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HCPCS Level IIA resourceful compilation of HCPCS codes
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E X P E R T
HCPCS.book Page i Wednesday, November 25, 2015 5:55 PM
U p d a t e a b l e
© 2016 Optum360, LLC
ContentsIntroduction ........................................... Introduction — i
Index.................................................................. Index — 1
A Codes............................................................................. 1
Transportation Services Including Ambulance ............................. 1
Medical and Surgical Supplies........................................................... 2
B Codes ...........................................................................17
Enternal and Parenteral Therapy ....................................................17
C Codes ...........................................................................19
Outpatient PPS ....................................................................................19
E Codes ...........................................................................27
Durable Medical Equipment ............................................................27
G Codes...........................................................................41
Procedures/Professional Services (Temporary)...........................41
H Codes...........................................................................77
Alcohol and Drug Abuse Treatment Services ..............................77
J Codes............................................................................79
J Codes Drugs.......................................................................................79
J Codes Chemotherapy Drugs .........................................................92
K Codes ...........................................................................95
Temporary Codes................................................................................95
L Codes ...........................................................................99
Orthotic Devices and Procedures....................................................99
Prosthetic Procedures..................................................................... 111
M Codes ........................................................................123
Medical Services............................................................................... 123
P Codes .........................................................................124
Pathology and Laboratory Services .............................................124
Q Codes.........................................................................126
Q Codes (Temporary) .......................................................................126
R Codes .........................................................................133
Diagnostic Radiology Services ......................................................133
S Codes .........................................................................135
Temporary National Codes (Non-Medicare) ..............................135
T Codes .........................................................................145
National T Codes Established for State Medicaid Agencies ...145
V Codes .........................................................................147
Vision Services ...................................................................................147
Hearing Services ...............................................................................149
Appendixes
Appendix 1 — Table of Drugs .............................. Appendixes — 1
Appendix 2 — Modifiers......................................Appendixes — 29
Appendix 3 — Abbreviations and Acronyms .........................................................Appendixes — 35
Appendix 4 — Internet-only Manuals (IOMs)................................................................Appendixes — 39
Appendix 5 — HCPCS Changes for 2017...... Appendixes — 173
Appendix 6 — Place of Service and Type of Service...................................................... Appendixes — 183
Appendix 7 — Deleted Code Crosswalk....... Appendixes — 187
Appendix 8 — Glossary .................................... Appendixes — 189
Appendix 9 — Physician Quality Reporting System (PQRS) ............................................. Appendixes — 193
Implant — continuedyttrium 90, S2095Zoladex, J9202
Implantable radiation dosimeter, ea, A4650Impregnated gauze dressing, A6222-A6230Incontinence
appliances and supplies, A4310, A4336,A5051-A5093, A5102-A5114, A5120-A5200
brief or diaper, T4521-T4528, T4543-T4544disposable/liner, T4535garment, A4520pediatric
brief or diaper, T4529-T4530pull-on protection, T4531-T4532
rectal insert, A4337reusable
diaper or brief, T4539pull-on protection, T4536underpad, A4553
underpaddisposable, T4541, T4542reusable, A4553, T4537, T4540
youthbrief or diaper, T4533pull-on protection, T4534
Indium 111capromab pendetide, A9507ibritumomab tiuxetan, A9542labeled
platelets, A9571white blood cells, A9570
oxyguinoline, A9547pentetate, A9548, A9572pentetreotide, A9572satumomab pendetide, A4642
Infant safety, CPR, training, S9447Infection, G9311-G9312Infusion
catheter, C1751dose optimization, for infusion, S3722IV, OPPS, C8957pump, C1772, C2626
ambulatory, with administrative equip-ment, E0781
epoprostenol, K0455heparin, dialysis, E1520implantable, E0782, E0783implantable, refill kit, A4220insulin, E0784mechanical, reusable, E0779, E0780nonprogrammable, C1891supplies, A4221, A4222, A4230-A4232Versa-Pole IV, E0776
Sipuleucel-T autologous CD54+, Q2043supplies, A4222, A4223
syringe cartridge, non-insulin pump,K0552
therapy, home, S9347, S9351, S9497-S9504Inhalation drugs
acetylcysteine, J7608albuterol, J7609, J7610, J7611Alupent, J7668-J7669atropine, J7635-J7636Atrovent, J7644Azmacort, J7684beclomethasone, J7622betamethasone, J7624bitolterol mesylate, J7628-J7629Brcanyl, J7680-J7681Brethine, J7680-J7681budesonide, J7626-J7627, J7633-J7634colistimethate sodium, S0142cromolyn sodium, J7631dexamethasone, J7637-J7638dornase alpha, J7639flunisolide, J7641formoterol, J7606, J7640Gastrocrom, J7631glycopyrolate, J7642-J7643iloprost, Q4074Intal, J7631ipratropium bromide, J7644-J7645isoetharine HCl, J7647-J7650isoproterenol HCl, J7657-J7660levalbuterol, J7607, J7614, J7615
Inhalation drugs — continuedmetaproterenol sulfate, J7667-J7670methacholine chloride, J7674Mucomyst, J7608Mucosil, J7608Nasalcrom, J7631NOC, J7699pentamidine isethionate, J7676Pulmicort Respules, J7627terbutaline sulfate, J7680-J7681Tobi, J7682tobramycin, J7682, J7685Tornalate, J7628-J7629triamcinolone, J7683-J7684
InitialECG, Medicare, G0403-G0405physical exam, Medicare, G0402
Injectablebulking agent
urinary tract, L8603-L8606vocal cord, L8607
Injection — see also Table of Drugsadjustment, bariatric band, S2083bulking agent
urinary tract, L8603-L8606vocal cord, L8607
contrast material, during MRI, A9576-A9579,Q9953
dermal filler for LDS, G0429sacroiliac joint, G0259-G0260supplies for self-administered, A4211,
A4224-A4225Inpatient telehealth pharmacologic manage-
ment, G0459Insert
convex, for ostomy, A5093diabetic, for shoe, A5512-A5513foot insert/plate, L3031implant
soft palate, C9727Insertion
cardioverter-defibrillator system, G0448intrauterine system, S4981tray, A4310-A4316
Instillation fecal microbiota, G0455Integra
bilayer matrix wound dressing, Q4104dermal regeneration template, Q4105flowable wound matrix, Q4114matrix, Q4108meshed bilayer wound matrix, C9363osteoconductive scaffold putty, C9359osteoconductive scaffold strip, C9362
Interfacecough stimulating device, A7020oral with suction pump, A7047
Interfyl wound matrix, Q4171Intermittent
limb compression device, E0676peritoneal dialysis system, E1592positive pressure breathing (IPPB) machine,
E0500Interphalangeal joint, prosthetic implant,
L8658Interscapular thoracic prosthesis
endoskeletal, L6570upper limb, L6350-L6370
Interspinous process distraction device,C1821
Interventionalcohol and/or drug, H0050leak of endoluminal contents, G9305-G9306
Intrafallopian transfercomplete cycle, gamete, S4013complete cycle, zygote, S4014donor egg cycle, S4023incomplete cycle, S4017
Intraocular lenses, C1780, C1840, Q1004-Q1005, S0596, V2630-V2632
new technologycategory 4, Q1004category 5, Q1005
presbyopia correcting function, V2788refractive correcting, S0596telescopic, C1840
Intratubal occlusion device, A4264
Intrauterine devicecopper contraceptive, J7300other, S4989Progestacert, S4989
Introducer sheathguiding, C1766, C1892, C1893other than guiding, C1894, C2629
Inversion device, A9285In vitro fertilization, S4011Iodine 125, A9527, A9532, C2638-C2639Iodine I-131
albumin, A9524iobenguane sulfate, A9508sodium iodide, A9517
Iodine swabs/wipes, A4247IPD
system, E1592IPPB machine, E0500
delivery device, A9274, E0784, S5560-S5561,S5565-S5571
home infusion administration, S9353intermediate acting, S5552long acting, S5553NPH, J1815, S5552outpatient IV treatment, G9147rapid onset, S5550-S5551
Ipratropium bromideadministered through DME, J7644-J7645
Iris Preventix pressure relief/reduction mat-tress, E0184
Iris therapeutic overlays, E0199IRM ankle-foot orthotic, L1950Iron
sucrose, J1756Irrigation/evacuation system, bowel
control unit, E0350disposable supplies for, E0352
Irrigation supplies, A4320, A4322, A4355,A4397-A4400
Surfitirrigation sleeve, A4397night drainage container set, A5102
Visi-flow irrigator, A4398, A4399Islet cell transplant
laparoscopy, G0342laparotomy, G0343percutaneous, G0341
Isocal, enteral nutrition, B4150HCN, B4152
Isoetharineinhalation solution
concentrated, J7647unit dose, J7649-J7650
Isolates, B4150, B4152Isoproterenol HCl
administered through DME, J7657-J7660Isosulfan blue, Q9968Isotein, enteral nutrition, B4153IV, G0459
administration set, non-PVC, S1016infusion, OPPS, C8957pole, E0776, K0105solution
5% dextrose/normal saline, J704210% LMD, J7100D-5-W, J7070dextran, J7100, J7110Gentran, J7100, J7110normal saline, A4217, J7030-J7040,
J7050Rheomacrodex, J7100Ringer’s lactate, J7120
tubing extension set, S1015
JJace tribrace, L1832Jacket
scoliosis, L1300, L1310J-cell battery, replacement for blood glucose
monitor, A4234Jejunostomy tube, B4087-B4088Joint device, C1776
transcutaneous electrical stimulation, E0762
KKaltostat, alginate dressing, A6196-A6199Kartop Patient Lift, toilet or bathroom (see
also Lift), E0625Keramatrix skin substitute, Q4165Keratectomy photorefractive, S0810Keratoprosthesis, C1818Keto-Diastix, box of 100 glucose/ketone
urine test strips, A4250Key-Pred
-25,-50, J2650Kidney
ESRD supply, A4651-A4913system, E1510wearable artificial, E1632
Kingsley gloves, above hands, L6890Kits
asthma, S8097enteral feeding supply (syringe) (pump)
(gravity), B4034-B4036fistula cannulation (set), A4730parenteral nutrition, B4220-B4224surgical dressing (tray), A4550tracheostomy, A4625
KneeAdjustabrace 3, L2999disarticulation, prosthesis, L5150-L5160,
L5312extension/flexion device, E1812immobilizer, L1830joint, miniature, L5826Knee-O-Prene Hinged Wraparound Knee
Support, L1810locks, L2405-L2425Masterbrace 3, L2999Masterhinge Adjustabrace 3, L2999orthotic (KO), E1810, L1810, L1820, L1830-
L1860, L1851-L1852Knee-O-Prene Hinged Knee Sleeve, L1810Knee-O-Prene Hinged Wraparound Knee
Support, L1810Knee Support, L2000-L2038, L2126-L2136KnitRite
prostheticsheath, L8400-L8415sock, L8420-L8435
stump sock, L8470-L8485K-Y Lubricating Jelly, A4332, A4402Kyphosis pad, L1020, L1025
LLaboratory tests
chemistry, P2028-P2038miscellaneous, Q0111-Q0115
Labor care (not resulting in delivery), S4005Lacrimal duct implant
permanent, A4263temporary, A4262
Lancet, A4258, A4259Laparoscopy, surgical
esophagomyotomy, S2079Laryngectomy
tube, A7520-A7522Larynx, artifcial, L8500Laser
application, S8948assisted uvulopalatoplasty (LAUP), S2080in situ keratomileusis, S0800myringotomy, S2225
Laser skin piercing device, for blood collec-tion, E0620
replacement lens, A4257LAUP, S2080Lead
adaptorneurostimulator, C1883pacing, C1883
cardioverter, defibrillator, C1777, C1895,C1896
environmental, home evaluation, T1029neurostimulator, C1778neurostimulator/test kit, C1897pacemaker, C1779, C1898, C1899ventricular, C1900
Implant—
LeadIndex
Index — 7© 2016 Optum360, LLC
LeadHCPCS Level II
Legbag, A4358, A5112extensions for walker, E0158Nextep Contour Lower Leg Walker, L2999Nextep Low Silhouette Lower Leg Walkers,
L2999rest, elevating, K0195rest, wheelchair, E0990strap, A5113, A5114, K0038, K0039
Legg Perthes orthotic, A4565, L1700-L1755Lens
aniseikonic, V2118, V2318contact, V2500-V2599deluxe feature, V2702eye, S0504-S0508, S0580-S0590, S0596,
V2100-V2615, V2700-V2799intraocular, C1780, C1840, V2630-V2632low vision, V2600-V2615mirror coating, V2761occupational multifocal, V2786polarization, V2762polycarbonate, V2784progressive, V2781skin piercing device, replacement, A4257telescopic, C1840tint, V2744
addition, V2745Lenticular lens
bifocal, V2221single vision, V2121trifocal, V2321
Lerman Minerva spinal orthotic, L0174Lesion
destruction, G0186Leukocyte
poor blood, each unit, P9016Levine, stomach tube, B4087-B4088Levonorgestrel, contraceptive implants and
supplies, J7297-J7298, J7301, J7306Lice infestation treatment, A9180Lifescan lancets, box of 100, A4259Lifestand manual wheelchair, K0009Lifestyle modification program, coronary
heart disease, S0340-S0342Lift
combination, E0637patient, and seat, E0621-E0635
HoyerHome Care, E0621Partner All-Purpose, hydraulic,
E0630Partner Power Multifunction, E0625
separate seat mechanism, any type, E0627,E0629
shoe, L3300-L3334standing frame system, E0638
Lift-Aid patient lifts, E0621Light box, E0203Lispro insulin, S5551Lithium battery for blood glucose monitor,
A4233-A4236Lithrotripsy, gallstones, S9034Little Ones
drainable pouch, A5063mini-pouch, A5054one-piece custom drainable pouch, A5061one-piece custom urostomy pouch, A5071pediatric belt, A4367pediatric urine collector, A4335urostomy pouch, transparent, A5073
Lively, knee-ankle-foot orthotic, L2038Lobectomy, lung, donor, S2061Lodging
recipient, escort nonemergency transport,A0180, A0200
transplant-related, S9975NOS, S9976
Lomustine, S0178Lonalac powder, enteral nutrition, B4150Lower limb, prosthesis, addition, L5968Low osmolar contrast
100-199 mgs iodine, Q9965200-299 mgs iodine, Q9966300-399 mgs iodine, Q9967400 or greater mgs iodine, Q9951
LPN services, T1003
Lubricant, A4332, A4402Lumbar
orthotic, L0625-L0627pad, L1030, L1040sacral orthotic (LSO), L0628-L0640
Lung biopsy plug, C2613Lung volume reduction surgery services,
G0302-G0305LVRS services, G0302-G0305Lymphedema therapy, S8950
MMadamist II medication compressor/nebuliz-
er, E0570Magnacal, enteral nutrition, B4152Magnetic
resonance angiography, C8900, C8901-C8914, C8918-C8920, C8931-C8936
resonance cholangiopancreatography,S8037
resonance imaging, low field, S8042source imaging, S8035
Maintenance contract, ESRD, A4890Male erection system, L7900Malibu cervical turtleneck safety collar, L0150Mammography, G0202-G0206Management
advanced illness, S0311disease, S0316-S0317
Mappingtopographic brain, S8040vessels, G0365
Markertissue, A4648
Maskburn compression, A6513CPAP, A7027oxygen, A4620surgical, for dialysis, A4928
Mastectomybra, L8002camisole, S8460form, L8020prosthesis, L8000-L8039, L8600sleeve, L8010
Masterbrace 3, L2999Masterfoot Walking Cast Sole, L3649Masterhinge Adjustabrace 3, L2999Masterhinge Elbow Brace 3, L3999Masterhinge Hip Hinge 3, L2999Masterhinge Shoulder Brace 3, L3999Masters 2 step, S3904Mattress
air pressure, E0186, E0197alternating pressure, E0277
pad, Bio Flote, E0181pad, KoalaKair, E0181
AquaPedic Sectional, E0196decubitus care, E0196dry pressure, E0184flotation, E0184gel pressure, E0196hospital bed, E0271, E0272
non-powered, pressure reducing, E0373Iris Preventix pressure relief/reduction,
E0184Overlay, E0371-E0372pressure reducing, E0181TenderFlor II, E0187TenderGel II, E0196water pressure, E0187, E0198
powered, pressure reducing, E0277MCCM, G9480MCP, multi-axial rotation unit, L5986MCT Oil, enteral nutrition, B4155Meals
adults in treatment, T1010per diem NOS, S9977
Mechanicalhand, L6708-L6709hook, L6706-L6707wound suction, A9272
Medialization material for vocal cord, C1878Medical and surgical supplies, A4206-A6404Medical conference, S0220-S0221Medical food, S9435
Medical home program, S0280-S0281Medical records copying fee, S9981-S9982Medical visit, G0463, G9246-G9247Medicare Care Choice Model (MCCM), G9480Medicare “welcome”
ECG, G0403-G0405physical, G0402
Medication management device, T1505Medication services
comprehensive, H2010reminder, S5185
Medi-Jector injection device, A4210MediSense 2 Pen blood glucose monitor,
E0607Medralone
40, J103080, J1040
Menotropins, S0122Mental health
assessment, H0031education, G0177hospitalization, H0035peer services, H0038self-help, H0038service plan, H0032services, NOS, H0046supportive treatment, H0026-H0037training, G0177
Meritene, enteral nutrition, B4150powder, B4150
MESA, S4028Mesh, C1781Metabolism error, food supplement, S9434Metacarpophalangeal joint prosthesis, L8630Metatarsal joint, prosthetic implant, L8641Meter, bath conductivity, dialysis, E1550Methylene blue injection, Q9968Methylprednisolone
acetate, J1020-J1040oral, J7509sodium succinate, J2920, J2930
Meunster Suspension, socket prosthesis,L6110
Microbiology test, P7001Microcapillary tube, A4651
sealant, A4652Micro-Fine
disposable insulin syringes, up to 1 cc, persyringe, A4206
lancets, box of 100, A4259Microlipids, enteral nutrition, B4155Mileage, ambulance, A0380, A0390Milk, breast
processing, T2101Milwaukee spinal orthotic, L1000Minerva, spinal orthotic, L0700, L0710Mini-bus, nonemergency transportation,
A0120Minimed
3 cc syringe, A4232506 insulin pump, E0784insulin infusion set with bent needle wings,
each, A4231Sof-Set 24” insulin infusion set, each, A4230
Miroderm wound matrix, Q4175Mitotic rate, G9292-G9294Mobilite hospital beds, E0293, E0295, E0297Moderate sedation, G0500Moducal, enteral nutrition, B4155Moisture exchanger for use with invasive
mechanical ventilation, A4483Moisturizer, skin, A6250Monitor
apnea, E0618blood glucose, E0607
Accu-Check, E0607Tracer II, E0607
blood pressure, A4670device, A9279pacemaker, E0610, E0615ultrafiltration, S9007
Monoject disposable insulin syringes, up to1 cc, per syringe, A4206
Monojector lancet device, A4258Morcellator, C1782
Mouthpiece (for respiratory equipment),A4617
MRCP, S8037MRI
contrast material, A9576-A9579, Q9954low field, S8042
Mucoprotein, blood, P2038Mucus trap, S8210Multidisciplinary services, children, T1026Multifetal pregnancy reduction, ultrasound
guidance, S8055Multiple post collar, cervical, L0180-L0200Multipositional patient support system,
E0636Muscular dystrophy, genetic test, S3853Myotonic muscular dystrophy, genetic test,
S3853Myringotomy, S2225
NNail trim, G0127, S0390Narrowing device, wheelchair, E0969Nasal
application device (for CPAP device), A7032-A7034
endoscopy, S2342vaccine inhalation, J3530
Nasogastric tubing, B4081, B4082Nebulizer, E0570-E0585
aerosol mask, A7015aerosols, E0580
Airlife Brand Misty-Neb, E0580Power-Mist, E0580Up-Draft Neb-U-Mist, E0580Up-Mist hand-held nebulizer, E0580
compressor, with, E0570Madamist II medication compressor/neb-
ulizer, E0570Pulmo-Aide compressor/nebulizer,
E0570Schuco Mist nebulizer system, E0570
corrugated tubingdisposable, A7010, A7018
distilled water, A7018filter
disposable, A7013non-disposable, A7014
heater, E1372large volume
disposable, prefilled, A7008disposable, unfilled, A7007
not used with oxygendurable glass, A7017
pneumatic, administration set, A7003,A7005, A7006
pneumatic, nonfiltered, A7004portable, E0570small volume, E0574spacer or nebulizer, S8100
with mask, S8101ultrasonic, dome and mouthpiece, A7016ultrasonic, reservoir bottle
nondisposable, A7009water, A7018water collection device large volume nebu-
lizer, A7012distilled water, A7018
Needle, A4215with syringe, A4206-A4209biopsy
bone marrow, C1830brachytherapy, C1715non-coring, A4212
Negative pressure wound therapydressing set, A6550pump, E2402
NephrAmine, parenteral nutrition, B5000Neuromuscular stimulator, E0745
ambulation of spinal cord injured, E0762Neurophysiology monitoring, G0453Neuro-Pulse, E0720Neurostimulator
functional transcutaneous, E0764generator
nonrechargeable, C1767
© 2016 Optum360, LLC8 — Index
HCPCS Level IILegIn
dex
Leg
— N
euro
stim
ulat
or
Transtracheal oxygen catheter, each N@7A4608CMS: 100-04,23,60.3
Supplies for Oxygen and Related Respiratory Equipment
Battery, heavy-duty; replacement for patient-ownedventilator E
A4611
Battery cables; replacement for patient-owned ventilator EA4612
Battery charger; replacement for patient-ownedventilator E@
A4613
Peak expiratory flow rate meter, hand held N7A4614
Cannula, nasal N7A4615CMS: 100-04,20,100.2; 100-04,23,60.3
Tubing (oxygen), per foot N@7A4616CMS: 100-04,20,100.2; 100-04,23,60.3
Mouthpiece N7A4617CMS: 100-04,20,100.2; 100-04,23,60.3
Breathing circuits N7(NU,RR,UE)A4618CMS: 100-04,20,100.2
Face tent N7(NU)A4619CMS: 100-04,20,100.2
Variable concentration mask N7A4620CMS: 100-04,20,100.2; 100-04,23,60.3
Tracheostomy, inner cannula N7A4623
Tracheal suction catheter, any type other than closed system,each N@7(NU)
A4624
Tracheostomy care kit for new tracheostomy N7A4625
Tracheostomy cleaning brush, each N@7A4626
Spacer, bag or reservoir, with or without mask, for use withmetered dose inhaler E
A4627
CMS: 100-02,15,110
Oropharyngeal suction catheter, each N@7(NU)A4628
Tracheostomy care kit for established tracheostomy N7A4629
Replacement Supplies for DME
Replacement batteries, medically necessary, transcutaneouselectrical stimulator, owned by patient E@7(NU)
A4630
Replacement bulb/lamp for ultraviolet light therapy system,each E@7(NU)
A4633
Replacement bulb for therapeutic light box, tabletopmodel N
A4634
Underarm pad, crutch, replacement, each E@7(NU,RR,UE)A4635
Replacement, handgrip, cane, crutch, or walker,each E@7(NU,RR,UE)
A4636
CMS: 100-04,23,60.3; 100-04,36,50.15
Replacement, tip, cane, crutch, walker, each E@7(NU,RR,UE)A4637CMS: 100-04,23,60.3; 100-04,36,50.15
Replacement battery for patient-owned ear pulse generator,each E@7(NU,RR,UE)
A4638
Replacement pad for infrared heating pad system,each E@7(RR)
A4639
Replacement pad for use with medically necessary alternatingpressure pad owned by patient E7(NU,RR,UE)
A4640
Radiopharmaceuticals
Radiopharmaceutical, diagnostic, not otherwiseclassified Nq
A4641
CMS: 100-04,13,60.3; 100-04,13,60.3.1; 100-04,13,60.3.2AHA: 4Q, '05, 1-6; 3Q, '04, 1-10
Indium In-111 satumomab pendetide, diagnostic, per studydose, up to 6 millicuries Nq@
A4642
Use this code for Oncoscint.AHA: 4Q, '05, 1-6; 3Q, '04, 1-10; 2Q, '02, 8-9
Miscellaneous Supplies
Tissue marker, implantable, any type, each Nq@,A4648AHA: 3Q, '13
Surgical supply; miscellaneous NA4649Determine if an alternative HCPCS Level II or a CPT code better describesthe service being reported. This code should be used only if a more specificcode is unavailable.
Implantable radiation dosimeter, each Nq@,A4650
Calibrated microcapillary tube, each N@,A4651AHA: 1Q, '02, 5
Microcapillary tube sealant N,A4652AHA: 1Q, '02, 5
Dialysis Supplies
Peritoneal dialysis catheter anchoring device, belt,each N@,
A4653
Syringe, with or without needle, each N@,A4657CMS: 100-04,13,60.7.1; 100-04,8,60.4.4; 100-04,8,60.4.6.3; 100-04,8,60.7;100-04,8,60.7.3AHA: 1Q, '02, 5
Sphygmomanometer/blood pressure apparatus with cuff andstethoscope N,
A4660
Blood pressure cuff only N,A4663
Automatic blood pressure monitor EA4670
Disposable cycler set used with cycler dialysis machine,each B@,
A4671
Drainage extension line, sterile, for dialysis, each B@,A4672
Extension line with easy lock connectors, used withdialysis B,
A4673
Chemicals/antiseptics solution used to clean/sterilize dialysisequipment, per 8 oz B@,
A4674
Activated carbon filter for hemodialysis, each N@,A4680
Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis,each N@,
A4690
Bicarbonate concentrate, solution, for hemodialysis, pergallon N@,
A4706
AHA: 1Q, '02, 5
Bicarbonate concentrate, powder, for hemodialysis, perpacket N@,
A4707
AHA: 1Q, '02, 5
Acetate concentrate solution, for hemodialysis, pergallon N@,
A4708
AHA: 1Q, '02, 5
Acid concentrate, solution, for hemodialysis, pergallon N@,
A4709
AHA: 1Q, '02, 5
Treated water (deionized, distilled, or reverse osmosis) forperitoneal dialysis, per gallon N@,
A4714
A4608
— A
4714Transportation Services Including A
mbulance
s Revised Codem Recycled/Reinstatedl New Code@ Quantity AlertCarrier DiscretionNoncovered by MedicareSpecial Coverage Instructions
A Codes — 7, SNF Excluded7 DMEPOS PaidAHA: Coding ClinicCMS: Pub 100g-w ASC Pmt© 2016 Optum360, LLC
A4714HCPCS Level II
Commode chair, mobile or stationary, with detachablearms Y7(RR)
E0165
Medicare covers commodes for patients confined to their beds or rooms,for patients without indoor bathroom facilities, and to patients who cannotclimb or descend the stairs necessary to reach the bathrooms in theirhomes.
Pail or pan for use with commode chair, replacementonly Y7(NU,RR,UE)
E0167
Medicare covers commodes for patients confined to their beds or rooms,for patients without indoor bathroom facilities, and to patients who cannotclimb or descend the stairs necessary to reach the bathrooms in theirhomes.
Commode chair, extra wide and/or heavy-duty, stationary ormobile, with or without arms, any type,each Y@7(NU,RR,UE)
E0168
Commode chair with integrated seat lift mechanism, electric,any type Y7(RR)
E0170
Commode chair with integrated seat lift mechanism, nonelectric,any type Y7(RR)
E0171
Seat lift mechanism placed over or on top of toilet, anytype E
E0172
Footrest, for use with commode chair, each Y@7(NU,RR,UE)E0175
Decubitus Care Equipment
Powered pressure reducing mattress overlay/pad, alternating,with pump, includes heavy-duty Y7(RR)
E0181
For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Pump for alternating pressure pad, for replacementonly Y7(RR)
E0182
For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Dry pressure mattress Y7(NU,RR,UE)E0184For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Gel or gel-like pressure pad for mattress, standard mattresslength and width Y7(NU,RR,UE)
E0185
For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Air pressure mattress Y7(RR)E0186For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Water pressure mattress Y7(RR)E0187For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Synthetic sheepskin pad Y7(NU,RR,UE)E0188For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Lambswool sheepskin pad, any size Y7(NU,RR,UE)E0189For Medicare coverage, a detailed written order must be received by thesupplier before a claim is submitted.
Positioning cushion/pillow/wedge, any shape or size, includesall components and accessories E
E0190
Heel or elbow protector, each Y@7(NU,RR,UE)E0191
Powered air flotation bed (low air loss therapy) Y7(RR)E0193CMS: 100-04,23,60.3
Air fluidized bed Y7(RR)E0194An air fluidized bed is covered by Medicare if the patient has a stage 3 orstage 4 pressure sore and, without the bed, would requireinstitutionalization. For Medicare coverage, a detailed written order mustbe received by the supplier before a claim is submitted.
Gel pressure mattress Y7(RR)E0196Medicare covers pads if physicians supervise their use in patients whohave decubitus ulcers or susceptibility to them. For Medicare coverage,a detailed written order must be received by the supplier before a claimis submitted.
Air pressure pad for mattress, standard mattress length andwidth Y7(RR)
E0197
Medicare covers pads if physicians supervise their use in patients whohave decubitus ulcers or susceptibility to them. For Medicare coverage,a detailed written order must be received by the supplier before a claimis submitted.
Water pressure pad for mattress, standard mattress length andwidth Y7(RR)
E0198
Medicare covers pads if physicians supervise their use in patients whohave decubitus ulcers or susceptibility to them.For Medicare coverage, adetailed written order must be received by the supplier before a claim issubmitted.
Dry pressure pad for mattress, standard mattress length andwidth Y7(NU,RR,UE)
E0199
Medicare covers pads if physicians supervise their use in patients whohave decubitus ulcers or susceptibility to them. For Medicare coverage,a detailed written order must be received by the supplier before a claimis submitted.
Heat/Cold Application
Heat lamp, without stand (table model), includes bulb, orinfrared element Y7(NU,RR,UE)
E0200
Phototherapy (bilirubin) light with photometer Y7(RR)E0202
Therapeutic lightbox, minimum 10,000 lux, table topmodel E
E0203
Heat lamp, with stand, includes bulb, or infraredelement Y7(NU,RR,UE)
E0205
Electric heat pad, standard Y7(NU,RR,UE)E0210
Electric heat pad, moist Y7(NU,RR,UE)E0215
Water circulating heat pad with pump Y7(NU,RR,UE)E0217
Water circulating cold pad with pump YE0218
Infrared heating pad system YE0221AHA: 1Q, '02, 5
Hydrocollator unit, includes pads Y7(NU,RR,UE)E0225
Noncontact wound-warming device (temperature control unit,AC adapter and power cord) for use with warming card andwound cover E
E0231
AHA: 1Q, '02, 5
Warming card for use with the noncontact wound-warmingdevice and noncontact wound-warming wound cover E
E0232
AHA: 1Q, '02, 5
Paraffin bath unit, portable (see medical supply code A4265 forparaffin) Y7(RR)
E0235
Pump for water circulating pad Y7(RR)E0236
Hydrocollator unit, portable Y7(NU,RR,UE)E0239
Bath and Toilet Aids
Bath/shower chair, with or without wheels, any size EE0240
Bathtub wall rail, each E@E0241
Bathtub rail, floor base EE0242
Toilet rail, each E@E0243
Raised toilet seat EE0244
Tub stool or bench EE0245
Transfer tub rail attachment EE0246
s Revised Codem Recycled/Reinstatedl New Code@ Quantity AlertCarrier DiscretionNoncovered by MedicareSpecial Coverage Instructions
© 2016 Optum360, LLCA-Y OPPS Status Indicators: Male Only; Female Onlyx Maternity Edity Age Edit28 — E Codes
HCPCS Level IIE0165D
urab
le M
edic
al E
quip
men
tE0
165
— E
0246
Electromagnetic therapy, to one or more areas for chronic StageIII and Stage IV pressure ulcers, arterial ulcers, diabetic ulcersand venous stasis ulcers not demonstrating measurable signsof healing after 30 days of conventional care as part of a therapyplan of care A
G0329
CMS: 100-04,32,11.2
Pharmacy dispensing fee for inhalation drug(s); initial 30-daysupply as a beneficiary M
G0333
Hospice evaluation and counseling services, preelection BG0337CMS: 100-04,11,10; 100-04,11,10.1
Image guided robotic linear accelerator-based stereotacticradiosurgery, complete course of therapy in one session or firstsession of fractionated treatment B,
G0339
AHA: 4Q, '13; 1Q, '04, 6
Image guided robotic linear accelerator-based stereotacticradiosurgery, delivery including collimator changes and customplugging, fractionated treatment, all lesions, per session, secondthrough fifth sessions, maximum 5 sessions per course oftreatment B,
G0340
AHA: 4Q, '13; 1Q, '04, 6
Percutaneous islet cell transplant, includes portal veincatheterization and infusion C,
G0341
CMS: 100-04,32,70
Laparoscopy for islet cell transplant, includes portal veincatheterization and infusion C,
G0342
CMS: 100-04,32,70
Laparotomy for islet cell transplant, includes portal veincatheterization and infusion C,
G0343
CMS: 100-04,32,70
Bone marrow aspiration performed with bone marrow biopsythrough the same incision on the same date of service N,
G0364
AHA: 3Q, '12, 6
Vessel mapping of vessels for hemodialysis access (services forpreoperative vessel mapping prior to creation of hemodialysisaccess using an autogenous hemodialysis conduit, includingarterial inflow and venous outflow) Sr
G0365
Physician service required to establish and document the needfor a power mobility device M,
G0372
CMS: 100-04,12,30.6.15.4
Observation/Emergency Department Services
Hospital observation service, per hour NG0378CMS: 100-02,6,20.6; 100-04,01,50.3.2; 100-04,4,290.1; 100-04,4,290.2.2;100-04,4,290.4.1; 100-04,4,290.4.2; 100-04,4,290.4.3; 100-04,4,290.5.1;100-04,4,290.5.2; 100-04,4,290.5.3AHA: 4Q, '05, 7, 9
Direct admission of patient for hospital observation care JG0379CMS: 100-02,6,20.6; 100-04,4,290.4.1; 100-04,4,290.4.2; 100-04,4,290.4.3;100-04,4,290.5.1; 100-04,4,290.5.2; 100-04,4,290.5.3AHA: 4Q, '05, 7, 9
Level 1 hospital emergency department visit provided in a typeB emergency department; (the ED must meet at least one of thefollowing requirements: (1) it is licensed by the state in whichit is located under applicable state law as an emergency roomor emergency department; (2) it is held out to the public (byname, posted signs, advertising, or other means) as a place thatprovides care for emergency medical conditions on an urgentbasis without requiring a previously scheduled appointment;or (3) during the calendar year immediately preceding thecalendar year in which a determination under 42 CFR 489.24 isbeing made, based on a representative sample of patient visitsthat occurred during that calendar year, it provides at leastone-third of all of its outpatient visits for the treatment ofemergency medical conditions on an urgent basis withoutrequiring a previously scheduled appointment) J
G0380
CMS: 100-04,4,160AHA: 4Q, '13; 1Q, '09, 1; 4Q, '07, 1
Level 2 hospital emergency department visit provided in a typeB emergency department; (the ED must meet at least one of thefollowing requirements: (1) it is licensed by the state in whichit is located under applicable state law as an emergency roomor emergency department; (2) it is held out to the public (byname, posted signs, advertising, or other means) as a place thatprovides care for emergency medical conditions on an urgentbasis without requiring a previously scheduled appointment;or (3) during the calendar year immediately preceding thecalendar year in which a determination under 42 CFR 489.24 isbeing made, based on a representative sample of patient visitsthat occurred during that calendar year, it provides at leastone-third of all of its outpatient visits for the treatment ofemergency medical conditions on an urgent basis withoutrequiring a previously scheduled appointment) J
G0381
CMS: 100-04,4,160AHA: 4Q, '13; 1Q, '09, 1; 4Q, '07, 1
Level 3 hospital emergency department visit provided in a typeB emergency department; (the ED must meet at least one of thefollowing requirements: (1) it is licensed by the state in whichit is located under applicable state law as an emergency roomor emergency department; (2) it is held out to the public (byname, posted signs, advertising, or other means) as a place thatprovides care for emergency medical conditions on an urgentbasis without requiring a previously scheduled appointment;or (3) during the calendar year immediately preceding thecalendar year in which a determination under 42 CFR 489.24 isbeing made, based on a representative sample of patient visitsthat occurred during that calendar year, it provides at leastone-third of all of its outpatient visits for the treatment ofemergency medical conditions on an urgent basis withoutrequiring a previously scheduled appointment) J
G0382
CMS: 100-04,4,160AHA: 4Q, '13; 1Q, '09, 1; 4Q, '07, 1
Level 4 hospital emergency department visit provided in a typeB emergency department; (the ED must meet at least one of thefollowing requirements: (1) it is licensed by the state in whichit is located under applicable state law as an emergency roomor emergency department; (2) it is held out to the public (byname, posted signs, advertising, or other means) as a place thatprovides care for emergency medical conditions on an urgentbasis without requiring a previously scheduled appointment;or (3) during the calendar year immediately preceding thecalendar year in which a determination under 42 CFR 489.24 isbeing made, based on a representative sample of patient visitsthat occurred during that calendar year, it provides at leastone-third of all of its outpatient visits for the treatment ofemergency medical conditions on an urgent basis withoutrequiring a previously scheduled appointment) J
G0383
CMS: 100-04,4,160AHA: 4Q, '13; 1Q, '09, 1; 4Q, '07, 1
G0329
— G
0383Procedures/Professional Services (Tem
porary)
s Revised Codem Recycled/Reinstatedl New Code@ Quantity AlertCarrier DiscretionNoncovered by MedicareSpecial Coverage Instructions
G Codes — 45, SNF Excluded7 DMEPOS PaidAHA: Coding ClinicCMS: Pub 100g-w ASC Pmt© 2016 Optum360, LLC
G0383HCPCS Level II
Lymphocyte immune globulin, antithymocyte globulin, equine,parenteral, 250 mg Kn@
J7504
Use this code for Atgam.CMS: 100-03,260.7; 100-04,17,80.3
Muromonab-CD3, parenteral, 5 mg E@J7505Use this code for Orthoclone OKT3.CMS: 100-04,17,80.3
Tacrolimus, immediate release, oral, 1 mg Nq@J7507Use this code for Prograf.CMS: 100-02,15,50.5; 100-04,17,80.3
Tacrolimus, extended release, (Astagraf XL), oral, 0.1mg Gn@
J7508
AHA: 1Q, '16, 6-8; 1Q, '14
Methylprednisolone, oral, per 4 mg Nq@J7509Use this code for Medrol, Methylpred.CMS: 100-02,15,50.5; 100-04,17,80.3
Prednisolone, oral, per 5 mg Nq@J7510Use this code for Delta-Cortef, Cotolone, Pediapred, Prednoral, Prelone.CMS: 100-02,15,50.5; 100-04,17,80.3
Lymphocyte immune globulin, antithymocyte globulin, rabbit,parenteral, 25 mg Kn@
J7511
Use this code for Thymoglobulin.CMS: 100-04,17,80.3AHA: 2Q, '02, 8-9; 1Q, '02, 5
Prednisone, immediate release or delayed release, oral, 1mg N
J7512
AHA: 1Q, '16, 6-8
Daclizumab, parenteral, 25 mg Kn@J7513Use this code for Zenapax.CMS: 100-02,15,50.5; 100-04,17,80.3AHA: 2Q, '05, 11
Cyclosporine, oral, 25 mg Nq@J7515Use this code for Neoral, Sandimmune, Gengraf, Sangcya.CMS: 100-04,17,80.3
Cyclosporine, parenteral, 250 mg Nq@J7516Use this code for Neoral, Sandimmune, Gengraf, Sangcya.CMS: 100-04,17,80.3
Mycophenolate mofetil, oral, 250 mg Nq@J7517Use this code for CellCept.CMS: 100-04,17,80.3
Mycophenolic acid, oral, 180 mg Nq@J7518Use this code for Myfortic Delayed Release.CMS: 100-04,17,80.3.1AHA: 2Q, '05, 11
Sirolimus, oral, 1 mg Nq@J7520Use this code for Rapamune.CMS: 100-02,15,50.5; 100-04,17,80.3
Tacrolimus, parenteral, 5 mg Kn@J7525Use this code for Prograf.CMS: 100-02,15,50.5; 100-04,17,80.3
Everolimus, oral, 0.25 mg Nq@J7527Use this code for Zortress, Afinitor.
Immunosuppressive drug, not otherwise classified NqJ7599Determine if an alternative HCPCS Level II or a CPT code better describesthe service being reported. This code should be used only if a more specificcode is unavailable.CMS: 100-02,15,50.5; 100-04,17,80.3AHA: 2Q, '13
Inhalation Drugs
Acetylcysteine, inhalation solution, compounded product,administered through DME, unit dose form, per g M@
J7604
Arformoterol, inhalation solution, FDA approved final product,noncompounded, administered through DME, unit dose form,15 mcg M@
J7605
Formoterol fumarate, inhalation solution, FDA approved finalproduct, noncompounded, administered through DME, unitdose form, 20 mcg M
J7606
Use this code for PERFOROMIST.
Levalbuterol, inhalation solution, compounded product,administered through DME, concentrated form, 0.5 mg M@
J7607
CMS: 100-03,200.2
Acetylcysteine, inhalation solution, FDA-approved final product,noncompounded, administered through DME, unit dose form,per g M@
J7608
Use this code for Acetadote, Mucomyst, Mucosil.
Albuterol, inhalation solution, compounded product,administered through DME, unit dose, 1 mg M@
J7609
Albuterol, inhalation solution, compounded product,administered through DME, concentrated form, 1 mg M@
J7610
Albuterol, inhalation solution, FDA-approved final product,noncompounded, administered through DME, concentratedform, 1 mg M@
J7611
Use this code for Accuneb, Proventil, Respirol, Ventolin.AHA: 2Q, '08, 10; 2Q, '07, 10
Levalbuterol, inhalation solution, FDA-approved final product,noncompounded, administered through DME, concentratedform, 0.5 mg M@
J7612
Use this code for Xopenex HFA.CMS: 100-03,200.2AHA: 2Q, '08, 10; 2Q, '07, 10
Albuterol, inhalation solution, FDA-approved final product,noncompounded, administered through DME, unit dose, 1mg M@
J7613
Use this code for Accuneb, Proventil, Respirol, Ventolin.AHA: 2Q, '08, 10; 2Q, '07, 10
Levalbuterol, inhalation solution, FDA-approved final product,noncompounded, administered through DME, unit dose, 0.5mg M@
J7614
Use this code for Xopenex.CMS: 100-03,200.2AHA: 2Q, '08, 10; 2Q, '07, 10
Levalbuterol, inhalation solution, compounded product,administered through DME, unit dose, 0.5 mg M@
J7615
CMS: 100-03,200.2
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg,FDA-approved final product, noncompounded, administeredthrough DME M@
J7620
Beclomethasone, inhalation solution, compounded product,administered through DME, unit dose form, per mg M@
J7622
Use this code for Beclovent, Beconase.AHA: 1Q, '02, 5
Betamethasone, inhalation solution, compounded product,administered through DME, unit dose form, per mg M@
J7624
AHA: 1Q, '02, 5
s Revised Codem Recycled/Reinstatedl New Code@ Quantity AlertCarrier DiscretionNoncovered by MedicareSpecial Coverage Instructions
© 2016 Optum360, LLCA-Y OPPS Status Indicators: Male Only; Female Onlyx Maternity Edity Age Edit90 — J Codes
HCPCS Level IIJ7504D
rugs
Adm
inis
tere
d O
ther
Tha
n O
ral M
etho
dJ7
504
— J
7624
Sacroiliac orthotic, flexible, provides pelvic-sacral support,reduces motion about the sacroiliac joint, includes straps,closures, may include pendulous abdomen design, customfabricated A7
L0622
Sacroiliac orthosis, provides pelvic-sacral support, with rigid orsemi-rigid panels over the sacrum and abdomen, reduces motionabout the sacroiliac joint, includes straps, closures, may includependulous abdomen design, prefabricated, off-the-shelf A7
L0623
Sacroiliac orthotic, provides pelvic-sacral support, with rigid orsemi-rigid panels placed over the sacrum and abdomen, reducesmotion about the sacroiliac joint, includes straps, closures, mayinclude pendulous abdomen design, custom fabricated A7
L0624
Lumbar orthosis, flexible, provides lumbar support, posteriorextends from L-1 to below L-5 vertebra, produces intracavitarypressure to reduce load on the intervertebral discs, includesstraps, closures, may include pendulous abdomen design,shoulder straps, stays, prefabricated, off-the-shelf A7
L0625
Lumbar orthosis, sagittal control, with rigid posterior panel(s),posterior extends from L-1 to below L-5 vertebra, producesintracavitary pressure to reduce load on the intervertebral discs,includes straps, closures, may include padding, stays, shoulderstraps, pendulous abdomen design, prefabricated item that hasbeen trimmed, bent, molded, assembled, or otherwisecustomized to fit a specific patient by an individual withexpertise A7
L0626
Lumbar orthosis, sagittal control, with rigid anterior andposterior panels, posterior extends from L-1 to below L-5vertebra, produces intracavitary pressure to reduce load on theintervertebral discs, includes straps, closures, may includepadding, shoulder straps, pendulous abdomen design,prefabricated item that has been trimmed, bent, molded,assembled, or otherwise customized to fit a specific patient byan individual with expertise A7
L0627
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support,posterior extends from sacrococcygeal junction to T-9 vertebra,produces intracavitary pressure to reduce load on theintervertebral discs, includes straps, closures, may include stays,shoulder straps, pendulous abdomen design, prefabricated,off-the-shelf A7
L0628
Lumbar-sacral orthotic, flexible, provides lumbo-sacral support,posterior extends from sacrococcygeal junction to T-9 vertebra,produces intracavitary pressure to reduce load on theintervertebral discs, includes straps, closures, may include stays,shoulder straps, pendulous abdomen design, customfabricated A7
L0629
Lumbar-sacral orthosis, sagittal control, with rigid posteriorpanel(s), posterior extends from sacrococcygeal junction to T-9vertebra, produces intracavitary pressure to reduce load on theintervertebral discs, includes straps, closures, may includepadding, stays, shoulder straps, pendulous abdomen design,prefabricated item that has been trimmed, bent, molded,assembled, or otherwise customized to fit a specific patient byan individual with expertise A7
L0630
Lumbar-sacral orthosis, sagittal control, with rigid anterior andposterior panels, posterior extends from sacrococcygeal junctionto T-9 vertebra, produces intracavitary pressure to reduce loadon the intervertebral discs, includes straps, closures, may includepadding, shoulder straps, pendulous abdomen design,prefabricated item that has been trimmed, bent, molded,assembled, or otherwise customized to fit a specific patient byan individual with expertise A7
L0631
Lumbar-sacral orthotic (LSO), sagittal control, with rigid anteriorand posterior panels, posterior extends from sacrococcygealjunction to T-9 vertebra, produces intracavitary pressure toreduce load on the intervertebral discs, includes straps, closures,may include padding, shoulder straps, pendulous abdomendesign, custom fabricated A7
L0632
Lumbar-sacral orthosis, sagittal-coronal control, with rigidposterior frame/panel(s), posterior extends from sacrococcygealjunction to T-9 vertebra, lateral strength provided by rigid lateralframe/panels, produces intracavitary pressure to reduce loadon intervertebral discs, includes straps, closures, may includepadding, stays, shoulder straps, pendulous abdomen design,prefabricated item that has been trimmed, bent, molded,assembled, or otherwise customized to fit a specific patient byan individual with expertise A7
L0633
Lumbar-sacral orthotic (LSO), sagittal-coronal control, with rigidposterior frame/panel(s), posterior extends from sacrococcygealjunction to T-9 vertebra, lateral strength provided by rigid lateralframe/panel(s), produces intracavitary pressure to reduce loadon intervertebral discs, includes straps, closures, may includepadding, stays, shoulder straps, pendulous abdomen design,custom fabricated A7
L0634
Lumbar-sacral orthotic (LSO), sagittal-coronal control, lumbarflexion, rigid posterior frame/panel(s), lateral articulating designto flex the lumbar spine, posterior extends from sacrococcygealjunction to T-9 vertebra, lateral strength provided by rigid lateralframe/panel(s), produces intracavitary pressure to reduce loadon intervertebral discs, includes straps, closures, may includepadding, anterior panel, pendulous abdomen design,prefabricated, includes fitting and adjustment A7
L0635
Lumbar-sacral orthotic (LSO), sagittal-coronal control, lumbarflexion, rigid posterior frame/panels, lateral articulating designto flex the lumbar spine, posterior extends from sacrococcygealjunction to T-9 vertebra, lateral strength provided by rigid lateralframe/panels, produces intracavitary pressure to reduce loadon intervertebral discs, includes straps, closures, may includepadding, anterior panel, pendulous abdomen design, customfabricated A7
L0636
Lumbar-sacral orthosis, sagittal-coronal control, with rigidanterior and posterior frame/panels, posterior extends fromsacrococcygeal junction to T-9 vertebra, lateral strengthprovided by rigid lateral frame/panels, produces intracavitarypressure to reduce load on intervertebral discs, includes straps,closures, may include padding, shoulder straps, pendulousabdomen design, prefabricated item that has been trimmed,bent, molded, assembled, or otherwise customized to fit aspecific patient by an individual with expertise A7
L0637
Lumbar-sacral orthotic (LSO), sagittal-coronal control, with rigidanterior and posterior frame/panels, posterior extends fromsacrococcygeal junction to T-9 vertebra, lateral strengthprovided by rigid lateral frame/panels, produces intracavitarypressure to reduce load on intervertebral discs, includes straps,closures, may include padding, shoulder straps, pendulousabdomen design, custom fabricated A7
L0638
Lumbar-sacral orthosis, sagittal-coronal control, rigidshell(s)/panel(s), posterior extends from sacrococcygeal junctionto T-9 vertebra, anterior extends from symphysis pubis toxyphoid, produces intracavitary pressure to reduce load on theintervertebral discs, overall strength is provided by overlappingrigid material and stabilizing closures, includes straps, closures,may include soft interface, pendulous abdomen design,prefabricated item that has been trimmed, bent, molded,assembled, or otherwise customized to fit a specific patient byan individual with expertise A7
L0639
L0622—
L0639O
rthotic Devices and Procedures
s Revised Codem Recycled/Reinstatedl New Code@ Quantity AlertCarrier DiscretionNoncovered by MedicareSpecial Coverage Instructions
L Codes — 101, SNF Excluded7 DMEPOS PaidAHA: Coding ClinicCMS: Pub 100g-w ASC Pmt© 2016 Optum360, LLC
L0639HCPCS Level II
Perphenazine, 4 mg, oral, FDA approved prescription antiemetic,for use as a complete therapeutic substitute for an IV antiemeticat the time of chemotherapy treatment, not to exceed a 48 hourdosage regimen Nq@
Q0175
Medicare covers at the time of chemotherapy if regimen doesn't exceed48 hours. Submit on the same claim as the chemotherapy. Use this codefor Trilifon.CMS: 100-02,15,50.5.4; 100-03,110.18; 100-04,17,80.2.1AHA: 1Q, '08, 1
Hydroxyzine pamoate, 25 mg, oral, FDA approved prescriptionantiemetic, for use as a complete therapeutic substitute for anIV antiemetic at the time of chemotherapy treatment, not toexceed a 48-hour dosage regimen Nq@
Q0177
Medicare covers at the time of chemotherapy if regimen doesn't exceed48 hours. Submit on the same claim as the chemotherapy. Use this codefor Vistaril.CMS: 100-02,15,50.5.4; 100-03,110.18; 100-04,17,80.2.1AHA: 1Q, '08, 1
Dolasetron mesylate, 100 mg, oral, FDA approved prescriptionantiemetic, for use as a complete therapeutic substitute for anIV antiemetic at the time of chemotherapy treatment, not toexceed a 24-hour dosage regimen Nq@
Q0180
Medicare covers at the time of chemotherapy if regimen doesn't exceed24 hours. Submit on the same claim as the chemotherapy. Use this codefor Anzemet.CMS: 100-02,15,50.5.4; 100-03,110.18; 100-04,17,80.2.1AHA: 1Q, '08, 1
Unspecified oral dosage form, FDA approved prescriptionantiemetic, for use as a complete therapeutic substitute for anIV antiemetic at the time of chemotherapy treatment, not toexceed a 48-hour dosage regimen Nq
Q0181
Medicare covers at the time of chemotherapy if regimen doesn't exceed48-hours. Submit on the same claim as the chemotherapy.CMS: 100-02,15,50.5.4; 100-03,110.18; 100-04,17,80.2.1AHA: 2Q, '12, 9; 1Q, '08, 1
Power adapter for use with electric or electric/pneumaticventricular assist device, vehicle type A7
Q0478
Power module for use with electric or electric/pneumaticventricular assist device, replacement only A7
Q0479
Driver for use with pneumatic ventricular assist device,replacement only A7
Q0480
AHA: 3Q, '05, 1-2
Microprocessor control unit for use with electric ventricularassist device, replacement only A7
Q0481
AHA: 3Q, '05, 1-2
Microprocessor control unit for use with electric/pneumaticcombination ventricular assist device, replacement only A7
Q0482
AHA: 3Q, '05, 1-2
Monitor/display module for use with electric ventricular assistdevice, replacement only A7
Q0483
AHA: 3Q, '05, 1-2
Monitor/display module for use with electric orelectric/pneumatic ventricular assist device, replacementonly A7
Q0484
AHA: 3Q, '05, 1-2
Monitor control cable for use with electric ventricular assistdevice, replacement only A7
Q0485
AHA: 3Q, '05, 1-2
Monitor control cable for use with electric/pneumatic ventricularassist device, replacement only A7
Q0486
AHA: 3Q, '05, 1-2
Leads (pneumatic/electrical) for use with any typeelectric/pneumatic ventricular assist device, replacementonly A7
Q0487
AHA: 3Q, '05, 1-2
Power pack base for use with electric ventricular assist device,replacement only A
Q0488
AHA: 3Q, '05, 1-2
Power pack base for use with electric/pneumatic ventricularassist device, replacement only A7
Q0489
AHA: 3Q, '05, 1-2
Emergency power source for use with electric ventricular assistdevice, replacement only A7
Q0490
AHA: 3Q, '05, 1-2
Emergency power source for use with electric/pneumaticventricular assist device, replacement only A7
Q0491
AHA: 3Q, '05, 1-2
Emergency power supply cable for use with electric ventricularassist device, replacement only A7
Q0492
AHA: 3Q, '05, 1-2
Emergency power supply cable for use with electric/pneumaticventricular assist device, replacement only A7
Q0493
AHA: 3Q, '05, 1-2
Emergency hand pump for use with electric or electric/pneumaticventricular assist device, replacement only A7
Q0494
AHA: 3Q, '05, 1-2
Battery/power pack charger for use with electric orelectric/pneumatic ventricular assist device, replacementonly A7
Q0495
AHA: 3Q, '05, 1-2
Battery, other than lithium-ion, for use with electric orelectric/pneumatic ventricular assist device, replacementonly A7
Q0496
AHA: 3Q, '05, 1-2
Battery clips for use with electric or electric/pneumaticventricular assist device, replacement only A7
Q0497
AHA: 3Q, '05, 1-2
Holster for use with electric or electric/pneumatic ventricularassist device, replacement only A7
Q0498
AHA: 3Q, '05, 1-2
Belt/vest/bag for use to carry external peripheral componentsof any type ventricular assist device, replacement only A7
Q0499
AHA: 3Q, '05, 1-2
Filters for use with electric or electric/pneumatic ventricularassist device, replacement only A@7
Q0500
The base unit for this code is for each filter.AHA: 3Q, '05, 1-2
Shower cover for use with electric or electric/pneumaticventricular assist device, replacement only A7
Q0501
AHA: 3Q, '05, 1-2
Mobility cart for pneumatic ventricular assist device,replacement only A7
Q0502
AHA: 3Q, '05, 1-2
Battery for pneumatic ventricular assist device, replacementonly, each A@7
Q0503
AHA: 3Q, '05, 1-2
Power adapter for pneumatic ventricular assist device,replacement only, vehicle type A7
Q0504
AHA: 3Q, '05, 1-2
Battery, lithium-ion, for use with electric or electric/pneumaticventricular assist device, replacement only A7
Q0506
Q0175
— Q
0506Tem
porary Codes
s Revised Codem Recycled/Reinstatedl New Code@ Quantity AlertCarrier DiscretionNoncovered by MedicareSpecial Coverage Instructions
Q Codes (Temporary) —, SNF Excluded7 DMEPOS PaidAHA: Coding ClinicCMS: Pub 100g-w ASC Pmt© 2016 Optum360, LLC127
Q0506HCPCS Level II
HCPCS Level II Appendix 1 — Table of Drugs and Biologicals
© 2016 Optum360, LLC Appendixes — 5
Appendix 1 —
Table of Drugs and B
iologicals
BUNAVAIL 6.3 MG ORAL J0574
BUPIVACAINE HCL 30 ML VAR S0020
BUPIVACAINE LIPOSOME 1 MG VAR C9290
BUPRENEX 0.1 MG IM, IV J0592
BUPRENORPHIN/NALOXONE UP TO 3 MG ORAL J0572
BUPRENORPHIN/NALOXONE > 10 MG ORAL J0575
BUPRENORPHINE HCL 0.1 MG IM, IV J0592
BUPRENORPHINE IMPLANT 74.2 MG OTH J0570
BUPRENORPHINE ORAL 1 MG ORAL J0571
BUPRENORPHINE/NALOXONE 3.1 TO 6 MG ORAL J0573
BUPRENORPHINE/NALOXONE 6.1 TO 10 MG ORAL J0574
BUPROPION HCL 150 MG ORAL S0106
BUSULFAN 2 MG ORAL J8510
BUSULFAN 1 MG IV J0594
BUSULFEX 2 MG ORAL J8510
BUTORPHANOL TARTRATE 2 MG IM, IV J0595
BUTORPHANOL TARTRATE 25 MG OTH S0012
C 1 ESTERASE INHIBITOR (HUMAN) (BERINERT)
10 UNITS IV J0597
C1 ESTERASE INHIBITOR (HUMAN) (CINRYZE)
10 UNITS IV J0598
C1 ESTERASE INHIBITOR (RECOMBINANT)
10 UNITS IV J0596
CABAZITAXEL 1 MG IV J9043
CABERGOLINE 0.25 MG ORAL J8515
CAFCIT 5 MG IV J0706
CAFFEINE CITRATE 5 MG IV J0706
CALCIJEX 0.1 MCG IM J0636
CALCIJEX 0.25 MCG INJ S0169
CALCIMAR UP TO 400 U SC, IM J0630
CALCITONIN SALMON 400 U SC, IM J0630
CALCITRIOL 0.1 MCG IM J0636
CALCITROL 0.25 MCG IM S0169
CALCIUM DISODIUM VERSENATE 1,000 MG IV, SC, IM J0600
CALCIUM GLUCONATE 10 ML IV J0610
CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE
10 ML IM, SC J0620
CALDOLOR 100 MG IV J1741
CAMPTOSAR 20 MG IV J9206
CANAKINUMAB 1 MG SC J0638
CANCIDAS 5 MG IV J0637
CAPECITABINE 150 MG ORAL J8520
CAPROMAB PENDETIDE STUDY DOSE UP TO 10 MCI
IV A9507
CAPSAICIN 8% PATCH 1 SQ CM OTH J7336
CARBIDOPA/LEVODOPA 5 MG/20 MG ORAL J7340
CARBOCAINE 10 ML VAR J0670
CARBOPLATIN 50 MG IV J9045
CARDIOGEN 82 STUDY DOSE UP TO 60 MCI
IV A9555
CARDIOLITE STUDY DOSE IV A9500
CARFILZOMIB 1 MG IV J9047
Drug Name Unit Per Route Code
CARIMUNE 500 MG IV J1566
CARMUSTINE 100 MG IV J9050
CARNITOR 1 G IV J1955
CARTICEL OTH J7330
CASPOFUNGIN ACETATE 5 MG IV J0637
CATAPRES 1 MG OTH J0735
CATHFLO 1 MG IV J2997
CAVERJECT 1.25 MCG VAR J0270
CEA SCAN STUDY DOSE UP TO 45 MCI
IV A9568
CEENU 10 MG ORAL S0178
CEFAZOLIN SODIUM 500 MG IM, IV J0690
CEFEPIME HCL 500 MG IV J0692
CEFIZOX 500 MG IV, IM J0715
CEFOBID 1 G IV S0021
CEFOPERAZONE SODIUM 1 G IV S0021
CEFOTAN 500 MG IM, IV S0074
CEFOTAXIME SODIUM 1 GM IV, IM J0698
CEFOTETAN DISODIUM 500 MG IM. IV S0074
CEFOXITIN SODIUM 1 GM IV, IM J0694
CEFTAROLINE FOSAMIL 10 MG IV J0712
CEFTAZIDIME 500 MG IM, IV J0713
CEFTAZIDIME AND AVIBACTAM 0.5 G/0.125 G
IV J0714
CEFTIZOXIME SODIUM 500 MG IV, IM J0715
CEFTOLOZANE AND TAZOBACTAM
50 MG/25 MG
IV J0695
CEFTRIAXONE SODIUM 250 MG IV, IM J0696
CEFUROXIME 750 MG IM, IV J0697
CEFUROXIME SODIUM STERILE 750 MG IM, IV J0697
CELESTONE SOLUSPAN 3 MG IM J0702
CELLCEPT 250 MG ORAL J7517
CENACORT A-40 10 MG IM J3301
CENACORT FORTE 5 MG IM J3302
CENTRUROIDES (SCORPION) IMMUNE F(AB)2 (EQUINE)
UP TO 120 MG
IV J0716
CEPHALOTHIN SODIUM UP TO 1 G INJ J1890
CEPHAPIRIN SODIUM 1 G IV J0710
CEPTAZ 500 MG IM, IV J0713
CEREBRYX 50 MG IM, IV Q2009
CEREBRYX 750 MG IM, IV S0078
CEREDASE 10 U IV J0205
CERETEC STUDY DOSE UP TO 25 MCI
IV A9521
CEREZYME 10 U IV J1786
CERTOLIZUMAB PEGOL 1 MG SC J0717
CERUBIDINE 10 MG IV J9150
CESAMET 1 MG ORAL J8650
CETUXIMAB 10 MG IV J9055
CHEALAMIDE 150 MG IV J3520
CHLORAMBUCIL 2 MG ORAL S0172
Drug Name Unit Per Route Code
Appendix 4 — Internet-only Manuals (IOMs) HCPCS Level II
104 — Appendixes © 2016 Optum360, LLC
App
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— In
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Teaching physicians submitting claims under this exception must:
• Not have other responsibilities (including the supervision of other personnel) at the time the service was provided by the resident;
• Have the primary medical responsibility for patients cared for by the residents;
• Ensure that the care provided was reasonable and necessary;
• Review the care provided by the resident during or immediately after each visit. This must include a review of the patient’s medical history, the resident’s findings on physical examination, the patient’s diagnosis, and treatment plan (i.e., record of tests and therapies); and
• Document the extent of his/her own participation in the review and direction of the services furnished to each patient.
Patients under this exception should consider the center to be their primary location for health care services. The residents must be expected to generally provide care to the same group of established patients during their residency training. The types of services furnished by residents under this exception include:
• Acute care for undifferentiated problems or chronic care for ongoingconditions including chronic mental illness;
• Coordination of care furnished by other physicians and providers; and,
• Comprehensive care not limited by organ system or diagnosis.
Residency programs most likely qualifying for this exception include family practice, general internal medicine, geriatric medicine, pediatrics, and obstetrics/gynecology.
Certain GME programs in psychiatry may qualify in special situations such as when the program furnishes comprehensive care for chronically mentally ill patients. These would be centers in which the range of services the residents are trained to furnish, and actually do furnish, include comprehensive medical care as well as psychiatric care. For example, antibiotics are being prescribed as well as psychotropic drugs.
100-04, 12, 180Care Plan Oversight ServicesThe Medicare Benefit Policy Manual, Chapter 15, contains requirements for coverage for medical and other health services including those of physicians and non-physician practitioners.
Care plan oversight (CPO) is the physician supervision of a patient receiving complex and/or multidisciplinary care as part of Medicare-covered services provided by a participating home health agency or Medicare approved hospice.
CPO services require complex or multidisciplinary care modalities involving: Regular physician development and/or revision of care plans; Review of subsequent reports of patient status; Review of related laboratory and other studies; Communication with other health professionals not employed in the same practice who are involved in the patient's care; Integration of new information into the medical treatment plan; and/or Adjustment of medical therapy.
The CPO services require recurrent physician supervision of a patient involving 30 or more minutes of the physician's time per month. Services not countable toward the 30 minutes threshold that must be provided in order to bill for CPO include, but are not limited to: Time associated with discussions with the patient, his or her family or friends to adjust medication or treatment; Time spent by staff getting or filing charts; Travel time; and/or Physician's time spent telephoning prescriptions into the pharmacist unless the telephone conversation involves discussions of pharmaceutical therapies.
Implicit in the concept of CPO is the expectation that the physician has coordinated an aspect of the patient's care with the home health agency or hospice during the month for which CPO services were billed. The physician who bills for CPO must be the same physician who signs the plan of care.
Nurse practitioners, physician assistants, and clinical nurse specialists, practicing within the scope of State law, may bill for care plan oversight. These non-physician practitioners must have been providing ongoing care for the beneficiary through evaluation and management services. These non-physician practitioners may not bill for CPO if they have been involved only with the delivery of the Medicare-covered home health or hospice service.
A. Home Health CPO Non-physician practitioners can perform CPO only if the physician signing the plan of care provides regular ongoing care under the same plan of care as does the NPP billing for CPO and either: The physician and NPP are part of the same group practice; or If the NPP is a nurse practitioner or clinical nurse specialist, the physician signing the plan of care also has a collaborative agreement with the NPP; or If the NPP is a physician assistant, the physician signing the plan of care is also the physician who provides general supervision of physician assistant services for the practice.
Billing may be made for care plan oversight services furnished by an NPP when: The NPP providing the care plan oversight has seen and examined the patient; The NPP
providing care plan oversight is not functioning as a consultant whose participation is limited to a single medical condition rather than multidisciplinary coordination of care; and The NPP providing care plan oversight integrates his or her care with that of the physician who signed the plan of care.
NPPs may not certify the beneficiary for home health care.
B. Hospice CPO The attending physician or nurse practitioner (who has been designated as the attending physician) may bill for hospice CPO when they are acting as an "attending physician".
An "attending physician" is one who has been identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care. They are not employed nor paid by the hospice. The care plan oversight services are billed using Form CMS-1500 or electronic equivalent.
For additional information on hospice CPO, see Chapter 11, 40.1.3.1 of this manual.
100-04, 12, 180.1Care Plan Oversight Billing Requirements
A. Codes for Which Separate Payment May Be Made Effective January 1, 1995, separate payment may be made for CPO oversight services for 30 minutes or more if the requirements specified in the Medicare Benefits Policy Manual, Chapter 15 are met.
Providers billing for CPO must submit the claim with no other services billed on that claim and may bill only after the end of the month in which the CPO services were rendered. CPO services may not be billed across calendar months and should be submitted (and paid) only for one unit of service.
Physicians may bill and be paid separately for CPO services only if all the criteria in the Medicare Benefit Policy Manual, Chapter 15 are met.
B. Physician Certification and Recertification of Home Health Plans of Care Effective 2001, two new HCPCS codes for the certification and recertification and development of plans of care for Medicare-covered home health services were created.
See the Medicare General Information, Eligibility, and Entitlement Manual, Pub. 100-01, Chapter 4, “Physician Certification and Recertification of Services,” 10-60, and the Medicare Benefit Policy Manual, Pub. 100-02, Chapter 7, “Home Health Services”, 30.
The home health agency certification code can be billed only when the patient has not received Medicare-covered home health services for at least 60 days. The home health agency recertification code is used after a patient has received services for at least 60 days (or one certification period) when the physician signs the certification after the initial certification period. The home health agency recertification code will be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapses and requires a new plan of care to start a new episode.
C. Provider Number of Home Health Agency (HHA) or HospiceFor claims for CPO submitted on or after January 1, 1997, physicians must enter on the Medicare claim form the 6-character Medicare provider number of the HHA or hospice providing Medicare-covered services to the beneficiary for the period during which CPO services was furnished and for which the physician signed the plan of care. Physicians are responsible for obtaining the HHA or hospice Medicare provider numbers.
Additionally, physicians should provide their UPIN to the HHA or hospice furnishing services to their patient.
NOTE: There is currently no place on the HIPAA standard ASC X12N 837 professional format to specifically include the HHA or hospice provider number required for a care plan oversight claim. For this reason, the requirement to include the HHA or hospice provider number on a care plan oversight claim is temporarily waived until a new version of this electronic standard format is adopted under HIPAA and includes a place to provide the HHA and hospice provider numbers for care plan oversight claims.
100-04, 12, 190.3List of Medicare Telehealth ServicesThe use of a telecommunications system may substitute for an in-person encounter for professional consultations, office visits, office psychiatry services, and a limited number of other physician fee schedule (PFS) services. The various services and corresponding current procedure terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes are listed below.
• Consultations (CPT codes 99241 - 99275) - Effective October 1, 2001 – December31, 2005;
HCPCS Level II Appendix 8 — Glossary
© 2016 Optum360, LLC Appendixes — 191
Appendix 8 —
Glossary
ocular implant. Implant inside muscular cone.
omnicardiogram. Method of mathematically interpreting the usual linear form of the electrocardiogram in a different, roughly circular shape. This interpretation is then compared to a normal template and an analysis is performed on two randomly selected cycles from leads I, II, V4, V, and/or V6.
oral. Pertaining to the mouth.
ordering physician. Physician who orders nonphysician services (e.g., laboratory services, pharmaceutical services, imaging services, or durable medical equipment) for a patient.
orphan drugs. Drugs that treat diseases that affect fewer than 200,000 people in the United States, as designated by the FDA. Orphan drugs follow a varied process from other drugs regulated by the FDA.
orthosis. Derived from a Greek word meaning "to make straight," it is an artificial appliance that supports, aligns, or corrects an anatomical deformity or improves the use of a moveable body part. Unlike a prosthesis, an orthotic device is always functional in nature.
orthotic. Associated with the making and fitting of an orthosis(es).
osteo-. Having to do with bone.
osteogenesis stimulator. Device used to stimulate the growth of bone by electrical impulses or ultrasound.
ostomy. Artificial (surgical) opening in the body used for drainage or for delivery of medications or nutrients.
pacemaker. Implantable cardiac device that controls the heart's rhythm and maintains regular beats by artificial electric discharges. This device consists of the pulse generator with a battery and the electrodes, or leads, which are placed in single or dual chambers of the heart, usually transvenously.
parenteral. Other than the alimentary canal and is usually used in a method of delivery context: total parenteral nutrition (TPN) and parenteral nutrition therapy (PNT) formulas, kits, and devices.
parenteral nutrition. Nutrients provided subcutaneously, intravenously, intramuscularly, or intradermally for patients during the postoperative period and in other conditions, such as shock, coma, and renal failure.
partial hospitalization. Situation in which the patient only stays part of each day over a long period. Cardiac, rehabilitation, and chronic pain patients, for example, could use this service.
passive mobilization. Pressure, movement, or pulling of a limb or body part utilizing an apparatus or device.
periradicular. Surrounding part of the tooth's root.
peritoneal. Space between the lining of the abdominal wall, or parietal peritoneum, and the surface layer of the abdominal organs, or visceral peritoneum. It contains a thin, watery fluid that keeps the peritoneal surfaces moist.
peritoneal dialysis. Dialysis that filters waste from blood inside the body using the peritoneum, the natural lining of the abdomen, as the semipermeable membrane across which ultrafiltration is accomplished. A special catheter is inserted into the abdomen and a dialysis solution is drained into the abdomen. This solution extracts fluids and wastes, which are then discarded when the fluid is drained. Various forms of peritoneal dialysis include CAPD, CCPD, and NIDP.
peritoneal effusion. Persistent escape of fluid within the peritoneal cavity.
pessary. Device placed in the vagina to support and reposition a prolapsing or retropositioned uterus, rectum, or vagina.
photocoagulation. Application of an intense laser beam of light to disrupt tissue and condense protein material to a residual mass, used especially for treating ocular conditions.
physician. Legally authorized practitioners including a doctor of medicine or osteopathy, a doctor of dental surgery or of dental medicine, a doctor of podiatric medicine, a doctor of optometry, and a chiropractor only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation).
PICC. Peripherally inserted central catheter. PICC is inserted into one of the large veins of the arm and threaded through the vein until the tip sits in a large vein just above the heart.
PQRS. Physician Quality Reporting System. Voluntary CMS reporting mechanism used to measure physician quality that will be mandatory as of January 1, 2015. Eligible providers submit quality data for set measures through approved reporting options.
prehensile. Ability to grasp, seize, or hold.
prodrug. Inactive drug that goes through a metabolic process when given resulting in a chemical conversion that changes the drug into an active pharmacological agent.
prophylaxis. Intervention or protective therapy intended to prevent a disease.
prostate cancer screening tests. Test that consists of any (or all) of the procedures provided for the early detection of prostate cancer to a man 50 years of age or older who has not had a test during the preceding year. The procedures are as follows: A digital rectal examination; A prostate-specific antigen blood test. After 2002, the list of procedures may be expanded as appropriate for the early detection of prostate cancer, taking into account changes in technology and standards of medical practice, availability, effectiveness, costs, and other factors.
prosthetic. Device that replaces all or part of an internal body organ or body part, or that replaces part of the function of a permanently inoperable or malfunctioning internal body organ or body part.
pulse generator. Component of a pacemaker or an implantable cardioverter defibrillator that contains the battery and the electronics for producing the electrical discharge sent to the heart to control cardiac rhythm. Insertion or replacement of the pulse generator may be done alone, not in conjunction with insertion or replacement of the entire pacemaker system.
residual limb. Portion of an arm or leg that remains attached to the body after an amputation.
screening mammography. Radiologic images taken of the female breast for the early detection of breast cancer.
screening pap smear. Diagnostic laboratory test consisting of a routine exfoliative cytology test (Papanicolaou test) provided to a woman for the early detection of cervical or vaginal cancer. The exam includes a clinical breast examination and a physician's interpretation of the results.
sialodochoplasty. Surgical repair of a salivary gland duct.
single-lead device. Implantable cardiac device (pacemaker or implantable cardioverter-defibrillator [ICD]) in which pacing and sensing components are placed in only one chamber of the heart.
skin substitute. Non-autologous human or non-human skin that forms a base for skin growth, often considered a graft dressing.
speech prosthetic. Electronic speech aid device for patient who has had a laryngectomy. One operates by placing a vibrating head against the throat; the other amplifies sound waves through a tube which is inserted into the user's mouth.
splint. Brace or support. 1) dynamic splint: brace that permits movement of an anatomical structure such as a hand, wrist, foot, or other part of the body after surgery or injury. 2) static splint: brace that prevents movement and maintains support and position for an anatomical structure after surgery or injury.
stent. Tube to provide support in a body cavity or lumen.
stereotactic radiosurgery. Delivery of externally-generated ionizing radiation to specific targets for destruction or inactivation. Most often utilized in the treatment of brain or spinal tumors, high-resolution stereotactic imaging is used to identify the target and then deliver the treatment. Computer-assisted planning may also be employed. Simple and complex cranial lesions and spinal lesions are typically treated in a single planning and treatment session, although a maximum of five sessions may be required. No incision is made for stereotactic radiosurgery procedures.
subcutaneous. Below the skin.
TENS. Transcutaneous electrical nerve stimulator. TENS is applied by placing electrode pads over the area to be stimulated and connecting the electrodes to a transmitter box, which sends a current through the skin to sensory nerve fibers to help decrease pain in that nerve distribution.
terminal device. Addition to an upper limb prosthesis that replaces the function and/or appearance of a missing hand.
TLSO. Thoracolumbosacral orthosis.