Part C Early Intervention

Assistive Technology HCPCS Codes

Effective December 2003 HCPCS Code Description

A0021 Outside state ambulance serv A0030 Air ambulance service A0040 Helicopter ambulance service A0050 Water amb service emergency A0080 Noninterest escort in non er A0090 Interest escort in non er A0100 Nonemergency transport taxi A0110 Nonemergency transport bus A0120 Noner transport mini-bus A0130 Noner transport wheelch van A0140 Nonemergency transport air A0160 Noner transport case worker A0170 Noner transport parking fees A0180 Noner transport lodgng recip A0190 Noner transport meals recip A0200 Noner transport lodgng escrt A0210 Noner transport meals escort A0225 Neonatal emergency transport A0300 Ambulance basic non-emer all A0302 Ambulance basic emergeny all A0304 Amb adv non-er no serv all A0306 Amb adv non-er spec serv all A0308 Amb adv er no spec serv all A0310 Amb adv er spec serv all A0320 Amb basic non-er + supplies A0322 Amb basic emerg + supplies A0324 Adv non-er serv sep mileage A0326 Adv non-er no serv sep mile A0328 Adv er no serv sep mileage A0330 Adv er spec serv sep mile A0340 Amb basic non-er + mileage A0342 Ambul basic emer + mileage A0344 Amb adv non-er no serv +mile A0346 Amb adv non-er serv + mile A0348 Adv emer no spec serv + mile A0350 Adv emer spec serv + mileage A0360 Basic non-er sep mile & supp A0362 Basic emer sep mile & supply A0364 Adv non-er no serv sep mi&su A0366 Adv non-er serv sep mil&supp A0368 Adv er no serv sep mile&supp A0370 Adv er spec serv sep mi&supp A0380 Basic life support mileage A0382 Basic support routine suppls A0384 Bls defibrillation supplies A0390 Advanced life support mileag

A0392 Als defibrillation supplies A0394 Als IV drug therapy supplies A0396 Als esophageal intub suppls A0398 Als routine disposble suppls A0420 Ambulance waiting 1/2 hr A0422 Ambulance 02 life sustaining A0424 Extra ambulance attendant A0888 Noncovered ambulance mileage A0999 Unlisted ambulance service A2000 Chiropractor manip of spine A4190 Transparent film each A4200 Gauze pad medicated/non-med A4202 Elastic gauze roll A4203 Non-elastic gauze roll A4204 Absorptve dressing A4205 Nonabsorptive dressing A4206 1 CC sterile syringe&needle A4207 2 CC sterile syringe&needle A4208 3 CC sterile syringe&needle A4209 5+ CC sterile syringe&needle A4210 Nonneedle injection device A4211 Supp for self-adm injections A4212 Non coring needle or stylet A4213 20+ CC syringe only A4214 30 CC sterile water/saline A4215 Sterile needle A4220 Infusion pump refill kit A4230 Infus insulin pump non needl A4231 Infusion insulin pump needle A4232 Syringe w/needle insulin 3cc A4244 Alcohol or peroxide per pint A4245 Alcohol wipes per box A4246 Betadine/phisohex solution A4247 Betadine/iodine swabs/wipes A4250 Urine reagent strips/tablets A4253 Blood glucose/reagent strips A4254 Battery for glucose monitor A4256 Calibrator solution/chips A4258 Lancet device each A4259 Lancets per box A4260 Levonorgestrel implant A4262 Temporary tear duct plug A4263 Permanent tear duct plug A4265 Paraffin A4270 Disposable endoscope sheath A4300 Cath impl vasc access portal A4301 Implantable access syst perc A4305 Drug delivery system >=50 ML A4306 Drug delivery system <=5 ML A4310 Insert tray w/o bag/cath A4311 Catheter w/o bag 2-way latex A4312 Cath w/o bag 2-way silicone A4313 Catheter w/bag 3-way A4314 Cath w/drainage 2-way latex

A4315 Cath w/drainage 2-way silcne A4316 Cath w/drainage 3-way A4320 Irrigation tray A4322 Irrigation syringe A4323 Saline irrigation solution A4326 Male external catheter A4327 Fem urinary collect dev cup A4328 Fem urinary collect pouch A4329 External catheter start set A4330 Stool collection pouch A4335 Incontinence supply A4338 Indwelling catheter latex A4340 Indwelling catheter special A4344 Cath indw foley 2 way silicn A4346 Cath indw foley 3 way A4347 Male external catheter A4351 Straight tip urine catheter A4352 Coude tip urinary catheter A4354 Cath insertion tray w/bag A4355 Bladder irrigation tubing A4356 Ext ureth clmp or compr dvc A4357 Bedside drainage bag A4358 Urinary leg bag A4359 Urinary suspensory w/o leg b A4361 Ostomy face plate A4362 Solid skin barrier A4363 Liquid skin barrier A4364 Ostomy/cath adhesive A4367 Ostomy belt A4397 Irrigation supply sleeve A4398 Irrigation supply bags A4399 Irrigation supply cone/cathe A4400 Ostomy irrigation set A4402 Lubricant per ounce A4404 Ostomy ring each A4421 Ostomy supply misc A4454 Tape all types all sizes A4455 Adhesive remover per ounce A4460 Elastic compression bandage A4465 Non-elastic extremity binder A4470 Gravlee jet washer A4480 Vabra aspirator A4490 Above knee surgical stocking A4495 Thigh length surg stocking A4500 Below knee surgical stocking A4510 Full length surg stocking A4550 Surgical trays A4554 Disposable underpads A4556 Electrodes A4557 Lead wires A4558 Conductive paste or gel A4560 Pessary A4565 Slings A4570 Splint

A4572 Rib belt A4575 Hyperbaric o2 chamber disps A4580 Cast supplies (plaster) A4581 Risser jacket supplies A4590 Special casting material A4595 TENS suppl 2 lead per month A4610 Med supplies for use in DME A4611 Heavy duty battery A4612 Battery cables A4613 Battery charger A4615 Cannula nasal A4616 Tubing (oxygen) per foot A4617 Mouth piece A4618 Breathing circuits A4619 Face tent A4620 Variable concentration mask A4621 Tracheotomy mask or collar A4622 Tracheostomy or larngectomy A4623 Tracheostomy inner cannula A4624 Tracheal suction tube A4625 Trach care kit for new trach A4626 Tracheostomy cleaning brush A4627 Spacer bag/reservoir A4628 Oropharyngeal suction cath A4629 Tracheostomy care kit A4630 Repl bat t.e.n.s. own by pt A4631 Wheelchair battery A4635 Underarm crutch pad A4636 Handgrip for cane etc A4637 Repl tip cane/crutch/walker A4640 Alternating pressure pad A4641 Diagnostic imaging agent A4642 Satumomab pendetide per dose A4643 High dose contrast MRI A4644 Contrast 100-199 MGs iodine A4645 Contrast 200-299 MGs iodine A4646 Contrast 300-399 MGs iodine A4647 Supp- paramagnetic contr mat A4649 Surgical supplies A4650 Supp esrd centrifuge A4655 Esrd syringe/needle A4660 Esrd blood pressure device A4663 Esrd blood pressure cuff A4670 Auto blood pressure monitor A4680 Activated carbon filters A4690 Dialyzers A4700 Standard dialysate solution A4705 Bicarb dialysate solution A4712 Sterile water A4714 Treated water for dialysis A4730 Fistula cannulation set dial A4735 Local/topical anesthetics A4740 Esrd shunt accessory A4750 Arterial or venous tubing

A4755 Arterial and venous tubing A4760 Standard testing solution A4765 Dialysate concentrate A4770 Blood testing supplies A4771 Blood clotting time tube A4772 Dextrostick/glucose strips A4773 Hemostix A4774 Ammonia test paper A4780 Esrd sterilizing agent A4790 Esrd cleansing agents A4800 Heparin/antidote dialysis A4820 Supplies hemodialysis kit A4850 Rubber tipped hemostats A4860 Disposable catheter caps A4870 Plumbing/electrical work A4880 Water storage tanks A4890 Contracts/repair/maintenance A4900 Capd supply kit A4901 Ccpd supply kit A4905 Ipd supply kit A4910 Esrd nonmedical supplies A4912 Gomco drain bottle A4913 Esrd supply A4914 Preparation kit A4918 Venous pressure clamp A4919 Supp dialysis dialyzer holde A4920 Harvard pressure clamp A4921 Measuring cylinder A4927 Gloves A5051 Pouch clsd w barr attached A5052 Clsd ostomy pouch w/o barr A5053 Clsd ostomy pouch faceplate A5054 Clsd ostomy pouch w/flange A5055 Stoma cap A5061 Pouch drainable w barrier at A5062 Drnble ostomy pouch w/o barr A5063 Drain ostomy pouch w/flange A5064 Drain ostomy pouch w/fceplte A5065 Drain ostomy pouch on fcplte A5071 Urinary pouch w/barrier A5072 Urinary pouch w/o barrier A5073 Urinary pouch on barr w/flng A5074 Urinary pouch w/faceplate A5075 Urinary pouch on faceplate A5081 Continent stoma plug A5082 Continent stoma catheter A5093 Ostomy accessory convex inse A5102 Bedside btle rigid/expanable A5105 Urinary suspensory A5112 Urinary leg bag A5113 Latex leg strap A5114 Foam/fabric leg strap A5119 Skin barrier wipes box pr 50 A5121 Solid skin barrier 6x6

A5122 Solid skin barrier 8x8 A5123 Skin barrier with flange A5126 Adhesive disc/foam pad A5131 Appliance cleaner A5149 Incontinence/ostomy supply A5500 Diab shoe for density insert A5501 Diabetic custom molded shoe A5502 Diabetic shoe density insert A5503 Diabetic shoe w/roller/rockr A5504 Diabetic shoe with wedge A5505 Diab shoe w/metatarsal bar A5506 Diabetic shoe w/off set heel A5507 Modification diabetic shoe A6020 Collagen dressing cover ea A9150 Misc/exper non-prescript dru A9160 Podiatrist non-covered servi A9170 Chiropractor non-covered ser A9190 Misc/expe personal comfort i A9270 Non-covered item or service A9300 Exercise equipment A9500 Technetium TC 99m sestamibi A9505 Thallous chloride TL 201/mci B4034 Enter feed supkit syr by day B4035 Enteral feed supp pump per d B4036 Enteral feed sup kit grav by B4081 Enteral ng tubing w/ stylet B4082 Enteral ng tubing w/o stylet B4083 Enteral stomach tube levine B4084 Gastrostomy/jejunostomy tubi B4085 Gastrostomy tube w/ring each B4150 Enteral formulae category i B4151 Enteral formulae category i- B4152 Enteral formulae category ii B4153 Enteral formulae category ii B4154 Enteral formulae category IV B4155 Enteral formulae category v B4156 Enteral formulae category vi B4164 Parenteral 50% dextrose solu B4168 Parenteral sol amino acid 3. B4172 Parenteral sol amino acid 5. B4176 Parenteral sol amino acid 7- B4178 Parenteral sol amino acid > B4180 Parenteral sol carb > 50% B4184 Parenteral sol lipids 10% B4186 Parenteral sol lipids 20% B4189 Parenteral sol amino acid & B4193 Parenteral sol 52-73 gm prot B4197 Parenteral sol 74-100 gm pro B4199 Parenteral sol > 100gm prote B4216 Parenteral nutrition additiv B4220 Parenteral supply kit premix B4222 Parenteral supply kit homemi B4224 Parenteral administration ki B5000 Parenteral sol renal-amirosy

B5100 Parenteral sol hepatic-fream B5200 Parenteral sol stres-brnch c B9000 Enter infusion pump w/o alrm B9002 Enteral infusion pump w/ ala B9004 Parenteral infus pump portab B9006 Parenteral infus pump statio B9998 Enteral supp not otherwise c B9999 Parenteral supp not othrws c D0120 Periodic oral evaluation D0140 Limit oral eval problm focus D0150 Comprehensve oral evaluation D0160 Extensv oral eval prob focus D0210 Intraor complete film series D0220 Intraoral periapical first f D0230 Intraoral periapical ea add D0240 Intraoral occlusal film D0250 Extraoral first film D0260 Extraoral ea additional film D0270 Dental bitewing single film D0272 Dental bitewings two films D0274 Dental bitewings four films D0290 Dental film skull/facial bon D0310 Dental saliography D0320 Dental tmj arthrogram incl i D0321 Dental other tmj films D0322 Dental tomographic survey D0330 Dental panoramic film D0340 Dental cephalometric film D0415 Bacteriologic study D0425 Caries susceptibility test D0460 Pulp vitality test D0470 Diagnostic casts D0471 Diagnostic photographs D0501 Histopathologic examinations D0502 Other oral pathology procedu D0999 Unspecified diagnostic proce D1110 Dental prophylaxis adult D1120 Dental prophylaxis child D1201 Topical fluor w prophy child D1203 Topical fluor w/o prophy chi D1204 Topical fluor w/o prophy adu D1205 Topical fluoride w/ prophy a D1310 Nutri counsel-control caries D1320 Tobacco counseling D1330 Oral hygiene instruction D1351 Dental sealant per tooth D1510 Space maintainer fxd unilat D1515 Fixed bilat space maintainer D1520 Remove unilat space maintain D1525 Remove bilat space maintain D1550 Recement space maintainer D2110 Amalgam one surface primary D2120 Amalgam two surfaces primary D2130 Amalgam three surfaces prima

D2131 Amalgam four/more surf prima D2140 Amalgam one surface permanen D2150 Amalgam two surfaces permane D2160 Amalgam three surfaces perma D2161 Amalgam 4 or > surfaces perm D2210 Silcate cement per restorat D2330 Resin one surface-anterior D2331 Resin two surfaces-anterior D2332 Resin three surfaces-anterio D2335 Resin 4/> surf or w incis an D2336 Composite resin crown D2380 Resin one surf poster primar D2381 Resin two surf poster primar D2382 Resin three/more surf post p D2385 Resin one surf poster perman D2386 Resin two surf poster perman D2387 Resin three/more surf post p D2410 Dental gold foil one surface D2420 Dental gold foil two surface D2430 Dental gold foil three surfa D2510 Dental inlay metalic 1 surf D2520 Dental inlay metallic 2 surf D2530 Dental inlay metl 3/more sur D2543 Dental onlay metallic 3 surf D2544 Dental onlay metl 4/more sur D2610 Inlay porcelain/ceramic 1 su D2620 Inlay porcelain/ceramic 2 su D2630 Dental onlay porc 3/more sur D2642 Dental onlay porcelin 2 surf D2643 Dental onlay porcelin 3 surf D2644 Dental onlay porc 4/more sur D2650 Inlay composite/resin one su D2651 Inlay composite/resin two su D2652 Dental inlay resin 3/mre sur D2662 Dental onlay resin 2 surface D2663 Dental onlay resin 3 surface D2664 Dental onlay resin 4/mre sur D2710 Crown resin laboratory D2720 Crown resin w/ high noble me D2721 Crown resin w/ base metal D2722 Crown resin w/ noble metal D2740 Crown porcelain/ceramic subs D2750 Crown porcelain w/ h noble m D2751 Crown porcelain fused base m D2752 Crown porcelain w/ noble met D2790 Crown full cast high noble m D2791 Crown full cast base metal D2792 Crown full cast noble metal D2810 Crown 3/4 cast metallic D2910 Dental recement inlay D2920 Dental recement crown D2930 Prefab stnlss steel crwn pri D2931 Prefab stnlss steel crown pe D2932 Prefabricated resin crown

D2933 Prefab stainless steel crown D2940 Dental sedative filling D2950 Core build-up incl any pins D2951 Tooth pin retention D2952 Post and core cast + crown D2954 Prefab post/core + crown D2955 Post removal D2960 Laminate labial veneer D2961 Lab labial veneer resin D2962 Lab labial veneer porcelain D2970 Temporary- fractured tooth D2980 Crown repair D2999 Dental unspec restorative pr D3110 Pulp cap direct D3120 Pulp cap indirect D3220 Therapeutic pulpotomy D3230 Pulpal therapy anterior prim D3240 Pulpal therapy posterior pri D3310 Anterior D3320 Root canal therapy 2 canals D3330 Root canal therapy 3 canals D3346 Retreat root canal anterior D3347 Retreat root canal bicuspid D3348 Retreat root canal molar D3351 Apexification/recalc initial D3352 Apexification/recalc interim D3353 Apexification/recalc final D3410 Apicoect/perirad surg anter D3421 Root surgery bicuspid D3425 Root surgery molar D3426 Root surgery ea add root D3430 Retrograde filling D3450 Root amputation D3460 Endodontic endosseous implan D3470 Intentional replantation D3910 Isolation- tooth w rubb dam D3920 Tooth splitting D3950 Canal prep/fitting of dowel D3960 Bleaching of discolored toot D3999 Endodontic procedure D4210 Gingivectomy/plasty per quad D4211 Gingivectomy/plasty per toot D4220 Gingival curettage per quadr D4240 Gingival flap proc w/ planin D4249 Crown lengthen hard tissue D4250 Mucogingival surg per quadra D4260 Osseous surgery per quadrant D4263 Bone replce graft first site D4264 Bone replce graft each add D4266 Guided tiss regen resorble D4267 Guided tiss regen nonresorb D4270 Pedicle soft tissue graft pr D4271 Free soft tissue graft proc D4273 Subepithelial tissue graft

D4274 Distal/proximal wedge proc D4320 Provision splnt intracoronal D4321 Provisional splint extracoro D4341 Periodontal scaling & root D4355 Full mouth debridement D4381 Localized chemo delivery D4910 Periodontal maint procedures D4920 Unscheduled dressing change D4999 Unspecified periodontal proc D5110 Dentures complete maxillary D5120 Dentures complete mandible D5130 Dentures immediat maxillary D5140 Dentures immediat mandible D5211 Dentures maxill part resin D5212 Dentures mand part resin D5213 Dentures maxill part metal D5214 Dentures mandibl part metal D5281 Removable partial denture D5410 Dentures adjust cmplt maxil D5411 Dentures adjust cmplt mand D5421 Dentures adjust part maxill D5422 Dentures adjust part mandbl D5510 Dentur repr broken compl bas D5520 Replace denture teeth complt D5610 Dentures repair resin base D5620 Rep part denture cast frame D5630 Rep partial denture clasp D5640 Replace part denture teeth D5650 Add tooth to partial denture D5660 Add clasp to partial denture D5710 Dentures rebase cmplt maxil D5711 Dentures rebase cmplt mand D5720 Dentures rebase part maxill D5721 Dentures rebase part mandbl D5730 Denture reln cmplt maxil ch D5731 Denture reln cmplt mand chr D5740 Denture reln part maxil chr D5741 Denture reln part mand chr D5750 Denture reln cmplt max lab D5751 Denture reln cmplt mand lab D5760 Denture reln part maxil lab D5761 Denture reln part mand lab D5810 Denture interm cmplt maxill D5811 Denture interm cmplt mandbl D5820 Denture interm part maxill D5821 Denture interm part mandbl D5850 Denture tiss conditn maxill D5851 Denture tiss condtin mandbl D5860 Overdenture complete D5861 Overdenture partial D5862 Precision attachment D5899 Removable prosthodontic proc D5911 Facial moulage sectional D5912 Facial moulage complete

D5913 Nasal prosthesis D5914 Auricular prosthesis D5915 Orbital prosthesis D5916 Ocular prosthesis D5919 Facial prosthesis D5922 Nasal septal prosthesis D5923 Ocular prosthesis interim D5924 Cranial prosthesis D5925 Facial augmentation implant D5926 Replacement nasal prosthesis D5927 Auricular replacement D5928 Orbital replacement D5929 Facial replacement D5931 Surgical obturator D5932 Postsurgical obturator D5933 Refitting of obturator D5934 Mandibular flange prosthesis D5935 Mandibular denture prosth D5936 Temp obturator prosthesis D5937 Trismus appliance D5951 Feeding aid D5952 Pediatric speech aid D5953 Adult speech aid D5954 Superimposed prosthesis D5955 Palatal lift prosthesis D5958 Intraoral con def inter plt D5959 Intraoral con def mod palat D5960 Modify speech aid prosthesis D5982 Surgical stent D5983 Radiation applicator D5984 Radiation shield D5985 Radiation cone locator D5986 Fluoride applicator D5987 Commissure splint D5988 Surgical splint D5999 Maxillofacial prosthesis D6010 Odontics endosteal implant D6020 Odontics abutment placement D6040 Odontics eposteal implant D6050 Odontics transosteal implnt D6055 Implant connecting bar D6080 Implant maintenance D6090 Repair implant D6095 Odontics repr abutment D6100 Removal of implant D6199 Implant procedure D6210 Prosthodont high noble metal D6211 Bridge base metal cast D6212 Bridge noble metal cast D6240 Bridge porcelain high noble D6241 Bridge porcelain base metal D6242 Bridge porcelain nobel metal D6250 Bridge resin w/high noble D6251 Bridge resin base metal

D6252 Bridge resin w/noble metal D6520 Dental retainer two surfaces D6530 Retainer metallic 3+ surface D6543 Dental retainr onlay 3 surf D6544 Dental retainr onlay 4/more D6545 Dental retainr cast metl D6720 Retain crown resin w hi nble D6721 Crown resin w/base metal D6722 Crown resin w/noble metal D6750 Crown porcelain high noble D6751 Crown porcelain base metal D6752 Crown porcelain noble metal D6780 Crown 3/4 high noble metal D6790 Crown full high noble metal D6791 Crown full base metal cast D6792 Crown full noble metal cast D6920 Dental connector bar D6930 Dental recement bridge D6940 Stress breaker D6950 Precision attachment D6970 Post & core plus retainer D6971 Cast post bridge retainer D6972 Prefab post & core plus reta D6973 Core build up for retainer D6975 Coping metal D6980 Bridge repair D6999 Fixed prosthodontic proc D7110 Oral surgery single tooth D7120 Each add tooth extraction D7130 Tooth root removal D7210 Rem imp tooth w mucoper flp D7220 Impact tooth remov soft tiss D7230 Impact tooth remov part bony D7240 Impact tooth remov comp bony D7241 Impact tooth rem bony w/comp D7250 Tooth root removal D7260 Oral antral fistula closure D7270 Tooth reimplantation D7272 Tooth transplantation D7280 Exposure impact tooth orthod D7281 Exposure tooth aid eruption D7285 Biopsy of oral tissue hard D7286 Biopsy of oral tissue soft D7290 Repositioning of teeth D7291 Transseptal fiberotomy D7310 Alveoplasty w/ extraction D7320 Alveoplasty w/o extraction D7340 Vestibuloplasty ridge extens D7350 Vestibuloplasty exten graft D7410 Rad exc lesion up to 1.25 cm D7420 Lesion > 1.25 cm D7430 Exc benign tumor to 1.25 cm D7431 Benign tumor exc > 1.25 cm D7440 Malig tumor exc to 1.25 cm

D7441 Malig tumor > 1.25 cm D7450 Rem odontogen cyst to 1.25cm D7451 Rem odontogen cyst > 1.25 cm D7460 Rem nonodonto cyst to 1.25cm D7461 Rem nonodonto cyst > 1.25 cm D7465 Lesion destruction D7470 Rem exostosis maxilla/mandib D7480 Partial ostectomy D7490 Mandible resection D7510 I&d absc intraoral soft tiss D7520 I&d abscess extraoral D7530 Removal fb skin/areolar tiss D7540 Removal of fb reaction D7550 Removal of sloughed off bone D7560 Maxillary sinusotomy D7610 Maxilla open reduct simple D7620 Clsd reduct simpl maxilla fx D7630 Open red simpl mandible fx D7640 Clsd red simpl mandible fx D7650 Open red simp malar/zygom fx D7660 Clsd red simp malar/zygom fx D7670 Open red simple alveolus fx D7680 Reduct simple facial bone fx D7710 Maxilla open reduct compound D7720 Clsd reduct compd maxilla fx D7730 Open reduct compd mandble fx D7740 Clsd reduct compd mandble fx D7750 Open red comp malar/zygma fx D7760 Clsd red comp malar/zygma fx D7770 Open reduc compd alveolus fx D7780 Reduct compnd facial bone fx D7810 Tmj open reduct-dislocation D7820 Closed tmp manipulation D7830 Tmj manipulation under anest D7840 Removal of tmj condyle D7850 Tmj meniscectomy D7852 Tmj repair of joint disc D7854 Tmj excisn of joint membrane D7856 Tmj cutting of a muscle D7858 Tmj reconstruction D7860 Tmj cutting into joint D7865 Tmj reshaping components D7870 Tmj aspiration joint fluid D7872 Tmj diagnostic arthroscopy D7873 Tmj arthroscopy lysis adhesn D7874 Tmj arthroscopy disc reposit D7875 Tmj arthroscopy synovectomy D7876 Tmj arthroscopy discectomy D7877 Tmj arthroscopy debridement D7880 Occlusal orthotic appliance D7899 Tmj unspecified therapy D7910 Dent sutur recent wnd to 5cm D7911 Dental suture wound to 5 cm D7912 Suture complicate wnd > 5 cm

D7920 Dental skin graft D7940 Reshaping bone orthognathic D7941 Bone cutting ramus closed D7942 Bone cutting ramus open D7943 Cutting ramus open w/graft D7944 Bone cutting segmented D7945 Bone cutting body mandible D7946 Reconstruction maxilla total D7947 Reconstruct maxilla segment D7948 Reconstruct midface no graft D7949 Reconstruct midface w/graft D7950 Mandible graft D7955 Repair maxillofacial defects D7960 Frenulectomy/frenulotomy D7970 Excision hyperplastic tissue D7971 Excision pericoronal gingiva D7980 Sialolithotomy D7981 Excision of salivary gland D7982 Sialodochoplasty D7983 Closure of salivary fistula D7990 Emergency tracheotomy D7991 Dental coronoidectomy D7995 Synthetic graft facial bones D7996 Implant mandible for augment D7999 Oral surgery procedure D8010 Limited dental tx primary D8020 Limited dental tx transition D8030 Limited dental tx adolescent D8040 Limited dental tx adult D8050 Intercep dental tx primary D8060 Intercep dental tx transitn D8070 Compre dental tx transition D8080 Compre dental tx adolescent D8090 Compre dental tx adult D8210 Orthodontic rem appliance tx D8220 Fixed appliance therapy habt D8660 Preorthodontic tx visit D8670 Periodic orthodontc tx visit D8680 Orthodontic retention D8690 Orthodontic treatment D8999 Orthodontic procedure D9110 Tx dental pain minor proc D9210 Dent anesthesia w/o surgery D9211 Regional block anesthesia D9212 Trigeminal block anesthesia D9215 Local anesthesia D9220 General anesthesia D9221 General anesthesia ea ad 15m D9230 Analgesia D9240 Intravenous sedation D9310 Dental consultation D9410 Dental house call D9420 Hospital call D9430 Office visit during hours

D9440 Office visit after hours D9610 Dent therapeutic drug inject D9630 Other drugs/medicaments D9910 Dent appl desensitizing med D9920 Behavior management D9930 Treatment of complications D9940 Dental occlusal guard D9941 Fabrication athletic guard D9950 Occlusion analysis D9951 Limited occlusal adjustment D9952 Complete occlusal adjustment D9970 Enamel microabrasion D9999 Adjunctive procedure E0100 Cane adjust/fixed with tip E0105 Cane adjust/fixed quad/3 pro E0110 Crutch forearm pair E0111 Crutch forearm each E0112 Crutch underarm pair wood E0113 Crutch underarm each wood E0114 Crutch underarm pair aluminu E0116 Crutch underarm each aluminu E0130 Walker rigid adjust/fixed ht E0135 Walker folding adjust/fixed E0141 Walker wheeled without seat E0142 Walker rigid wheeled with se E0143 Walker folding wheeled w/o s E0145 Walker whled seat/crutch att E0146 Walker wheeled with seat E0147 Walker variable wheel resist E0153 Forearm crutch platform atta E0154 Walker platform attachment E0155 Walker rigd pick-up/wheel at E0156 Walker seat attachment E0157 Walker crutch attachment E0158 Walker leg extensions E0160 Sitz type bath or equipment E0161 Sitz bath/equipment w/faucet E0162 Sitz bath chair E0163 Commode chair stationry fxd E0164 Commode chair mobile fixed a E0165 Commode chair stationry det E0166 Commode chair mobile detach E0167 Commode chair pail or pan E0175 Commode chair foot rest E0176 Air pressre pad/cushion nonp E0177 Water press pad/cushion nonp E0178 Gel pressre pad/cushion nonp E0179 Dry pressre pad/cushion nonp E0180 Press pad alternating w pump E0181 Press pad alternating w/ pum E0182 Pressure pad alternating pum E0184 Dry pressure mattress E0185 Gel pressure mattress pad E0186 Air pressure mattress

E0187 Water pressure mattress E0188 Synthetic sheepskin pad E0189 Lambswool sheepskin pad E0191 Protector heel or elbow E0192 Pad wheelchr low press/posit E0193 Powered air flotation bed E0194 Air fluidized bed E0196 Gel pressure mattress E0197 Air pressure pad for mattres E0198 Water pressure pad for mattr E0199 Dry pressure pad for mattres E0200 Heat lamp without stand E0202 Phototherapy light w/ photom E0205 Heat lamp with stand E0210 Electric heat pad standard E0215 Electric heat pad moist E0220 Hot water bottle E0225 Hydrocollator unit E0230 Ice cap or collar E0235 Paraffin bath unit portable E0236 Pump for water circulating p E0237 Heat/cold pad with pump E0238 Heat pad non-electric moist E0239 Hydrocollator unit portable E0241 Bath tub wall rail E0242 Bath tub rail floor E0243 Toilet rail E0244 Toilet seat raised E0245 Tub stool or bench E0246 Transfer tub rail attachment E0249 Pad water circulating heat u E0250 Hosp bed fixed ht w/ mattres E0251 Hosp bed fixd ht w/o mattres E0255 Hospital bed var ht w/ mattr E0256 Hospital bed var ht w/o matt E0260 Hosp bed semi-electr w/ matt E0261 Hosp bed semi-electr w/o mat E0265 Hosp bed total electr w/ mat E0266 Hosp bed total elec w/o matt E0270 Hospital bed institutional t E0271 Mattress innerspring E0272 Mattress foam rubber E0273 Bed board E0274 Over-bed table E0275 Bed pan standard E0276 Bed pan fracture E0277 Alternating pressure mattres E0280 Bed cradle E0290 Hosp bed fx ht w/o rails w/m E0291 Hosp bed fx ht w/o rail w/o E0292 Hosp bed var ht w/o rail w/o E0293 Hosp bed var ht w/o rail w/ E0294 Hosp bed semi-elect w/ mattr E0295 Hosp bed semi-elect w/o matt

E0296 Hosp bed total elect w/ matt E0297 Hosp bed total elect w/o mat E0305 Rails bed side half length E0310 Rails bed side full length E0315 Bed accessories boards or ta E0325 Urinal male jug-type E0326 Urinal female jug-type E0350 Control unit bowel system E0352 Disposable pack w/bowel syst E0424 Stationary compressed gas 02 E0425 Gas system stationary compre E0430 Oxygen system gas portable E0431 Portable gaseous 02 E0434 Portable liquid 02 E0435 Oxygen system liquid portabl E0439 Stationary liquid 02 E0440 Oxygen system liquid station E0441 Oxygen contents gas per/unit E0442 Oxygen contents liq per/unit E0443 Port 02 contents gas/unit E0444 Port 02 contents liq/unit E0450 Volume vent stationary/porta E0452 Intermit assis device w cpap E0453 Ventilator 12 hrs/less per d E0455 Oxygen tent excl croup/ped t E0457 Chest shell E0459 Chest wrap E0460 Neg press vent portabl/statn E0462 Rocking bed w/ or w/o side r E0480 Percussor elect/pneum home m E0500 Ippb all types E0550 Humidif extens supple w ippb E0555 Humidifier for use w/ regula E0560 Humidifier supplemental w/ i E0565 Compressor air power source E0570 Nebulizer with compression E0575 Nebulizer ultrasonic E0580 Nebulizer for use w/ regulat E0585 Nebulizer w/ compressor & he E0600 Suction pump portab hom modl E0601 Cont airway pressure device E0605 Vaporizer room type E0606 Drainage board postural E0607 Blood glucose monitor home E0608 Apnea monitor E0609 Blood gluc mon w/special fea E0610 Pacemaker monitr audible/vis E0615 Pacemaker monitr digital/vis E0621 Patient lift sling or seat E0625 Patient lift bathroom or toi E0627 Seat lift incorp lift-chair E0628 Seat lift for pt furn-electr E0629 Seat lift for pt furn-non-el E0630 Patient lift hydraulic

E0635 Patient lift electric E0650 Pneuma compresor non-segment E0651 Pneum compressor segmental E0652 Pneum compres w/cal pressure E0655 Pneumatic appliance half arm E0660 Pneumatic appliance full leg E0665 Pneumatic appliance full arm E0666 Pneumatic appliance half leg E0667 Seg pneumatic appl full leg E0668 Seg pneumatic appl full arm E0669 Seg pneumatic appli half leg E0671 Pressure pneum appl full leg E0672 Pressure pneum appl full arm E0673 Pressure pneum appl half leg E0690 Ultraviolet cabinet E0700 Safety equipment E0710 Restraints any type E0720 Tens two lead E0730 Tens four lead E0731 Conductive garment for tens/ E0740 Incontinence treatment systm E0744 Neuromuscular stim for scoli E0745 Neuromuscular stim for shock E0746 Electromyograph biofeedback E0747 Osteogen stimltor not spinal E0748 Osteogenic stimulator spinal E0749 Osteogenesis stim surgical i E0751 Pulse generator or receiver E0753 Neurostimul electrodes/leads E0755 Electronic salivary reflex s E0776 Iv pole E0781 External ambulatory infus pu E0782 Non-programble infusion pump E0783 Programmable infusion pump E0784 Ext amb infusn pump insulin E0791 Parenteral infusion pump sta E0840 Tract frame attach headboard E0850 Traction stand free standing E0860 Tract equip cervical tract E0870 Tract frame attach footboard E0880 Trac stand free stand extrem E0890 Traction frame attach pelvic E0900 Trac stand free stand pelvic E0910 Trapeze bar attached to bed E0920 Fracture frame attached to b E0930 Fracture frame free standing E0935 Exercise device passive moti E0940 Trapeze bar free standing E0941 Gravity assisted traction de E0942 Cervical head harness/halter E0943 Cervical pillow E0944 Pelvic belt/harness/boot E0945 Belt/harness extremity E0946 Fracture frame dual w cross

E0947 Fracture frame attachmnts pe E0948 Fracture frame attachmnts ce E0950 Tray E0951 Loop heel E0952 Loop tie E0953 Pneumatic tire E0954 Wheelchair semi-pneumatic ca E0958 Whlchr att- conv 1 arm drive E0959 Amputee adapter E0961 Wheelchair brake extension E0962 Wheelchair 1 inch cushion E0963 Wheelchair 2 inch cushion E0964 Wheelchair 3 inch cushion E0965 Wheelchair 4 inch cushion E0966 Wheelchair head rest extensi E0967 Wheelchair hand rims E0968 Wheelchair commode seat E0969 Wheelchair narrowing device E0970 Wheelchair no. 2 footplates E0971 Wheelchair anti-tipping devi E0972 Transfer board or device E0973 Wheelchair adjustabl height E0974 Wheelchair grade-aid E0975 Wheelchair reinforced seat u E0976 Wheelchair reinforced back u E0977 Wheelchair wedge cushion E0978 Wheelchair belt w/airplane b E0979 Wheelchair belt with velcro E0980 Wheelchair safety vest E0990 Whellchair elevating leg res E0991 Wheelchair upholstry seat E0992 Wheelchair solid seat insert E0993 Wheelchair back upholstery E0994 Wheelchair arm rest E0995 Wheelchair calf rest E0996 Wheelchair tire solid E0997 Wheelchair caster w/ a fork E0998 Wheelchair caster w/o a fork E0999 Wheelchr pneumatic tire w/wh E1000 Wheelchair tire pneumatic ca E1001 Wheelchair wheel E1031 Rollabout chair with casters E1050 Whelchr fxd full length arms E1060 Wheelchair detachable arms E1065 Wheelchair power attachment E1066 Wheelchair battery charger E1069 Wheelchair deep cycle batter E1070 Wheelchair detachable foot r E1083 Hemi-wheelchair fixed arms E1084 Hemi-wheelchair detachable a E1085 Hemi-wheelchair fixed arms E1086 Hemi-wheelchair detachable a E1087 Wheelchair lightwt fixed arm E1088 Wheelchair lightweight det a

E1089 Wheelchair lightwt fixed arm E1090 Wheelchair lightweight det a E1091 Wheelchair youth E1092 Wheelchair wide w/ leg rests E1093 Wheelchair wide w/ foot rest E1100 Whchr s-recl fxd arm leg res E1110 Wheelchair semi-recl detach E1130 Whlchr stand fxd arm ft rest E1140 Wheelchair standard detach a E1150 Wheelchair standard w/ leg r E1160 Wheelchair fixed arms E1170 Whlchr ampu fxd arm leg rest E1171 Wheelchair amputee w/o leg r E1172 Wheelchair amputee detach ar E1180 Wheelchair amputee w/ foot r E1190 Wheelchair amputee w/ leg re E1195 Wheelchair amputee heavy dut E1200 Wheelchair amputee fixed arm E1210 Whlchr moto ful arm leg rest E1211 Wheelchair motorized w/ det E1212 Wheelchair motorized w full E1213 Wheelchair motorized w/ det E1220 Whlchr special size/constrc E1221 Wheelchair spec size w foot E1222 Wheelchair spec size w/ leg E1223 Wheelchair spec size w foot E1224 Wheelchair spec size w/ leg E1225 Wheelchair spec sz semi-recl E1226 Wheelchair spec sz full-recl E1227 Wheelchair spec sz spec ht a E1228 Wheelchair spec sz spec ht b E1230 Power operated vehicle E1240 Whchr litwt det arm leg rest E1250 Wheelchair lightwt fixed arm E1260 Wheelchair lightwt foot rest E1270 Wheelchair lightweight leg r E1280 Whchr h-duty det arm leg res E1285 Wheelchair heavy duty fixed E1290 Wheelchair hvy duty detach a E1295 Wheelchair heavy duty fixed E1296 Wheelchair special seat heig E1297 Wheelchair special seat dept E1298 Wheelchair spec seat depth/w E1300 Whirlpool portable E1310 Whirlpool non-portable E1350 Oxygen repair or service E1353 Oxygen supplies regulator E1355 Oxygen supplies stand/rack E1372 Oxy suppl heater for nebuliz E1375 Oxygen suppl nebulizer porta E1377 Oxygen concentrator to 244 c E1378 Oxygen concentrator to 488 c E1379 Oxygen concentrator to 732 c E1380 Oxygen concentrator to 976 c

E1381 Oxygen concentrat to 1220 cu E1382 Oxygen concentrat to 1464 cu E1383 Oxygen concentrat to 1708 cu E1384 Oxygen concentrat to 1952 cu E1385 Oxygen concentrator > 1952 c E1399 Durable medical equipment mi E1400 Oxygen concentrator < 2 lite E1401 Oxygen concentrator 2-3 lite E1402 Oxygen concentrator 3-4 lite E1403 Oxygen concentrator 4-5 lite E1404 Oxygen concentrator > 5 lite E1405 O2/water vapor enrich w/heat E1406 O2/water vapor enrich w/o he E1510 Kidney dialysate delivry sys E1520 Heparin infusion pump for di E1530 Air bubble detector for dial E1540 Pressure alarm for dialysis E1550 Bath conductivity meter E1560 Blood leak detector for dial E1570 Adjustable chair for esrd pt E1575 Transducer protector/fluid b E1580 Unipuncture control system E1590 Hemodialysis machine E1592 Auto interm peritoneal dialy E1594 Cycler dialysis machine E1600 Deliv/install equip for dial E1610 Reverse osmosis water purifi E1615 Deionizer water purification E1620 Blood pump for dialysis E1625 Water softening system E1630 Reciprocating peritoneal dia E1632 Wearable artificial kidney E1635 Compact travel hemodialyzer E1636 Sorbent cartridges for dialy E1640 Replacement components for d E1699 Dialysis equipment unspecifi E1700 Jaw motion rehab system E1701 Repl cushions for jaw motion E1702 Repl measr scales jaw motion E1800 Adjust elbow ext/flex device E1805 Adjust wrist ext/flex device E1810 Adjust knee ext/flex device E1815 Adjust ankle ext/flex device E1820 Soft interface material E1825 Adjust finger ext/flex devc E1830 Adjust toe ext/flex device G0001 Drawing blood for specimen G0002 Temporary urinary catheter G0004 ECG transm phys review & int G0005 ECG 24 hour recording G0006 ECG transmission & analysis G0007 ECG phy review & interpret G0008 Admin influenza virus vac G0009 Admin pneumococcal vaccine

G0010 Admin hepatitis b vaccine G0015 Post symptom ECG tracing G0016 Post symptom ECG md review G0025 Collagen skin test kit G0026 Fecal leukocyte examination G0027 Semen analysis G0030 PET imaging prev PET single G0031 PET imaging prev PET multple G0032 PET follow SPECT 78464 singl G0033 PET follow SPECT 78464 mult G0034 PET follow SPECT 76865 singl G0035 PET follow SPECT 78465 mult G0036 PET follow cornry angio sing G0037 PET follow cornry angio mult G0038 PET follow myocard perf sing G0039 PET follow myocard perf mult G0040 PET follow stress echo singl G0041 PET follow stress echo mult G0042 PET follow ventriculogm sing G0043 PET follow ventriculogm mult G0044 PET following rest ECG singl G0045 PET following rest ECG mult G0046 PET follow stress ECG singl G0047 PET follow stress ECG mult G0050 Residual urine by ultrasound G0054 Blood cholesterol test G0055 Glucose post dose measure G0056 Glucose tolerance 3 specimen G0057 Glucose tolerance>3 specimen G0058 Auto multichannel 20 tests G0059 Auto multichannel 21 tests G0060 Auto multichannel 22 tests G0061 Lung volume reduction surg H5300 Occupational therapy J0120 Tetracyclin injection J0150 Injection adenosine 6 MG J0170 Adrenalin epinephrin inject J0190 Inj biperiden lactate/5 mg J0205 Alglucerase injection J0210 Methyldopate hcl injection J0256 Alpha 1-proteinase 500 MG J0280 Aminophyllin 250 MG inj J0290 Ampicillin 500 MG inj J0295 Ampicillin sodium per 1.5 gm J0300 Amobarbital 125 MG inj J0330 Succinycholine chloride inj J0340 Nandrolon phenpropionate inj J0350 Injection anistreplase 30 u J0360 Hydralazine hcl injection J0380 Inj metaraminol bitartrate J0390 Chloroquine injection J0400 Inj trimethaphan camsylate J0460 Atropine sulfate injection J0470 Dimecaprol injection

J0475 Baclofen 10 MG injection J0500 Dicyclomine injection J0510 Benzquinamide injection J0515 Inj benztropine mesylate J0520 Bethanechol chloride inject J0530 Penicillin g benzathine inj J0540 Penicillin g benzathine inj J0550 Penicillin g benzathine inj J0560 Penicillin g benzathine inj J0570 Penicillin g benzathine inj J0580 Penicillin g benzathine inj J0585 Botulinum toxin a per 100 u J0590 Ethylnorepinephrine hcl inj J0600 Edetate calcium disodium inj J0610 Calcium gluconate injection J0620 Calcium glycer & lact/10 ML J0630 Calcitonin salmon injection J0635 Calcitriol injection J0640 Leucovorin calcium injection J0670 Inj mepivacaine HCL/10 ml J0690 Cefazolin sodium injection J0694 Cefoxitin sodium injection J0695 Cefonocid sodium injection J0696 Ceftriaxone sodium injection J0697 Sterile cefuroxime injection J0698 Cefotaxime sodium injection J0702 Betamethasone acet&sod phosp J0704 Betamethasone sod phosp/4 MG J0710 Cephapirin sodium injection J0713 Inj ceftazidime per 500 mg J0715 Ceftizoxime sodium / 500 MG J0720 Chloramphenicol sodium injec J0725 Chorionic gonadotropin/1000u J0730 Chlorpheniramin maleate inj J0743 Cilastatin sodium injection J0745 Inj codeine phosphate /30 MG J0760 Colchicine injection J0770 Colistimethate sodium inj J0780 Prochlorperazine injection J0800 Corticotropin injection J0810 Cortisone injection J0835 Inj cosyntropin per 0.25 MG J0850 Cytomegalovirus imm IV /vial J0895 Deferoxamine mesylate inj J0900 Testosterone enanthate inj J0945 Brompheniramine maleate inj J0970 Estradiol valerate injection J1000 Depo-estradiol cypionate inj J1020 Methylprednisolone 20 MG inj J1030 Methylprednisolone 40 MG inj J1040 Methylprednisolone 80 MG inj J1050 Medroxyprogesterone inj J1055 Medrxyprogester acetate inj J1060 Testosterone cypionate 1 ML

J1070 Testosterone cypionat 100 MG J1080 Testosterone cypionat 200 MG J1090 Testosterone cypionate 50 MG J1095 Inj dexamethasone acetate J1100 Dexamethosone sodium phos J1110 Inj dihydroergotamine mesylt J1120 Acetazolamid sodium injectio J1160 Digoxin injection J1165 Phenytoin sodium injection J1170 Hydromorphone injection J1180 Dyphylline injection J1200 Diphenhydramine hcl injectio J1205 Chlorothiazide sodium inj J1212 Dimethyl sulfoxide 50% 50 ML J1230 Methadone injection J1240 Dimenhydrinate injection J1245 Dipyridamole injection J1250 Inj dobutamine HCL/250 mg J1320 Amitriptyline injection J1330 Ergonovine maleate injection J1362 Erythromycin glucep / 250 MG J1364 Erythro lactobionate /500 MG J1380 Estradiol valerate 10 MG inj J1390 Estradiol valerate 20 MG inj J1410 Inj estrogen conjugate 25 MG J1435 Injection estrone per 1 MG J1436 Etidronate disodium inj J1440 Filgrastim 300 mcg injeciton J1441 Filgrastim 480 mcg injection J1455 Foscarnet sodium injection J1460 Gamma globulin 1 CC inj J1470 Gamma globulin 2 CC inj J1480 Gamma globulin 3 CC inj J1490 Gamma globulin 4 CC inj J1500 Gamma globulin 5 CC inj J1510 Gamma globulin 6 CC inj J1520 Gamma globulin 7 CC inj J1530 Gamma globulin 8 CC inj J1540 Gamma globulin 9 CC inj J1550 Gamma globulin 10 CC inj J1560 Gamma globulin > 10 CC inj J1561 Immune globulin injection J1562 Immune globulin 10% /5 grams J1570 Ganciclovir sodium injection J1580 Garamycin gentamicin inj J1600 Gold sodium thiomaleate inj J1610 Glucagon hydrochloride/1 MG J1620 Gonadorelin hydroch/ 100 mcg J1625 Granisetron hydrochlor/1 MG J1630 Haloperidol injection J1631 Haloperidol decanoate inj J1642 Inj heparin sodium per 10 u J1644 Inj heparin sodium per 1000u J1650 Inj enoxaparin sodium 30 mg

J1670 Tetanus immune globulin inj J1690 Prednisolone tebutate inj J1700 Hydrocortisone acetate inj J1710 Hydrocortisone sodium ph inj J1720 Hydrocortisone sodium succ i J1730 Diazoxide injection J1739 Hydroxyprogesterone cap 125 J1741 Hydroxyprogesterone cap 250 J1760 Iron dextran 2 CC inj J1770 Iron dextran 5 CC inj J1780 Iron dextran 10 CC inj J1785 Injection imiglucerase /unit J1790 Droperidol injection J1800 Propranolol injection J1810 Droperidol/fentanyl inj J1820 Insulin injection J1830 Interferon beta-1b / .25 MG J1840 Kanamycin sulfate 500 MG inj J1850 Kanamycin sulfate 75 MG inj J1885 Ketorolac tromethamine inj J1890 Cephalothin sodium injection J1910 Kutapressin injection J1930 Propiomazine injection J1940 Furosemide injection J1950 Leuprolide acetate /3.75 MG J1955 Inj levocarnitine per 1 gm J1960 Levorphanol tartrate inj J1970 Methotrimeprazine injection J1980 Hyoscyamine sulfate inj J1990 Chlordiazepoxide injection J2000 Lidocaine injection J2010 Lincomycin injection J2050 Liver injection J2060 Lorazepam injection J2150 Mannitol injection J2175 Meperidine hydrochl /100 MG J2180 Meperidine/promethazine inj J2210 Methylergonovin maleate inj J2240 Metocurine iodide injection J2250 Inj midazolam hydrochloride J2260 Inj milrinone lactate / 5 ML J2270 Morphine sulfate injection J2275 Morphine sulfate injection J2300 Inj nalbuphine hydrochloride J2310 Inj naloxone hydrochloride J2320 Nandrolone decanoate 50 MG J2321 Nandrolone decanoate 100 MG J2322 Nandrolone decanoate 200 MG J2330 Thiothixene injection J2350 Niacinamide/niacin injection J2360 Orphenadrine injection J2370 Phenylephrine hcl injection J2400 Chloroprocaine hcl injection J2405 Ondansetron hcl injection

J2410 Oxymorphone hcl injection J2430 Pamidronate disodium /30 MG J2440 Papaverin hcl injection J2460 Oxytetracycline injection J2480 Hydrochlorides of opium inj J2510 Penicillin g procaine inj J2512 Inj pentagastrin per 2 ML J2515 Pentobarbital sodium inj J2540 Penicillin g potassium inj J2545 Pentamidine isethionte/300mg J2550 Promethazine hcl injection J2560 Phenobarbital sodium inj J2590 Oxytocin injection J2597 Inj desmopressin acetate J2640 Prednisolone sodium ph inj J2650 Prednisolone acetate inj J2670 Totazoline hcl injection J2675 Inj progesterone per 50 MG J2680 Fluphenazine decanoate 25 MG J2690 Procainamide hcl injection J2700 Oxacillin sodium injeciton J2710 Neostigmine methylslfte inj J2720 Inj protamine sulfate/10 MG J2725 Inj protirelin per 250 mcg J2730 Pralidoxime chloride inj J2760 Phentolaine mesylate inj J2765 Metoclopramide hcl injection J2790 Rho d immune globulin inj J2800 Methocarbamol injection J2810 Inj theophylline per 40 MG J2820 Sargramostim injection J2860 Secobarbital sodium inj J2910 Aurothioglucose injeciton J2912 Sodium chloride injection J2920 Methylprednisolone injection J2930 Methylprednisolone injection J2950 Promazine hcl injeciton J2970 Methicillin sodium injection J2995 Inj streptokinase /250000 IU J2996 Alteplase recombinant inj J3000 Streptomycin injection J3005 Strontium-89 chloride /10 ML J3010 Fentanyl citrate injeciton J3030 Sumatriptan succinate / 6 MG J3070 Pentazocine hcl injeciton J3080 Chlorprothixene injection J3105 Terbutaline sulfate inj J3120 Testosterone enanthate inj J3130 Testosterone enanthate inj J3140 Testosterone suspension inj J3150 Testosteron propionate inj J3230 Chlorpromazine hcl injection J3240 Thyrotropin injection J3250 Trimethobenzamide hcl inj

J3260 Tobramycin sulfate injection J3265 Injection torsemide 10 mg/ml J3270 Imipramine hcl injection J3280 Thiethylperazine maleate inj J3301 Triamcinolone acetonide inj J3302 Triamcinolone diacetate inj J3303 Triamcinolone hexacetonl inj J3305 Inj trimetrexate glucoronate J3310 Perphenazine injeciton J3320 Spectinomycn di-hcl inj J3350 Urea injection J3360 Diazepam injection J3364 Urokinase 5000 IU injection J3365 Urokinase 250,000 IU inj J3370 Vancomycin hcl injeciton J3390 Methoxamine injection J3400 Triflupromazine hcl inj J3410 Hydroxyzine hcl injeciton J3420 Vitamin b12 injection J3430 Vitamin k phytonadione inj J3450 Mephentermine sulfate inj J3470 Hyaluronidase injection J3475 Inj magnesium sulfate J3480 Inj potassium chloride J3490 Drugs unclassified injection J3520 Edetate disodium per 150 mg J3530 Nasal vaccine inhalation J3535 Metered dose inhaler drug J3570 Laetrile amygdalin vit B17 J7030 Normal saline solution infus J7040 Normal saline solution infus J7042 5% dextrose/normal saline J7050 Normal saline solution infus J7051 Sterile saline/water J7060 5% dextrose/water J7070 D5w infusion J7100 Dextran 40 infusion J7110 Dextran 75 infusion J7120 Ringers lactate infusion J7130 Hypertonic saline solution J7140 Prescription oral drug J7150 Prescription oral chemo drug J7190 Factor viii J7191 Factor VIII (porcine) J7192 Factor viii recombinant J7194 Factor ix complex J7196 Othr hemophilia clot factors J7197 Antithrombin iii injection J7300 Intraut copper contraceptive J7500 Azathiop po tab 50mg 100s ea J7501 Azathioprine parenteral J7502 Cyclosporine oral solution J7503 Cyclosporine parenteral J7504 Lymphocyte immune globulin

J7505 Monoclonal antibodies J7506 Prednisone J7507 Tacrolimus oral per 1 MG J7508 Tacrolimus oral per 5 MG J7509 Methylprednisolone oral J7510 Prednisolone oral per 5 mg J7599 Immunosuppressive drug noc J7610 Acetylcysteine 10% injection J7615 Acetylcysteine 20% injection J7620 Albuterol sulfate .o83% inj J7625 Albuterol sulfate .5% inj J7627 Bitolterolmesylate inhal sol J7630 Cromolyn sodium injeciton J7640 Epinephrine injection J7645 Ipratropium bromide .02%/ml J7650 Isoetharine hcl .1% inj J7651 Isoetharine hcl .125% inj J7652 Isoetharine hcl .167% inj J7653 Isoetharine hcl .2%/ inj J7654 Isoetharine hcl .25% inj J7655 Isoetharine hcl 1% inj J7660 Isoproterenol hcl .5% inj J7665 Isoproterenol hcl 1% inj J7670 Metaproterenol sulfate .4% J7672 Metaproterenol sulfate .6% J7675 Metaproterenol sulfate 5% J7699 Inhalation solution for DME J7799 Non-inhalation drug for DME J8499 Oral prescrip drug non chemo J8530 Cyclophosphamide oral 25 MG J8560 Etoposide oral 50 MG J8600 Melphalan oral 2 MG J8610 Methotrexate oral 2.5 MG J8999 Oral prescription drug chemo J9000 Doxorubic hcl 10 MG vl chemo J9010 Doxorubicin hcl 50 MG inj J9015 Aldesleukin/single use vial J9020 Asparaginase injection J9031 Bcg live intravesical vac J9040 Bleomycin sulfate injection J9045 Carboplatin injection J9050 Carmus bischl nitro inj J9060 Cisplatin 10 MG injeciton J9062 Cisplatin 50 MG injeciton J9065 Inj cladribine per 1 MG J9070 Cyclophosphamide 100 MG inj J9080 Cyclophosphamide 200 MG inj J9090 Cyclophosphamide 500 MG inj J9091 Cyclophosphamide 1.0 grm inj J9092 Cyclophosphamide 2.0 grm inj J9093 Cyclophosphamide lyophilized J9094 Cyclophosphamide lyophilized J9095 Cyclophosphamide lyophilized J9096 Cyclophosphamide lyophilized

J9097 Cyclophosphamide lyophilized J9100 Cytarabine hcl 100 MG inj J9110 Cytarabine hcl 500 MG inj J9120 Dactinomycin actinomycin d J9130 Dacarbazine 10 MG inj J9140 Dacarbazine 200 MG inj J9150 Daunorubicin hcl injection J9165 Diethylstilbestrol injection J9181 Etoposide 10 MG inj J9182 Etoposide 100 MG inj J9185 Fludarabine phosphate inj J9190 Fluorouracil injection J9200 Floxuridine injection J9202 Goserelin acetate implant J9208 Ifosfomide injection J9209 Mesna injection J9211 Idarubicin hcl injeciton J9213 Interferon alfa-2a inj J9214 Interferon alfa-2b inj J9215 Interferon alfa-n3 inj J9216 Interferon gamma 1-b inj J9217 Leuprolide acetate suspnsion J9218 Leuprolide acetate injeciton J9230 Mechlorethamine hcl inj J9245 Inj melphalan hydrochl 50 MG J9250 Methotrexate sodium inj J9260 Methotrexate sodium inj J9265 Paclitaxel injection J9266 Pegaspargase/singl dose vial J9268 Pentostatin injection J9270 Plicamycin (mithramycin) inj J9280 Mitomycin 5 MG inj J9290 Mitomycin 20 MG inj J9291 Mitomycin 40 MG inj J9293 Mitoxantrone hydrochl / 5 MG J9320 Streptozocin injection J9340 Thiotepa injection J9360 Vinblastine sulfate inj J9370 Vincristine sulfate 1 MG inj J9375 Vincristine sulfate 2 MG inj J9380 Vincristine sulfate 5 MG inj J9390 Vinorelbine tartrate/10 mg J9999 Chemotherapy drug K0001 Standard wheelchair K0002 Stnd hemi (low seat) whlchr K0003 Lightweight wheelchair K0004 High strength ltwt whlchr K0005 Ultralightweight wheelchair K0006 Heavy duty wheelchair K0007 Extra heavy duty wheelchair K0008 Cstm manual wheelchair/base K0009 Other manual wheelchair/base K0010 Stnd wt frame power whlchr K0011 Stnd wt pwr whlchr w control

K0012 Ltwt portbl power whlchr K0013 Custom power whlchr base K0014 Other power whlchr base K0015 Detach non-adjus hght armrst K0016 Detach adjust armrst cmplete K0017 Detach adjust armrest base K0018 Detach adjust armrst upper K0019 Arm pad each K0020 Fixed adjust armrest pair K0021 Anti-tipping device each K0022 Reinforced back upholstery K0023 Planr back insrt foam w/strp K0024 Plnr back insrt foam w/hrdwr K0025 Hook-on headrest extension K0026 Back upholst lgtwt whlchr K0027 Back upholst other whlchr K0028 Fully reclining back K0029 Reinforced seat upholstery K0030 Solid plnr seat sngl dnsfoam K0031 Safety belt/pelvic strap K0032 Seat uphols lgtwt whlchr K0033 Seat upholstery other whlchr K0034 Heel loop each K0035 Heel loop with ankle strap K0036 Toe loop each K0037 High mount flip-up footrest K0038 Leg strap each K0039 Leg strap h style each K0040 Adjustable angle footplate K0041 Large size footplate each K0042 Standard size footplate each K0043 Ftrst lower extension tube K0044 Ftrst upper hanger bracket K0045 Footrest complete assembly K0046 Elevat legrst low extension K0047 Elevat legrst up hangr brack K0048 Elevate legrest complete K0049 Calf pad each K0050 Ratchet assembly K0051 Cam relese assem ftrst/lgrst K0052 Swingaway detach footrest K0053 Elevate footrest articulate K0054 Seat wdth 10-12/15/17/20 wc K0055 Seat dpth 15/17/18 ltwt wc K0056 Seat ht <17 or <=21 ltwt wc K0057 Seat wdth 19/20 hvy dty wc K0058 Seat dpth 17/18 power wc K0059 Plastic coated handrim each K0060 Steel handrim each K0061 Aluminum handrim each K0062 Handrim 8-10 vert/obliq proj K0063 Hndrm 12-16 vert/obliq proj K0064 Zero pressure tube flat free K0065 Spoke protectors

K0066 Solid tire any size each K0067 Pneumatic tire any size each K0068 Pneumatic tire tube each K0069 Rear whl complete solid tire K0070 Rear whl compl pneum tire K0071 Front castr compl pneum tire K0072 Frnt cstr cmpl sem-pneum tir K0073 Caster pin lock each K0074 Pneumatic caster tire each K0075 Semi-pneumatic caster tire K0076 Solid caster tire each K0077 Front caster assem complete K0078 Pneumatic caster tire tube K0079 Wheel lock extension pair K0080 Anti-rollback device pair K0081 Wheel lock assembly complete K0082 22 nf deep cycl acid battery K0083 22 nf gel cell battery each K0084 Grp 24 deep cycl acid battry K0085 Group 24 gel cell battery K0086 U-1 lead acid battery each K0087 U-1 gel cell battery each K0088 Battry chrgr acid/gel cell K0089 Battery charger dual mode K0090 Rear tire power wheelchair K0091 Rear tire tube power whlchr K0092 Rear assem cmplt powr whlchr K0093 Rear zero pressure tire tube K0094 Wheel tire for power base K0095 Wheel tire tube each base K0096 Wheel assem powr base complt K0097 Wheel zero presure tire tube K0098 Drive belt power wheelchair K0099 Front caster power whelchair K0100 Amputee adapter pair K0101 One-arm drive attachment K0102 Crutch and cane holder K0103 Transfer board < 25" K0104 Cylinder tank carrier K0105 Iv hanger K0106 Arm trough each K0107 Wheelchair tray K0108 Other accessories K0109 Customize whlchr base frame K0110 Maint drug infus cath per wk K0111 External drug infusion pump K0112 Trunk vest supprt innr frame K0113 Trunk vest suprt w/o inr frm K0114 Whlchr back suprt inr frame K0115 Back module orthotic system K0116 Back & seat modul orthot sys K0119 Azathioprine oral tab 50 MG K0120 Azathioprine prentrl 100 MG K0121 Cyclosporine oral 25 MG

K0122 Cyclosporine prentrl 250 MG K0123 Imun/antithmocyt glob 250 MG K0124 Monoclonal antibo paren 5 MG K0125 Prednisone oral 5 MG K0126 Replace multi-podus splint K0127 Replace ankle contrac splint K0128 Replace foot drop splint K0129 Ankle contracture splint K0130 Foot drop splint recumbent K0137 Skin barrier liquid per oz K0138 Skin barrier paste per oz K0139 Skin barrier powder per oz K0140 Acetylcysteine inhalation K0141 Albuterol sulfate inhalation K0142 Cromolyn sodium inhalation K0143 Isoetharine hydrochl inhalat K0144 Isoproterenol hydrochl inhal K0145 Metaproterenol inhalation K0146 Terbutaline inhalation K0152 Paste/powdrs/granuls/beads K0154 Wound pouch each K0163 Vacuum erection system K0168 Disposable nebulizer set K0169 Disposable nebulizer small K0170 Non disposable nebulizer set K0171 Filtered nebulizer set K0172 Disposable nebulizer unfill K0173 Disposable nebulizer prefill K0174 Reservoir bottle w nebulizer K0175 Disposable corrugated tubing K0176 Non dispos corrugated tubing K0177 Water collec dev w nebulizer K0178 Disposbl filter w compressor K0179 Non-dispos filter w/compress K0180 Aerosol mask with nebulizer K0181 Dome & mouthpiece w/ nebuliz K0182 Water distilled w/ nebulizer K0183 Nasal application with cpap K0184 Nasal pillows/seals pair K0185 Headgear with cpap device K0186 Chin strap with cpap device K0187 Tubing with cpap device K0188 Filter disposable with cpap K0189 Filter non-disposable w/cpap K0190 Disposable canister w/pump K0191 Non-disposbl canister w/pump K0192 Tubing used w/ suction pump K0193 Airway pressure dev/w hmdfer K0194 Assist device w/humidifier K0195 Elevating whlchair leg rests K0196 Alginate dressing <=16 sq in K0197 Alginate drsg >16 <=48 sq in K0198 Alginate dressing > 48 sq in K0199 Alginate drsg wound filler

K0203 Composite drsg <= 16 sq in K0204 Composite drsg >16<=48 sq in K0205 Composite drsg > 48 sq in K0206 Contact layer <= 16 sq in K0207 Contact layer >16<= 48 sq in K0208 Contact layer > 48 sq in K0209 Foam drsg <=16 sq in w/o bdr K0210 Foam drg >16<=48 sq in w/o b K0211 Foam drg > 48 sq in w/o brdr K0212 Foam drg <=16 sq in w/border K0213 Foam drg >16<=48 sq in w/bdr K0214 Foam drg > 48 sq in w/border K0215 Foam dressing wound filler K0216 Non-sterile gauze<=16 sq in K0217 Non-sterile gauze>16<=48 sq K0218 Non-sterile gauze > 48 sq in K0219 Gauze <= 16 sq in w/border K0220 Gauze >16 <=48 sq in w/bordr K0221 Gauze > 48 sq in w/border K0222 Gauze <=16 in no w/sal w/o b K0223 Gauze >16<=48 no w/sal w/o b K0224 Gauze > 48 in no w/sal w/o b K0228 Gauze <= 16 sq in water/sal K0229 Gauze >16<=48 sq in watr/sal K0230 Gauze > 48 sq in water/salne K0234 Hydrocolld drg <=16 w/o bdr K0235 Hydrocolld drg >16<=48 w/o b K0236 Hydrocolld drg > 48 in w/o b K0237 Hydrocolld drg <=16 in w/bdr K0238 Hydrocolld drg >16<=48 w/bdr K0239 Hydrocolld drg > 48 in w/bdr K0240 Hydrocolld drg filler paste K0241 Hydrocolloid drg filler dry K0242 Hydrogel drg <=16 in w/o bdr K0243 Hydrogel drg >16<=48 w/o bdr K0244 Hydrogel drg >48 in w/o bdr K0245 Hydrogel drg <= 16 in w/bdr K0246 Hydrogel drg >16<=48 in w/b K0247 Hydrogel drg > 48 sq in w/b K0248 Hydrogel drsg gel filler K0249 Hydrogel drsg dry filler K0250 Skin seal protect moisturizr K0251 Absorpt drg <=16 sq in w/o b K0252 Absorpt drg >16 <=48 w/o bdr K0253 Absorpt drg > 48 sq in w/o b K0254 Absorpt drg <=16 sq in w/bdr K0255 Absorpt drg >16<=48 in w/bdr K0256 Absorpt drg > 48 sq in w/bdr K0257 Transparent film <= 16 sq in K0258 Transparent film >16<=48 in K0259 Transparent film > 48 sq in K0260 Wound cleanser any type/size K0261 Wound filler gel/paste /oz K0262 Wound filler dry form / gram

K0263 Non-sterile elastic gauze/yd K0264 Non-sterile no elastic gauze K0265 Tape per 18 sq inches K0266 Impreg gauze no h20/sal/yard K0268 Humidifier with cpap device K0269 Aerosol compressor cpap dev K0270 Ultrasonic generator w nebul K0271 Drainable pouch w/ faceplate K0272 Drainable pouch w/o facepl K0273 Urinary pouch w/faceplate K0274 Urinary pouch w/o faceplate K0275 Ostomy faceplate reusuable K0276 Ostomy faceplat custom reuse K0277 Skin barrier solid 4x4 equiv K0278 Skin barrier with flange K0279 Skin barrier extended wear K0280 Extension drainage tubing K0281 Lubricant catheter insertion K0283 Saline solution dispenser K0284 External infusion pump reuse K0285 Repair prosthesis per 15 min K0400 Skin support attachment each K0401 Diabetic deluxe shoe K0402 Sterile gauze <= 16 sq in K0403 Sterile gauze>16 <= 48 sq in K0404 Sterile gauze > 48 sq in K0405 Sterile elastic gauze /yd K0406 Sterile non-elastic gauze/yd K0407 Urinary cath skin attachment K0408 Urinary cath leg strap K0409 Sterile H2O irrigation solut K0410 Male ext cath w/adh coating K0411 Male ext cath w/adh strip K0412 Mycophenolate mofetil 25o mg L0100 Cerv craniosten helmet mold L0110 Cerv craniostenosis hel non- L0120 Cerv flexible non-adjustable L0130 Flex thermoplastic collar mo L0140 Cervical semi-rigid adjustab L0150 Cerv semi-rig adj molded chn L0160 Cerv semi-rig wire occ/mand L0170 Cervical collar molded to pt L0172 Cerv col thermplas foam 2 pi L0174 Cerv col foam 2 piece w thor L0180 Cer post col occ/man sup adj L0190 Cerv collar supp adj cerv ba L0200 Cerv col supp adj bar & thor L0210 Thoracic rib belt L0220 Thor rib belt custom fabrica L0300 Thor-lum-sac-ort flx cus fit L0310 Tlso flexible custom fabrica L0315 Tlso flex elas rigid post pa L0317 Tlso flex hypext elas post p L0320 Tlso a-p contrl w apron frnt

L0330 Tlso ant-pos-lateral control L0340 Tlso a-p-l-rotary with apron L0350 Tlso flex compress jacket cu L0360 Tlso flex compress jacket mo L0370 Tlso a-p-l-rotary hyperexten L0380 Tlso a-p-l-rot w/ pos extens L0390 Tlso a-p-l control molded L0400 Tlso a-p-l w interface mater L0410 Tlso a-p-l two piece constr L0420 Tlso a-p-l 2 piece w interfa L0430 Tlso a-p-l w interface custm L0440 Tlso a-p-l overlap frnt cust L0500 Lso flexible custom fitted L0510 Lso flexible custom fabricat L0515 Lso flex elas w/ rig post pa L0520 Lso a-p-l control with apron L0530 Lso ant-pos control w apron L0540 Lso lumbar flexion a-p-l L0550 Lso a-p-l control molded L0560 Lso a-p-l w interface L0565 Lso a-p-l control custom L0600 Sacroiliac flexible cust fit L0610 Sacroiliac flexible custm fa L0620 Sacroiliac semi-rig w apron L0700 Ctlso a-p-l control molded L0710 Ctlso a-p-l control w/ inter L0810 Halo cervical into jckt vest L0820 Halo cervical into body jack L0830 Halo cerv into milwaukee typ L0860 Magnetic resonanc image comp L0900 Tors & ptosis suprt cust fit L0910 Torso & ptosis supp custm fa L0920 Pendulous abd suprt cust fit L0930 Pendulous abdomen supp custm L0940 Post surg support custom fit L0950 Post surg support custom fab L0960 Post surgical support pads L0970 Tlso corset front L0972 Lso corset front L0974 Tlso full corset L0976 Lso full corset L0978 Axillary crutch extension L0980 Peroneal straps pair L0982 Stocking supp grips set of f L0984 Protective body sock each L1000 Ctlso milwauke initial model L1010 Ctlso axilla sling L1020 Kyphosis pad L1025 Kyphosis pad floating L1030 Lumbar bolster pad L1040 Lumbar or lumbar rib pad L1050 Sternal pad L1060 Thoracic pad L1070 Trapezius sling

L1080 Outrigger L1085 Outrigger bil w/ vert extens L1090 Lumbar sling L1100 Ring flange plastic/leather L1110 Ring flange plas/leather mol L1120 Covers for upright each L1200 Furnsh initial orthosis only L1210 Lateral thoracic extension L1220 Anterior thoracic extension L1230 Milwaukee type superstructur L1240 Lumbar derotation pad L1250 Anterior asis pad L1260 Anterior thoracic derotation L1270 Abdominal pad L1280 Rib gusset (elastic) each L1290 Lateral trochanteric pad L1300 Body jacket mold to patient L1310 Post-operative body jacket L1499 Unlist proc for spinal ortho L1500 Thkao mobility frame L1510 Thkao standing frame L1520 Thkao swivel walker L1600 Abduct hip flex frejka w cvr L1610 Abduct hip flex frejka covr L1620 Abduct hip flex pavlik harne L1630 Abduct control hip semi-flex L1640 Pelv band/spread bar thigh c L1650 Abduct hip adjustable custom L1660 Abduct hip plastic custom fi L1680 Pelvic & hip control thigh c L1685 Post-op hip abduct custom fa L1686 Post-op hip abduct custom fi L1700 Leg perthes orth toronto typ L1710 Legg perthes orth newington L1720 Legg perthes orthosis trilat L1730 Legg perthes orth scottish r L1750 Legg perthes sling L1755 Legg perthes patten bottom t L1800 Knee orthoses elas w stays L1810 Ko elastic with joints L1815 Elastic with condylar pads L1820 Ko elas w/ condyle pads & jo L1825 Ko elastic knee cap L1830 Ko immobilizer canvas longit L1832 Ko adj pos rigid supp custom L1834 Ko w/0 joint rigid molded to L1840 Ko derot ant cruciate custom L1844 Ko w/adj jt rot cntrl custom L1845 Ko w/ adj flex/ext rotat cus L1846 Ko w adj flex/ext rotat mold L1850 Ko swedish type L1855 Ko plas doub upright jnt mol L1858 Ko polycentric pneumatic pad L1860 Ko supracondylar socket mold

L1870 Ko doub upright lacers molde L1880 Ko doub upright cuffs/lacers L1885 Knee upright w/resistance L1900 Afo sprng wir drsflx calf bd L1902 Afo ankle gauntlet L1904 Afo molded ankle gauntlet L1906 Afo multiligamentus ankle su L1910 Afo sing bar clasp attach sh L1920 Afo sing upright w/ adjust s L1930 Afo custom fitted plastic L1940 Afo molded to patient plasti L1945 Afo molded plas rig ant tib L1950 Afo spiral molded to pt plas L1960 Afo pos solid ank plastic mo L1970 Afo plastic molded w/ankle j L1980 Afo sing solid stirrup calf L1990 Afo doub solid stirrup calf L2000 Kafo sing fre stirr thi/calf L2010 Kafo sng solid stirrup w/o j L2020 Kafo dbl solid stirrup band/ L2030 Kafo dbl solid stirrup w/o j L2036 Kafo plas doub free knee mol L2037 Kafo plas sing free knee mol L2038 Kafo w/o joint multi-axis an L2040 Hkafo torsion bil rot straps L2050 Hkafo torsion cable hip pelv L2060 Hkafo torsion ball bearing j L2070 Hkafo torsion unilat rot str L2080 Hkafo unilat torsion cable L2090 Hkafo unilat torsion ball br L2102 Afo tibial fx cast plstr mol L2104 Afo tib fx cast synthetic mo L2106 Afo tib fx cast plaster mold L2108 Afo tib fx cast molded to pt L2112 Afo tib fx soft custom fitte L2114 Afo tib fx semi-rigid custom L2116 Afo tib fx rigid custom fitt L2122 Kafo fem fx cast plaster mol L2124 Kafo fem fx cast synthet mol L2126 Kafo fem fx cast thermoplas L2128 Kafo fem fx cast molded to p L2132 Kafo fem fx cast soft custom L2134 Kafo fem fx cast semi-rig cu L2136 Kafo fem fx cast rigid cust L2180 Plas shoe insert w ank joint L2182 Drop lock knee L2184 Limited motion knee joint L2186 Adj motion knee jnt lerman t L2188 Quadrilateral brim L2190 Waist belt L2192 Pelvic band & belt thigh fla L2200 Limited ankle motion ea jnt L2210 Dorsiflexion assist each joi L2220 Dorsi & plantar flex ass/res

L2230 Split flat caliper stirr & p L2240 Round caliper and plate atta L2250 Foot plate molded stirrup at L2260 Reinforced solid stirrup L2265 Long tongue stirrup L2270 Varus/valgus strap padded/li L2275 Plastic mod low ext pad/line L2280 Molded inner boot L2300 Abduction bar jointed adjust L2310 Abduction bar-straight L2320 Non-molded lacer L2330 Lacer molded to patient mode L2335 Anterior swing band L2340 Pre-tibial shell molded to p L2350 Prosthetic type socket molde L2360 Extended steel shank L2370 Patten bottom L2375 Torsion ank & half solid sti L2380 Torsion straight knee joint L2385 Straight knee joint heavy du L2390 Offset knee joint each L2395 Offset knee joint heavy duty L2397 Suspension sleeve lower ext L2405 Knee joint drop lock ea jnt L2415 Knee joint cam lock each joi L2425 Knee disc/dial lock/adj flex L2435 Knee joint polycentric joint L2492 Knee lift loop drop lock rin L2500 Thi/glut/ischia wgt bearing L2510 Th/wght bear quad-lat brim m L2520 Th/wght bear quad-lat brim c L2525 Th/wght bear nar m-l brim mo L2526 Th/wght bear nar m-l brim cu L2530 Thigh/wght bear lacer non-mo L2540 Thigh/wght bear lacer molded L2550 Thigh/wght bear high roll cu L2570 Hip clevis type 2 posit jnt L2580 Pelvic control pelvic sling L2600 Hip clevis/thrust bearing fr L2610 Hip clevis/thrust bearing lo L2620 Pelvic control hip heavy dut L2622 Hip joint adjustable flexion L2624 Hip adj flex ext abduct cont L2627 Plastic mold recipro hip & c L2628 Metal frame recipro hip & ca L2630 Pelvic control band & belt u L2640 Pelvic control band & belt b L2650 Pelv & thor control gluteal L2660 Thoracic control thoracic ba L2670 Thorac cont paraspinal uprig L2680 Thorac cont lat support upri L2750 Plating chrome/nickel pr bar L2760 Extension per extension per L2770 Low ext orthosis per bar/jnt

L2780 Non-corrosive finish L2785 Drop lock retainer each L2795 Knee control full kneecap L2800 Knee cap medial or lateral p L2810 Knee control condylar pad L2820 Soft interface below knee se L2830 Soft interface above knee se L2840 Tibial length sock fx or equ L2850 Femoral lgth sock fx or equa L2860 Torsion mechanism knee/ankle L2999 Unlisted proc for lower ext L3000 Ft insert ucb berkeley shell L3001 Foot insert remov molded spe L3002 Foot insert plastazote or eq L3003 Foot insert silicone gel eac L3010 Foot longitudinal arch suppo L3020 Foot longitud/metatarsal sup L3030 Foot arch support remov prem L3040 Ft arch suprt premold longit L3050 Foot arch supp premold metat L3060 Foot arch supp longitud/meta L3070 Arch suprt att to sho longit L3080 Arch supp att to shoe metata L3090 Arch supp att to shoe long/m L3100 Hallus-valgus nght dynamic s L3140 Abduction rotation bar shoe L3150 Abduct rotation bar w/o shoe L3160 Shoe styled positioning dev L3170 Foot plastic heel stabilizer L3201 Oxford w supinat/pronat inf L3202 Oxford w/ supinat/pronator c L3203 Oxford w/ supinator/pronator L3204 Hightop w/ supp/pronator inf L3206 Hightop w/ supp/pronator chi L3207 Hightop w/ supp/pronator jun L3208 Surgical boot each infant L3209 Surgical boot each child L3211 Surgical boot each junior L3212 Benesch boot pair infant L3213 Benesch boot pair child L3214 Benesch boot pair junior L3215 Orthopedic ftwear ladies oxf L3216 Orthoped ladies shoes dpth i L3217 Ladies shoes hightop depth i L3218 Ladies surgical boot each L3219 Orthopedic mens shoes oxford L3221 Orthopedic mens shoes dpth i L3222 Mens shoes hightop depth inl L3223 Mens surgical boot each L3224 Woman's shoe oxford brace L3225 Man's shoe oxford brace L3230 Custom shoes depth inlay L3250 Custom mold shoe remov prost L3251 Shoe molded to pt silicone s

L3252 Shoe molded plastazote cust L3253 Shoe molded plastazote cust L3254 Orth foot non-stndard size/w L3255 Orth foot non-standard size/ L3257 Orth foot add charge split s L3260 Ambulatory surgical boot eac L3265 Plastazote sandal each L3300 Sho lift taper to metatarsal L3310 Shoe lift elev heel/sole neo L3320 Shoe lift elev heel/sole cor L3330 Lifts elevation metal extens L3332 Shoe lifts tapered to one-ha L3334 Shoe lifts elevation heel /i L3340 Shoe wedge sach L3350 Shoe heel wedge L3360 Shoe sole wedge outside sole L3370 Shoe sole wedge between sole L3380 Shoe clubfoot wedge L3390 Shoe outflare wedge L3400 Shoe metatarsal bar wedge ro L3410 Shoe metatarsal bar between L3420 Full sole/heel wedge btween L3430 Sho heel count plast reinfor L3440 Heel leather reinforced L3450 Shoe heel sach cushion type L3455 Shoe heel new leather standa L3460 Shoe heel new rubber standar L3465 Shoe heel thomas with wedge L3470 Shoe heel thomas extend to b L3480 Shoe heel pad & depress for L3485 Shoe heel pad removable for L3500 Shoe misc add insole leather L3510 Shoe misc addition insole ru L3520 Shoe insole felt cver w/ lea L3530 Shoe misc additions sole hal L3540 Shoe misc additions sole ful L3550 Shoe misc add toe tap standa L3560 Shoe misc add toe tap horses L3570 Shoe special extension to in L3580 Shoe convert instep velcro c L3590 Shoe convert firm to soft cn L3595 Shoe misc additions march ba L3600 Trans shoe calip plate exist L3610 Trans shoe caliper plate new L3620 Trans shoe solid stirrup exi L3630 Trans shoe solid stirrup new L3640 Shoe dennis browne splint bo L3649 Unlist proc orth shoe modif/ L3650 Shlder fig 8 abduct restrain L3660 Abduct restrainer canvas&web L3670 Acromio/clavicular canvas&we L3700 Elbow orthoses elas w stays L3710 Elbow elastic with metal joi L3720 Forearm/arm cuffs free motio

L3730 Forearm/arm cuffs ext/flex a L3740 Cuffs adj lock w/ active con L3800 Whfo short opponen no attach L3805 Whfo long opponens no attach L3810 Whfo thumb abduction bar L3815 Whfo second m.p. abduction a L3820 Whfo ip ext asst w/ mp ext s L3825 Whfo m.p. extension stop L3830 Whfo m.p. extension assist L3835 Whfo m.p. spring extension a L3840 Whfo spring swivel thumb L3845 Whfo thumb ip ext ass w/ mp L3850 Action wrist w/ dorsiflex as L3855 Whfo adj m.p. flexion contro L3860 Whfo adj m.p. flex ctrl & i. L3890 Torsion mechanism wrist/elbo L3900 Hinge extension/flex wrist/f L3901 Hinge ext/flex wrist finger L3902 Whfo ext power compress gas L3904 Whfo electric custom fitted L3906 Wrist gauntlet molded to pt L3907 Whfo wrst gauntlt thmb spica L3908 Wrist cock-up non-molded L3910 Whfo swanson design L3912 Flex glove w/elastic finger L3914 WHO wrist extension cock-up L3916 Whfo wrist extens w/ outrigg L3918 HFO knuckle bender L3920 Knuckle bender with outrigge L3922 Knuckle bend 2 seg to flex j L3924 Oppenheimer L3926 Thomas suspension L3928 Finger extension w/ clock sp L3930 Finger extension with wrist L3932 Safety pin spring wire L3934 Safety pin modified L3936 Palmer L3938 Dorsal wrist L3940 Dorsal wrist w/ outrigger at L3942 Reverse knuckle bender L3944 Reverse knuckle bend w/ outr L3946 HFO composite elastic L3948 Finger knuckle bender L3950 Oppenheimer w/ knuckle bend L3952 Oppenheimer w/ rev knuckle 2 L3954 Spreading hand L3960 Sewho airplan desig abdu pos L3962 Sewho erbs palsey design abd L3963 Molded w/ articulating elbow L3964 Mobile arm supp fitted to pt L3965 Radial arm supp adj rancho t L3966 Mobile arm supports reclinin L3968 Frict arm supp dampening to L3969 Monosuspension arm/hand supp

L3970 Elevat proximal arm support L3972 Offset/lat rocker arm w/ ela L3974 Mobile arm support supinator L3980 Upp ext fx orthosis humeral L3982 Upper ext fx orthosis rad/ul L3984 Upper ext fx orthosis wrist L3985 Forearm hand fx orth w/ wr h L3986 Humeral rad/ulna wrist fx or L3995 Sock fracture or equal each L3999 Unlisted proc upper limb ort L4000 Repl girdle milwaukee orth L4010 Replace trilateral socket br L4020 Replace quadlat socket brim L4030 Replace socket brim cust fit L4040 Replace molded thigh lacer L4045 Replace non-molded thigh lac L4050 Replace molded calf lacer L4055 Replace non-molded calf lace L4060 Replace high roll cuff L4070 Replace prox & dist upright L4080 Repl met band kafo-afo prox L4090 Repl met band kafo-afo calf/ L4100 Repl leath cuff kafo prox th L4110 Repl leath cuff kafo-afo cal L4130 Replace pretibial shell L4200 Orthotic device repair hrly L4210 Orth dev repair/repl minor p L4310 Mult-podus/eq orth prep mgmt L4320 Mgmt sys pos intrfac velcro L4350 Pneumatic ankle cntrl splint L4360 Pneumatic walking splint L4370 Pneumatic full leg splint L4380 Pneumatic knee splint L5000 Sho insert w arch toe filler L5010 Mold socket ank hgt w/ toe f L5020 Tibial tubercle hgt w/ toe f L5050 Ank symes mold sckt sach ft L5060 Symes met fr leath socket ar L5100 Molded socket shin sach foot L5105 Plast socket jts/thgh lacer L5150 Mold sckt ext knee shin sach L5160 Mold socket bent knee shin s L5200 Kne sing axis fric shin sach L5210 No knee/ankle joints w/ ft b L5220 No knee joint with artic ali L5230 Fem focal defic constant fri L5250 Hip canad sing axi cons fric L5270 Tilt table locking hip sing L5280 Hemipelvect canad sing axis L5300 Bk sach soft cover & finish L5310 Knee disart sach soft cv/fin L5320 Ak open end sach soft cv/fin L5330 Hip canadian sach sft cv/fin L5340 Hemipelvectomy canad cv/fin

L5400 Postop dress & 1 cast chg bk L5410 Postop dsg bk ea add cast ch L5420 Postop dsg & 1 cast chg ak/d L5430 Postop dsg ak ea add cast ch L5450 Postop app non-wgt bear dsg L5460 Postop app non-wgt bear dsg L5500 Init bk ptb plaster direct L5505 Init ak ischal plstr direct L5510 Prep BK ptb plaster molded L5520 Perp BK ptb thermopls direct L5530 Prep BK ptb thermopls molded L5535 Prep BK ptb open end socket L5540 Prep BK ptb laminated socket L5560 Prep AK ischial plast molded L5570 Prep AK ischial direct form L5580 Prep AK ischial thermo mold L5585 Prep AK ischial open end L5590 Prep AK ischial laminated L5595 Hip disartic sach thermopls L5600 Hip disart sach laminat mold L5610 Above knee hydracadence L5611 Ak 4 bar link w/fric swing L5613 Ak 4 bar ling w/hydraul swig L5614 4-bar link above knee w/swng L5616 Ak univ multiplex sys frict L5617 AK/BK self-aligning unit ea L5618 Test socket symes L5620 Test socket below knee L5622 Test socket knee disarticula L5624 Test socket above knee L5626 Test socket hip disarticulat L5628 Test socket hemipelvectomy L5629 Below knee acrylic socket L5630 Syme typ expandabl wall sckt L5631 Ak/knee disartic acrylic soc L5632 Symes type ptb brim design s L5634 Symes type poster opening so L5636 Symes type medial opening so L5637 Below knee total contact L5638 Below knee leather socket L5639 Below knee wood socket L5640 Knee disarticulat leather so L5642 Above knee leather socket L5643 Hip flex inner socket ext fr L5644 Above knee wood socket L5645 Ak flexibl inner socket ext L5646 Below knee air cushion socke L5647 Below knee suction socket L5648 Above knee air cushion socke L5649 Isch containmt/narrow m-l so L5650 Tot contact ak/knee disart s L5651 Ak flex inner socket ext fra L5652 Suction susp ak/knee disart L5653 Knee disart expand wall sock

L5654 Socket insert symes L5655 Socket insert below knee L5656 Socket insert knee articulat L5658 Socket insert above knee L5660 Sock insrt syme silicone gel L5661 Multi-durometer symes L5662 Socket insert bk silicone ge L5663 Sock knee disartic silicone L5664 Socket insert ak silicone ge L5665 Multi-durometer below knee L5666 Below knee cuff suspension L5667 Socket insert w lock lower L5668 Socket insert w/o lock lower L5669 Below knee socket w/o lock L5670 Bk molded supracondylar susp L5672 Bk removable medial brim sus L5674 Bk latex sleeve suspension/e L5675 Bk latex sleeve susp/eq hvy L5676 Bk knee joints single axis p L5677 Bk knee joints polycentric p L5678 Bk joint covers pair L5680 Bk thigh lacer non-molded L5682 Bk thigh lacer glut/ischia m L5684 Bk fork strap L5686 Bk back check L5688 Bk waist belt webbing L5690 Bk waist belt padded and lin L5692 Ak pelvic control belt light L5694 Ak pelvic control belt pad/l L5695 Ak sleeve susp neoprene/equa L5696 Ak/knee disartic pelvic join L5697 Ak/knee disartic pelvic band L5698 Ak/knee disartic silesian ba L5699 Shoulder harness L5700 Replace socket below knee L5701 Replace socket above knee L5702 Replace socket hip L5704 Custom shape covr below knee L5705 Custm shape cover above knee L5706 Custm shape cvr knee disart L5707 Custm shape cover hip disart L5710 Kne-shin exo sng axi mnl loc L5711 Knee-shin exo mnl lock ultra L5712 Knee-shin exo frict swg & st L5714 Knee-shin exo variable frict L5716 Knee-shin exo mech stance ph L5718 Knee-shin exo frct swg & sta L5722 Knee-shin pneum swg frct exo L5724 Knee-shin exo fluid swing ph L5726 Knee-shin ext jnts fld swg e L5728 Knee-shin fluid swg & stance L5780 Knee-shin pneum/hydra pneum L5785 Exoskeletal bk ultralt mater L5790 Exoskeletal ak ultra-light m

L5795 Exoskel hip ultra-light mate L5810 Endoskel knee-shin mnl lock L5811 Endo knee-shin mnl lck ultra L5812 Endo knee-shin frct swg & st L5816 Endo knee-shin polyc mch sta L5818 Endo knee-shin frct swg & st L5822 Endo knee-shin pneum swg frc L5824 Endo knee-shin fluid swing p L5828 Endo knee-shin fluid swg/sta L5830 Endo knee-shin pneum/swg pha L5840 Multi-axial knee/shin system L5845 Knee-shin sys stance flexion L5846 Knee-shin sys microprocessor L5850 Endo ak/hip knee extens assi L5855 Mech hip extension assist L5910 Endo below knee alignable sy L5920 Endo ak/hip alignable system L5925 Above knee manual lock L5930 High activity knee frame L5940 Endo bk ultra-light material L5950 Endo ak ultra-light material L5960 Endo hip ultra-light materia L5962 Below knee flex cover system L5964 Above knee flex cover system L5966 Hip flexible cover system L5970 Foot external keel sach foot L5972 Flexible keel foot L5974 Foot single axis ankle/foot L5976 Energy storing foot L5978 Ft prosth multiaxial ankl/ft L5979 Multi-axial ankle/ft prosth L5980 Flex foot system L5981 Flex-walk sys low ext prosth L5982 Exoskeletal axial rotation u L5984 Endoskeletal axial rotation L5985 Lwr ext dynamic prosth pylon L5986 Multi-axial rotation unit L5999 Unlist proc lwr ext prosthes L6000 Par hand robin-aids thum rem L6010 Hand robin-aids little/ring L6020 Part hand robin-aids no fing L6050 Wrst MLd sck flx hng tri pad L6055 Wrst mold sock w/exp interfa L6100 Elb mold sock flex hinge pad L6110 Elbow mold sock suspension t L6120 Elbow mold doub splt soc ste L6130 Elbow stump activated lock h L6200 Elbow mold outsid lock hinge L6205 Elbow molded w/ expand inter L6250 Elbow inter loc elbow forarm L6300 Shlder disart int lock elbow L6310 Shoulder passive restor comp L6320 Shoulder passive restor cap L6350 Thoracic intern lock elbow

L6360 Thoracic passive restor comp L6370 Thoracic passive restor cap L6380 Postop dsg cast chg wrst/elb L6382 Postop dsg cast chg elb dis/ L6384 Postop dsg cast chg shlder/t L6386 Postop ea cast chg & realign L6388 Postop applicat rigid dsg on L6400 Below elbow prosth tiss shap L6450 Elb disart prosth tiss shap L6500 Above elbow prosth tiss shap L6550 Shldr disar prosth tiss shap L6570 Scap thorac prosth tiss shap L6580 Wrist/elbow bowden cable mol L6582 Wrist/elbow bowden cbl dir f L6584 Elbow fair lead cable molded L6586 Elbow fair lead cable dir fo L6588 Shdr fair lead cable molded L6590 Shdr fair lead cable direct L6600 Polycentric hinge pair L6605 Single pivot hinge pair L6610 Flexible metal hinge pair L6615 Disconnect locking wrist uni L6616 Disconnect insert locking wr L6620 Flexion-friction wrist unit L6623 Spring-ass rot wrst w/ latch L6625 Rotation wrst w/ cable lock L6628 Quick disconn hook adapter o L6629 Lamination collar w/ couplin L6630 Stainless steel any wrist L6632 Latex suspension sleeve each L6635 Lift assist for elbow L6637 Nudge control elbow lock L6640 Shoulder abduction joint pai L6641 Excursion amplifier pulley t L6642 Excursion amplifier lever ty L6645 Shoulder flexion-abduction j L6650 Shoulder universal joint L6655 Standard control cable extra L6660 Heavy duty control cable L6665 Teflon or equal cable lining L6670 Hook to hand cable adapter L6672 Harness chest/shlder saddle L6675 Harness figure of 8 sing con L6676 Harness figure of 8 dual con L6680 Test sock wrist disart/bel e L6682 Test sock elbw disart/above L6684 Test socket shldr disart/tho L6686 Suction socket L6687 Frame typ socket bel elbow/w L6688 Frame typ sock above elb/dis L6689 Frame typ socket shoulder di L6690 Frame typ sock interscap-tho L6691 Removable insert each L6692 Silicone gel insert or equal

L6700 Terminal device model #3 L6705 Terminal device model #5 L6710 Terminal device model #5x L6715 Terminal device model #5xa L6720 Terminal device model #6 L6725 Terminal device model #7 L6730 Terminal device model #7lo L6735 Terminal device model #8 L6740 Terminal device model #8x L6745 Terminal device model #88x L6750 Terminal device model #10p L6755 Terminal device model #10x L6765 Terminal device model #12p L6770 Terminal device model #99x L6775 Terminal device model#555 L6780 Terminal device model #ss555 L6790 Hooks-accu hook or equal L6795 Hooks-2 load or equal L6800 Hooks-aprl vc or equal L6805 Modifier wrist flexion unit L6806 Trs grip vc L6807 Trs adept child vc L6808 Trs adept infant vc L6809 Trs super sport passive L6810 Pincher tool otto bock or eq L6825 Hands dorrance vo L6830 Hand aprl vc L6835 Hand sierra vo L6840 Hand becker imperial L6845 Hand becker lock grip L6850 Term dvc-hand becker plylite L6855 Hand robin-aids vo L6860 Hand robin-aids vo soft L6865 Hand passive hand L6867 Hand detroit infant hand L6868 Passive inf hand steeper/hos L6870 Hand child mitt L6872 Hand nyu child hand L6873 Hand mech inf steeper or equ L6875 Hand bock vc L6880 Hand bock vo L6890 Production glove L6895 Custom glove L6900 Hand restorat thumb/1 finger L6905 Hand restoration multiple fi L6910 Hand restoration no fingers L6915 Hand restoration replacmnt g L6920 Wrist disarticul switch ctrl L6925 Wrist disart myoelectronic c L6930 Below elbow switch control L6935 Below elbow myoelectronic ct L6940 Elbow disarticulation switch L6945 Elbow disart myoelectronic c L6950 Above elbow switch control

L6955 Above elbow myoelectronic ct L6960 Shldr disartic switch contro L6965 Shldr disartic myoelectronic L6970 Interscapular-thor switch ct L6975 Interscap-thor myoelectronic L7010 Hand otto back steeper/eq sw L7015 Hand sys teknik village swit L7020 Electronic greifer switch ct L7025 Electron hand myoelectronic L7030 Hand sys teknik vill myoelec L7035 Electron greifer myoelectro L7040 Prehensile actuator hosmer s L7045 Electron hook child michigan L7160 Elbow boston/eq switch ctrl L7165 Elbow boston/eq myoelectron L7170 Electronic elbow hosmer swit L7180 Electronic elbow utah myoele L7185 Electron elbow adolescent sw L7186 Electron elbow child switch L7190 Elbow adolescent myoelectron L7191 Elbow child myoelectronic ct L7260 Electron wrist rotator otto L7261 Electron wrist rotator utah L7266 Servo control steeper or equ L7272 Analogue control unb or equa L7274 Proportional ctl 12 volt uta L7360 Six volt bat otto bock/eq ea L7362 Battery chrgr six volt otto L7364 Twelve volt battery utah/equ L7366 Battery chrgr 12 volt utah/e L7499 Unlisted proc for upper ext L7500 Prosthetic dvc repair hourly L7510 Prosthetic device repair rep L8000 Mastectomy bra L8010 Mastectomy sleeve L8020 Mastectomy form L8030 Breast prosthesis silicone/e L8100 Elas suprt stock bk med wgt L8110 Elastic supp stocking bk hvy L8120 Elastic supp stockng bk surg L8130 Elastic supp stocking ak med L8140 Elastic supp stocking ak hvy L8150 Elastic supp stockng ak surg L8160 Supp stocking full lgth med L8170 Supp stocking full lgth hvy L8180 Supp stocking heavy surg wei L8190 Elas stocking leotards med w L8200 Elas stocking leotards surg L8210 Elastic stocking custom made L8220 Elastic stocking lymphedema L8230 Elasticstocking garter belt L8300 Truss single w/ standard pad L8310 Truss double w/ standard pad L8320 Truss addition to std pad wa

L8330 Truss add to std pad scrotal L8400 Sheath below knee L8410 Sheath above knee L8415 Sheath upper limb L8420 Sock wool below knee L8430 Sock wool above knee L8435 Sock wool upper limb L8440 Shrinker below knee L8460 Shrinker above knee L8465 Shrinker upper limb L8470 Stump sock single below knee L8480 Stump sock single above knee L8485 Stump sock fitting uppr limb L8490 Air seal suction reten systm L8499 Unlisted misc prosthetic ser L8500 Artificial larynx L8501 Tracheostomy speaking valve L8600 Implant breast silicone/eq L8603 Collagen imp urinary 2.5 CC L8605 Tissue expander L8610 Ocular prosthesis L8611 Orbital prosthesis L8612 Aqueous shunt prosthesis L8613 Ossicular prosthesis L8614 Cochlear device/system L8615 Temporomandibular prosthesis L8616 Maxillary prosthesis L8617 Mandibular prosthesis L8618 Palate prosthesis L8619 Replace cochlear processor L8620 Radial head prosthesis L8621 Distal humerus prosthesis L8622 Prox ulna/radial prosthesis L8623 Distal ulnar prosthesis L8624 Distal radial prosthesis L8625 Trapezium prosthesis L8626 Wrist prosthesis L8627 Lunate prosthesis L8628 Carpus prosthesis L8629 Scaphoid prosthesis L8630 Metacarpophalangeal prosth L8640 Patellar prosthesis L8641 Metatarsal joint prosthesis L8642 Hallux implant L8655 Hand/fngr flexor tend prosth L8656 Hand/finger extensor tendon L8657 Tendon pros other hand/finge L8658 Interphalangeal joint prosth L8670 Vascular graft, synthetic L8680 Biliary stent permanent L8690 Testicular prosthesis L9999 Prosthet/orthotic sales tax M0005 Off visit 2/more modalities M0006 One phys therapy modality

M0007 Combined phys ther mod & tx M0008 Combined phys ther mod & tx M0064 Visit for drug monitoring M0075 Cellular therapy M0076 Prolotherapy M0100 Intragastric hypothermia M0101 Cutting or removal of corns M0300 IV chelationtherapy M0301 Fabric wrapping of aneurysm M0302 Assessment of cardiac output P2028 Cephalin floculation test P2029 Congo red blood test P2031 Hair analysis P2033 Blood thymol turbidity P2038 Blood mucoprotein P3000 Screen pap by tech w md supv P3001 Screening pap smear by phys P7001 Culture bacterial urine P9010 Whole blood for transfusion P9011 Blood split unit P9012 Cryoprecipitate each unit P9013 Unit/s blood fibrinogen P9014 Gamma globulin 1 ML P9015 Rh immune globulin 1 ML P9016 Leukocyte poor blood, unit P9017 One donor fresh frozn plasma P9018 Plasma protein fract, unit P9019 Platelet concentrate unit P9020 Plaelet rich plasma unit P9021 Red blood cells unit P9022 Washed red blood cells unit P9603 One-way allow prorated miles P9604 One-way allow prorated trip P9610 Urine specimen collect singl P9615 Urine specimen collect mult Q0034 Admin of influenza vaccine Q0035 Cardiokymography Q0068 Extracorpeal plasmapheresis Q0081 Infusion ther other than che Q0082 Activity therapy w/partial h Q0083 Chemo by other than infusion Q0084 Chemotherapy by infusion Q0085 Chemo by both infusion and o Q0086 Physical therapy evaluation/ Q0091 Obtaining screen pap smear Q0092 Set up port xray equipment Q0103 Physical therapy evaluation Q0104 Phys therapy re-evaluation Q0109 Occupational therapy eval Q0110 Occupational therap re-eval Q0111 Wet mounts/ w preparations Q0112 Potassium hydroxide preps Q0113 Pinworm examinations Q0114 Fern test

Q0115 Post-coital mucous exam Q0116 Hemoglbn sngle analyte exam Q0132 Dispensing fee DME neb drug Q0136 Non esrd epoetin alpha inj Q9920 Epoetin with hct <= 20 Q9921 Epoetin with hct = 21 Q9922 Epoetin with hct = 22 Q9923 Epoetin with hct = 23 Q9924 Epoetin with hct = 24 Q9925 Epoetin with hct = 25 Q9926 Epoetin with hct = 26 Q9927 Epoetin with hct = 27 Q9928 Epoetin with hct = 28 Q9929 Epoetin with hct = 29 Q9930 Epoetin with hct = 30 Q9931 Epoetin with hct = 31 Q9932 Epoetin with hct = 32 Q9933 Epoetin with hct = 33 Q9934 Epoetin with hct = 34 Q9935 Epoetin with hct = 35 Q9936 Epoetin with hct = 36 Q9937 Epoetin with hct = 37 Q9938 Epoetin with hct = 38 Q9939 Epoetin with hct = 39 Q9940 Epoetin with hct >= 40 R0070 Transport portable x-ray R0075 Transport port x-ray multipl R0076 Transport portable EKG V2020 Vision svcs frames purchases V2025 Eyeglasses delux frames V2100 Lens spher single plano 4.00 V2101 Single visn sphere 4.12-7.00 V2102 Singl visn sphere 7.12-20.00 V2103 Spherocylindr 4.00d/12-2.00d V2104 Spherocylindr 4.00d/2.12-4d V2105 Spherocylinder 4.00d/4.25-6d V2106 Spherocylinder 4.00d/>6.00d V2107 Spherocylinder 4.25d/12-2d V2108 Spherocylinder 4.25d/2.12-4d V2109 Spherocylinder 4.25d/4.25-6d V2110 Spherocylinder 4.25d/over 6d V2111 Spherocylindr 7.25d/.25-2.25 V2112 Spherocylindr 7.25d/2.25-4d V2113 Spherocylindr 7.25d/4.25-6d V2114 Spherocylinder over 12.00d V2115 Lens lenticular bifocal V2116 Nonaspheric lens bifocal V2117 Aspheric lens bifocal V2118 Lens aniseikonic single V2199 Lens single vision not oth c V2200 Lens spher bifoc plano 4.00d V2201 Lens sphere bifocal 4.12-7.0 V2202 Lens sphere bifocal 7.12-20. V2203 Lens sphcyl bifocal 4.00d/.1

V2204 Lens sphcy bifocal 4.00d/2.1 V2205 Lens sphcy bifocal 4.00d/4.2 V2206 Lens sphcy bifocal 4.00d/ove V2207 Lens sphcy bifocal 4.25-7d/. V2208 Lens sphcy bifocal 4.25-7/2. V2209 Lens sphcy bifocal 4.25-7/4. V2210 Lens sphcy bifocal 4.25-7/ov V2211 Lens sphcy bifo 7.25-12/.25- V2212 Lens sphcyl bifo 7.25-12/2.2 V2213 Lens sphcyl bifo 7.25-12/4.2 V2214 Lens sphcyl bifocal over 12. V2215 Lens lenticular bifocal V2216 Lens lenticular nonaspheric V2217 Lens lenticular aspheric bif V2218 Lens aniseikonic bifocal V2219 Lens bifocal seg width over V2220 Lens bifocal add over 3.25d V2299 Lens bifocal speciality V2300 Lens sphere trifocal 4.00d V2301 Lens sphere trifocal 4.12-7. V2302 Lens sphere trifocal 7.12-20 V2303 Lens sphcy trifocal 4.0/.12- V2304 Lens sphcy trifocal 4.0/2.25 V2305 Lens sphcy trifocal 4.0/4.25 V2306 Lens sphcyl trifocal 4.00/>6 V2307 Lens sphcy trifocal 4.25-7/. V2308 Lens sphc trifocal 4.25-7/2. V2309 Lens sphc trifocal 4.25-7/4. V2310 Lens sphc trifocal 4.25-7/>6 V2311 Lens sphc trifo 7.25-12/.25- V2312 Lens sphc trifo 7.25-12/2.25 V2313 Lens sphc trifo 7.25-12/4.25 V2314 Lens sphcyl trifocal over 12 V2315 Lens lenticular trifocal V2316 Lens lenticular nonaspheric V2317 Lens lenticular aspheric tri V2318 Lens aniseikonic trifocal V2319 Lens trifocal seg width > 28 V2320 Lens trifocal add over 3.25d V2399 Lens trifocal speciality V2410 Lens variab asphericity sing V2430 Lens variable asphericity bi V2499 Variable asphericity lens V2500 Contact lens pmma spherical V2501 Cntct lens pmma-toric/prism V2502 Contact lens pmma bifocal V2503 Cntct lens pmma color vision V2510 Cntct gas permeable sphericl V2511 Cntct toric prism ballast V2512 Cntct lens gas permbl bifocl V2513 Contact lens extended wear V2520 Contact lens hydrophilic V2521 Cntct lens hydrophilic toric V2522 Cntct lens hydrophil bifocl

V2523 Cntct lens hydrophil extend V2530 Contact lens gas impermeable V2531 Contact lens gas permeable V2599 Contact lens/es other type V2600 Hand held low vision aids V2610 Single lens spectacle mount V2615 Telescop/othr compound lens V2623 Plastic eye prosth custom V2624 Polishing artifical eye V2625 Enlargemnt of eye prosthesis V2626 Reduction of eye prosthesis V2627 Scleral cover shell V2628 Fabrication & fitting V2629 Prosthetic eye other type V2630 Anter chamber intraocul lens V2631 Iris support intraoclr lens V2632 Post chmbr intraocular lens V2700 Balance lens V2710 Glass/plastic slab off prism V2715 Prism lens/es V2718 Fresnell prism press-on lens V2730 Special base curve V2740 Rose tint plastic V2741 Non-rose tint plastic V2742 Rose tint glass V2743 Non-rose tint glass V2744 Tint photochromatic lens/es V2750 Anti-reflective coating V2755 UV lens/es V2760 Scratch resistant coating V2770 Occluder lens/es V2780 Oversize lens/es V2781 Progressive lens per lens V2785 Corneal tissue processing V2790 Amniotic membrane V2799 Miscellaneous vision service V5008 Hearing screening V5010 Assessment for hearing aid V5011 Hearing aid fitting/checking V5014 Hearing aid repair/modifying V5020 Conformity evaluation V5030 Body-worn hearing aid air V5040 Body-worn hearing aid bone V5050 Body-worn hearing aid in ear V5060 Behind ear hearing aid V5070 Glasses air conduction V5080 Glasses bone conduction V5090 Hearing aid dispensing fee V5100 Body-worn bilat hearing aid V5110 Hearing aid dispensing fee V5120 Body-worn binaur hearing aid V5130 In ear binaural hearing aid V5140 Behind ear binaur hearing ai V5150 Glasses binaural hearing aid

V5160 Dispensing fee binaural V5170 Within ear cros hearing aid V5180 Behind ear cros hearing aid V5190 Glasses cros hearing aid V5200 Cros hearing aid dispens fee V5210 In ear bicros hearing aid V5220 Behind ear bicros hearing ai V5230 Glasses bicros hearing aid V5240 Dispensing fee bicros V5241 Dispensing fee, monaural V5242 Hearing aid, monaural, cic V5243 Hearing aid, monaural, itc V5244 Hearing aid, prog, mon, cic V5245 Hearing aid, prog, mon, itc V5246 Hearing aid, prog, mon, ite V5247 Hearing aid, prog, mon, bte V5248 Hearing aid, binaural, cic V5249 Hearing aid, binaural, itc V5250 Hearing aid, prog, bin, cic V5251 Hearing aid, prog, bin, itc V5252 Hearing aid, prog, bin, ite V5253 Hearing aid, prog, bin, bte V5254 Hearing id, digit, mon, cic V5255 Hearing aid, digit, mon, itc V5256 Hearing aid, digit, mon, ite V5257 Hearing aid, digit, mon, bte V5258 Hearing aid, digit, bin, cic V5259 Hearing aid, digit, bin, itc V5260 Hearing aid, digit, bin, ite V5261 Hearing aid, digit, bin, bte V5262 Hearing aid, disp, monaural V5263 Hearing aid, disp, binaural V5264 Ear mold/insert V5265 Ear mold/insert, disp V5266 Battery for hearing device V5267 Hearing aid supply/accessory V5268 ALD Telephone Amplifier V5269 Alerting device, any type V5270 ALD, TV amplifier, any type V5271 ALD, TV caption decoder V5272 Tdd V5273 ALD for cochlear implant V5274 ALD unspecified V5275 Ear impression V5298 Hearing aid noc V5299 Hearing service V5336 Repair communication device V5362 Speech screening V5363 Language screening V5364 Dysphagia screening