467b8fa | Abortion | Abortion | |
| | | 794 | AcupunctureMA12.004c | Miscellaneous (12) | MA12.004c | MA12.004 | 5f7e1494-96da-48b4-93ce-192427fc02d6 | Acupuncture | Acupuncture | {"795": {"Id":795,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Acupuncture","MPPolicyAttachmentInternalSourceId":8418,"PolicyAttachmentPageName":"45106d8a-e91c-408b-a6a9-2e5abbed8714"},} |
| | | 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"},} |
| | | 445 | Agalsidasebeta(Fabrazyme®)MA08.033c | Pharmacy (08) | MA08.033c | MA08.033 | cebae34d-a86a-4fd1-8dcf-98a57f509ee7 | Agalsidase beta (Fabrazyme®) | Agalsidase beta (Fabrazyme®) | |
| | | 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) | |
| | | 1205 | AlwaysBundledProcedureCodesMA00.026u | Administrative (00) | MA00.026u | MA00.026 | fb0415f4-080c-4653-a23c-1a905adb9d8c | Always Bundled Procedure Codes | Always Bundled Procedure Codes | {"1206": {"Id":1206,"MPAttachmentLetter":"B","Title":"Procedures/Services Not Eligible for Separate Reimbursement","MPPolicyAttachmentInternalSourceId":8885,"PolicyAttachmentPageName":"95a4adf3-a80b-4af7-b254-7eb0523a6255"},"1207": {"Id":1207,"MPAttachmentLetter":"C","Title":"Procedures/Services Not Eligible for Reimbursement","MPPolicyAttachmentInternalSourceId":8886,"PolicyAttachmentPageName":"6469baf9-9e77-41b2-9d57-aa669ad62642"},"1208": {"Id":1208,"MPAttachmentLetter":"A","Title":"Always Bundled Procedures (MPFSD Indicator B)","MPPolicyAttachmentInternalSourceId":8887,"PolicyAttachmentPageName":"b2c47111-f459-4d10-9217-7d758f68bbd8"},} |
| | | 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 | |
| | | 873 | AmbulatoryElectrocardiography(AECG)MonitoringandMobileCardiacOutpatientTelemetry(MCOT)MonitoringMA07.026p | Medicine (07) | MA07.026p | MA07.026 | 74d09c5f-1f0d-4d2b-b995-f8fc6198197a | 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®) | |
| | | 1123 | AnesthesiaServicesforEpidural,ParavertebralFacetandSacroiliacJointInjectionsforSpinalJointManagementMA01.008b | Anesthesia (01) | MA01.008b | MA01.008 | 9ff8c92f-88b3-41bb-9512-a104871610a8 | 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 | |
| | | 618 | Apos®biomechanicalshoesystemMA05.070 | DME (05) | MA05.070 | MA05.070 | 47c99712-e793-41e9-896f-5bb670f548c6 | 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"},} |
| | | 515 | ArtificialIntervertebralLumbarDiscInsertionMA11.114b | Surgery (11) | MA11.114b | MA11.114 | 5fa4dad7-a936-4c6f-b09e-1871181da1f7 | Artificial Intervertebral Lumbar Disc Insertion | Artificial Intervertebral Lumbar Disc Insertion | |
| | | 90 | AsparaginaseErwiniaChrysanthemi(Erwinaze®),asparaginaseerwiniachrysanthemi(recombinant)-rywn(Rylaze®)MA08.085g | Pharmacy (08) | MA08.085g | MA08.085 | bbb2ec04-6a36-462b-b4e8-4bf1b585ef3a | Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®) | Asparaginase Erwinia Chrysanthemi (Erwinaze®), asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze®) | |
| | | 174 | Atezolizumab(Tecentriq®)MA08.127c | Pharmacy (08) | MA08.127c | MA08.127 | 470a7101-b73c-4c56-a95d-c6d00feed802 | Atezolizumab (Tecentriq®) | Atezolizumab (Tecentriq®) | {"175": {"Id":175,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7935,"PolicyAttachmentPageName":"2a674725-e065-4aeb-ac7d-90d71ca86c29"},} |
| | | 1078 | AuricularProsthesesMA05.068 | DME (05) | MA05.068 | MA05.068 | 1196f21f-3450-490c-852b-febc54f66776 | Auricular Prostheses | Auricular Prostheses | |
| | | 176 | AutomaticExternalCardioverterDefibrillators(WearableandNonwearable)MA05.005g | DME (05) | MA05.005g | MA05.005 | fd4b92c2-e09e-49c1-aade-91437bc8c2ef | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | Automatic External Cardioverter Defibrillators (Wearable and Nonwearable) | {"177": {"Id":177,"MPAttachmentLetter":"B","Title":"ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":7940,"PolicyAttachmentPageName":"5626697d-c6b7-4906-8ce9-5f2f089769ae"},"178": {"Id":178,"MPAttachmentLetter":"A","Title":"ICD-10 codes used to represent the Wearable Automatic External Defibrillator (AED):","MPPolicyAttachmentInternalSourceId":7941,"PolicyAttachmentPageName":"b841973a-3d60-4fd9-913e-342663acb136"},} |
| | | 970 | AutonomicNervousSystemTestingMA07.027f | Medicine (07) | MA07.027f | MA07.027 | 395653c6-5556-4b09-8bb6-9f5cbb54d2dd | Autonomic Nervous System Testing | Autonomic Nervous System Testing | |
| | | 739 | Avelumab(Bavencio®)MA08.122c | Pharmacy (08) | MA08.122c | MA08.122 | 65770840-7606-4b9c-9fc4-1a8d5cdf6a68 | Avelumab (Bavencio®) | Avelumab (Bavencio®) | {"740": {"Id":740,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":8158,"PolicyAttachmentPageName":"0ce161e8-c92b-462c-933c-0a3ed2885ae9"},} |
| | | 453 | BalloonCatheterDilationofSinusOstiaforTreatmentofChronicRhinosinusitisMA11.100e | Surgery (11) | MA11.100e | MA11.100 | 4ec6f182-b318-469b-b306-43eb105418a4 | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis | Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic 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 | |
| | | 435 | Bevacizumab(Avastin®)andRelatedBiosimilarsForOncologicUseMA08.072m | Pharmacy (08) | MA08.072m | MA08.072 | 0cef7ca4-a77e-4393-ae91-438493192dbe | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | {"436": {"Id":436,"MPAttachmentLetter":"B","Title":"ICD 10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":8155,"PolicyAttachmentPageName":"fdf5c494-26dc-4cd0-b7ad-c7d899f1080d"},"437": {"Id":437,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements","MPPolicyAttachmentInternalSourceId":8156,"PolicyAttachmentPageName":"f2633c9a-36db-450b-b34b-725a855121ce"},} |
| | | 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 | |
| | | 331 | Blepharoplasty,RepairofBlepharoptosis,RepairofBrowPtosis,andCanthoplasty/CanthopexyMA11.047d | Surgery (11) | MA11.047d | MA11.047 | cec9b72e-baaf-485a-bae9-786ae6020695 | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy | {"332": {"Id":332,"MPAttachmentLetter":"A","Title":"ICD-10 Coding","MPPolicyAttachmentInternalSourceId":7944,"PolicyAttachmentPageName":"8e4d325e-184b-4d8e-b3a9-f6949a3156f7"},} |
| | | 454 | Blinatumomab(Blincyto®)MA08.058f | Pharmacy (08) | MA08.058f | MA08.058 | a4c5d6e6-affe-4ced-8308-084c9c9be6b4 | 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"},} |
| | | 728 | BrentuximabVedotin(Adcetris®)MA08.068i | Pharmacy (08) | MA08.068i | MA08.068 | 6b7ada7d-6cf4-4a75-b3ca-73aa5c8dc08e | Brentuximab Vedotin (Adcetris®) | Brentuximab Vedotin (Adcetris®) | {"729": {"Id":729,"MPAttachmentLetter":"A","Title":"ICD 10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7785,"PolicyAttachmentPageName":"b95f3feb-558a-4cbb-996f-e24227c06f0f"},} |
| | | 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®) | |
| | | 67 | Canakinumab(Ilaris®)MA08.101b | Pharmacy (08) | MA08.101b | MA08.101 | 65d5da76-4026-4359-8b9f-bb8e36f6d124 | Canakinumab (Ilaris®) | Canakinumab (Ilaris®) | |
| | | 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"},} |
| | | 758 | CareManagementandCarePlanningServicesMA00.006n | Administrative (00) | MA00.006n | MA00.006 | 01b0b8c2-eef7-4039-99cd-dae23b2c63e8 | Care Management and Care Planning Services | Care Management and Care Planning Services | |
| | | 637 | Carfilzomib(Kyprolis)MA08.062h | Pharmacy (08) | MA08.062h | MA08.062 | e398b664-20bc-4529-b33b-7b500da57db8 | Carfilzomib (Kyprolis) | Carfilzomib (Kyprolis) | |
| | | 39 | CastandSplintApplicationsandAssociatedSuppliesMA00.012c | Administrative (00) | MA00.012c | MA00.012 | bda6ce16-012b-4729-b2f6-1fc760164679 | Cast and Splint Applications and Associated Supplies | Cast and Splint Applications and Associated Supplies | {"40": {"Id":40,"MPAttachmentLetter":"A","Title":"Procedures Related to Cast and Splint Applications and Associated Supplies","MPPolicyAttachmentInternalSourceId":7876,"PolicyAttachmentPageName":"a3deedd4-346e-4c65-8ee1-a2d2b106ff2e"},} |
| | | 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"},} |
| | | 334 | CatheterAblationofCardiacArrhythmiasMA11.060g | Surgery (11) | MA11.060g | MA11.060 | ff571ab5-803e-4115-98d9-d2bedd280117 | Catheter Ablation of Cardiac Arrhythmias | Catheter Ablation of Cardiac Arrhythmias | |
| | | 181 | Cemiplimab-rwlc(Libtayo®)MA08.124c | Pharmacy (08) | MA08.124c | MA08.124 | 6ea90eb0-52f4-4d24-a70d-9dac5c7c22de | Cemiplimab-rwlc (Libtayo®) | Cemiplimab-rwlc (Libtayo®) | |
| | | 580 | Cerliponasealfa(Brineura®)MA08.089c | Pharmacy (08) | MA08.089c | MA08.089 | b45f74bc-8810-436d-bb2c-24e6eadc8335 | Cerliponase alfa (Brineura®) | Cerliponase alfa (Brineura®) | |
| | | 182 | CervicalTractionDevicesforIn-homeUseMA05.009a | DME (05) | MA05.009a | MA05.009 | 78002a30-681b-4bd3-806f-5801a06f1502 | 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"},} |
| | | 183 | ChemicalPeelsMA11.103b | Surgery (11) | MA11.103b | MA11.103 | 0ba008b1-a216-4c89-b43e-259b874b6c3a | Chemical Peels | Chemical Peels | |
| | | 1199 | ChimericAntigenReceptor(CAR)TherapyMA08.093m | Pharmacy (08) | MA08.093m | MA08.093 | 6cb6213d-3eac-4680-af56-f20612814462 | Chimeric Antigen Receptor (CAR) Therapy | Chimeric Antigen Receptor (CAR) Therapy | {"1200": {"Id":1200,"MPAttachmentLetter":"A","Title":"ICD 10 codes","MPPolicyAttachmentInternalSourceId":8758,"PolicyAttachmentPageName":"6c83a308-cb90-46fd-ad78-c07c77a71140"},} |
| | | 964 | ChiropracticServicesMA10.004i | Rehabilitation Services (10) | MA10.004i | MA10.004 | 1bf4f989-e8fe-478c-92dc-271df20e0080 | Chiropractic Services | Chiropractic Services | |
| | | 732 | CoagulationFactorsMA08.004v | Pharmacy (08) | MA08.004v | MA08.004 | 3859f8b4-b0b8-4620-9793-5a2ea6ac6b4b | 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 | |
| | | 526 | Computer-AidedDetection(CAD)SystemforUsewithChestRadiographsMA09.014a | Radiology (09) | MA09.014a | MA09.014 | 82f2160d-33d0-469b-b1c2-239300eb08d2 | 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 | |
| | | 1201 | ContinuousGlucoseMonitorsandHomeBloodGlucoseMonitorsandSuppliesMA00.002n | Administrative (00) | MA00.002n | MA00.002 | c62eacf7-b9ac-4786-ae54-8ad08ae59765 | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies | {"1202": {"Id":1202,"MPAttachmentLetter":"B","Title":"Implantable Continuous Glucose Monitors (I-CGM)","MPPolicyAttachmentInternalSourceId":8695,"PolicyAttachmentPageName":"c8a0ec87-1235-43fb-bbdf-3d90c7dadabb"},"1203": {"Id":1203,"MPAttachmentLetter":"A","Title":"ICD10: Long-Term Interstitial CGMS (Non-Implantable)","MPPolicyAttachmentInternalSourceId":8696,"PolicyAttachmentPageName":"9e7ba912-0457-4a52-88c0-e9ad00c52a5e"},} |
| | | 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 | |
| | | 44 | CoverageofMedicalDevicesMA05.040b | DME (05) | MA05.040b | MA05.040 | f151966a-f669-4fce-8e49-d7196d0d9f9e | 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 | |
| | | 59 | CriteriaforReimbursementofEmergencyRoomServicesMA00.044c | Administrative (00) | MA00.044c | MA00.044 | 4acb8b84-82bc-4376-ab34-107802217c38 | 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®) | |
| | | 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®) | |
| | | 108 | DayRehabilitationMA10.005b | Rehabilitation Services (10) | MA10.005b | MA10.005 | 5e5c8ce3-3dcb-444d-b62e-fbcdb2662295 | 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) | |
| | | 737 | Denosumab(Prolia®,Xgeva®),Romosozumab-aqqg(Evenity®)MA08.052l | Pharmacy (08) | MA08.052l | MA08.052 | b358a612-f04d-4a19-99a7-ec3c067e5a8c | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®) | {"738": {"Id":738,"MPAttachmentLetter":"A","Title":"ICD-10-CM Codes","MPPolicyAttachmentInternalSourceId":8083,"PolicyAttachmentPageName":"74fffa12-d524-4d17-a075-0dd00ea4f1cf"},} |
| | | 1016 | DermabrasionforRhinophyma,Septoplasty,Rhinoplasty,andSeptorhinoplastyMA11.099d | Surgery (11) | MA11.099d | MA11.099 | 3c5ac79a-6f80-4d16-a9f3-c17ec4eb6b75 | 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 | |
| | | 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) | |
| | | 213 | Drug-ElutingBeadsandBlandEmbolizationfortheTreatmentofHepaticMalignanciesPolicyMA07.041b | Medicine (07) | MA07.041b | MA07.041 | 62806d68-7113-4dd0-99ad-63300f2caadb | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies Policy | Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies Policy | |
| | | 1045 | DurableMedicalEquipment(DME)MA05.044q | DME (05) | MA05.044q | MA05.044 | abab7a6b-65ff-499f-8b8a-3c671a8f5cd1 | Durable Medical Equipment (DME) | Durable Medical Equipment (DME) | {"1046": {"Id":1046,"MPAttachmentLetter":"B","Title":"Items that Do Not Meet the Definition of Durable Medical Equipment (DME) or Excluded from Coverage by Medicare","MPPolicyAttachmentInternalSourceId":8660,"PolicyAttachmentPageName":"6c5dfb28-e630-463c-bc89-9f6c7b8ba7e1"},"1047": {"Id":1047,"MPAttachmentLetter":"A2","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":8661,"PolicyAttachmentPageName":"55901395-ea8b-4d5a-b225-ea80f0eb0b0b"},"1048": {"Id":1048,"MPAttachmentLetter":"A1","Title":"Equipment that Meets the Definition of Durable Medical Equipment (DME)","MPPolicyAttachmentInternalSourceId":8662,"PolicyAttachmentPageName":"11f3ca81-e5af-4e23-8b90-22e3df6b6cc0"},} |
| | | 452 | DurableMedicalEquipment(DME)NotSubjecttoaRentaltoPurchaseMaximumMA05.028e | DME (05) | MA05.028e | MA05.028 | 50b2766c-5a1a-42e1-a4b6-ab406b5e5ea8 | 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"},} |
| | | 1083 | Eculizumab(Soliris®)andRelatedBiosimilars,Ravulizumab-cwvz(Ultomiris™)forintravenousadministrationMA08.044i | Pharmacy (08) | MA08.044i | MA08.044 | b09db9e1-3fa2-424c-bc53-43e20eeaad7f | 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"},} |
| | | 702 | Efgartigimodalfa-fcab(Vyvgart)andefgartigimodalfaandhyaluronidase-qvfc(VyvgartHytrulo)MA08.142c | Pharmacy (08) | MA08.142c | MA08.142 | 9d401399-9ec9-40b4-a531-cd73ddaf3b29 | 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™) | |
