1HCPCS Codes Effective January 2004

*NOTE: This HCPCS listing does not indicate what is or is not considered appropriate assistive technology for

First Steps purposes. Please consult Program policy or listserv messages for further guidance.

HCPCS Code Description A0021 Outside state ambulance serv 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 A0368 Adv er no serv sep mile&supp A0382 Basic support routine suppls A0384 Bls defibrillation supplies 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 A0425 Ground mileage A0426 Als 1 A0427 ALS1-emergency A0428 bls A0429 BLS-emergency A0430 Fixed wing air transport A0431 Rotary wing air transport A0432 PI volunteer ambulance co A0433 als 2 A0434 Specialty care transport A0435 Fixed wing air mileage A0436 Rotary wing air mileage A0888 Noncovered ambulance mileage A0999 Unlisted ambulance service A4206 1 CC sterile syringe&needle A4207 2 CC sterile syringe&needle A4208 3 CC sterile syringe&needle A4209 5+ CC sterile syringe&needle

2A4210 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 A4221 Maint drug infus cath per wk A4222 Drug infusion pump supplies 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 A4255 Glucose monitor platforms A4256 Calibrator solution/chips A4258 Lancet device each A4259 Lancets per box A4260 Levonorgestrel implant A4261 Cervical cap contraceptive A4262 Temporary tear duct plug A4263 Permanent tear duct plug A4265 Paraffin A4270 Disposable endoscope sheath A4280 Brst prsths adhsv attchmnt A4290 Sacral nerve stim test lead 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 A4319 Sterile H2O irrigation solut A4320 Irrigation tray A4321 Cath therapeutic irrig agent A4322 Irrigation syringe A4323 Saline irrigation solution A4324 Male ext cath w/adh coating A4325 Male ext cath w/adh strip A4326 Male external catheter A4327 Fem urinary collect dev cup A4328 Fem urinary collect pouch

3A4329 External catheter start set A4330 Stool collection pouch A4331 Extension drainage tubing A4332 Lubricant for cath insertion A4333 Urinary cath anchor device A4334 Urinary cath leg strap 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 A4348 Male ext cath extended wear A4351 Straight tip urine catheter A4352 Coude tip urinary catheter A4353 Intermittent urinary cath 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 A4364 Liq adhes for facial prosth A4365 Adhesive remover wipes A4367 Ostomy belt A4368 Ostomy filter A4369 Skin barrier liquid per oz A4370 Skin barrier paste per oz A4371 Skin barrier powder per oz A4372 Skin barrier solid 4x4 equiv A4373 Skin barrier with flange A4374 Skin barrier extended wear A4375 Drainable plastic pch w fcpl A4376 Drainable rubber pch w fcplt A4377 Drainable plstic pch w/o fp A4378 Drainable rubber pch w/o fp A4379 Urinary plastic pouch w fcpl A4380 Urinary rubber pouch w fcplt A4381 Urinary plastic pouch w/o fp A4382 Urinary hvy plstc pch w/o fp A4383 Urinary rubber pouch w/o fp A4384 Ostomy faceplt/silicone ring A4385 Ost skn barrier sld ext wear A4386 Ost skn barrier w flng ex wr A4387 Ost clsd pouch w att st barr A4388 Drainable pch w ex wear barr A4389 Drainable pch w st wear barr A4390 Drainable pch ex wear convex A4391 Urinary pouch w ex wear barr A4392 Urinary pouch w st wear barr

4A4393 Urine pch w ex wear bar conv A4394 Ostomy pouch liq deodorant A4395 Ostomy pouch solid deodorant A4396 Peristomal hernia supprt blt A4397 Irrigation supply sleeve A4398 Ostomy irrigation bag A4399 Ostomy irrig cone/cath w brs 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 A4462 Abdmnl drssng holder/binder A4464 Joint support device/garment A4465 Non-elastic extremity binder A4470 Gravlee jet washer A4480 Vabra aspirator A4481 Tracheostoma filter A4483 Moisture exchanger 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, pair A4557 Lead wires, pair A4558 Conductive paste or gel A4561 Pessary rubber, any type A4562 Pessary, non rubber,any type A4565 Slings A4570 Splint A4572 Rib belt A4575 Hyperbaric o2 chamber disps A4580 Cast supplies (plaster) A4590 Special casting material A4595 TENS suppl 2 lead per month A4608 Transtracheal oxygen cath A4611 Heavy duty battery A4612 Battery cables A4613 Battery charger A4614 Hand-held PEFR meter 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

5A4623 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

6A4890 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 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 drain btl w/wo tube 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 Disk/foam pad +or- adhesive A5131 Appliance cleaner A5200 Percutaneous catheter anchor 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 A5508 Diabetic deluxe shoe A6020 Collagen wound dressing

7A6021 Collagen dressing <=16 sq in A6022 Collagen drsg>6<=48 sq in A6023 Collagen dressing >48 sq in A6024 Collagen dsg wound filler A6025 Silicone gel sheet, each A6154 Wound pouch each A6196 Alginate dressing <=16 sq in A6197 Alginate drsg >16 <=48 sq in A6198 alginate dressing > 48 sq in A6199 Alginate drsg wound filler A6200 Compos drsg <=16 no border A6201 Compos drsg >16<=48 no bdr A6202 Compos drsg >48 no border A6203 Composite drsg <= 16 sq in A6204 Composite drsg >16<=48 sq in A6205 Composite drsg > 48 sq in A6206 Contact layer <= 16 sq in A6207 Contact layer >16<= 48 sq in A6208 Contact layer > 48 sq in A6209 Foam drsg <=16 sq in w/o bdr A6210 Foam drg >16<=48 sq in w/o b A6211 Foam drg > 48 sq in w/o brdr A6212 Foam drg <=16 sq in w/border A6213 Foam drg >16<=48 sq in w/bdr A6214 Foam drg > 48 sq in w/border A6215 Foam dressing wound filler A6216 Non-sterile gauze<=16 sq in A6217 Non-sterile gauze>16<=48 sq A6218 Non-sterile gauze > 48 sq in A6219 Gauze <= 16 sq in w/border A6220 Gauze >16 <=48 sq in w/bordr A6221 Gauze > 48 sq in w/border A6222 Gauze <=16 in no w/sal w/o b A6223 Gauze >16<=48 no w/sal w/o b A6224 Gauze > 48 in no w/sal w/o b A6228 Gauze <= 16 sq in water/sal A6229 Gauze >16<=48 sq in watr/sal A6230 Gauze > 48 sq in water/salne A6231 Hydrogel dsg<=16 sq in A6232 Hydrogel dsg>16<=48 sq in A6233 Hydrogel dressing >48 sq in A6234 Hydrocolld drg <=16 w/o bdr A6235 Hydrocolld drg >16<=48 w/o b A6236 Hydrocolld drg > 48 in w/o b A6237 Hydrocolld drg <=16 in w/bdr A6238 Hydrocolld drg >16<=48 w/bdr A6239 Hydrocolld drg > 48 in w/bdr A6240 Hydrocolld drg filler paste A6241 Hydrocolloid drg filler dry A6242 Hydrogel drg <=16 in w/o bdr A6243 Hydrogel drg >16<=48 w/o bdr A6244 Hydrogel drg >48 in w/o bdr

8A6245 Hydrogel drg <= 16 in w/bdr A6246 Hydrogel drg >16<=48 in w/b A6247 Hydrogel drg > 48 sq in w/b A6248 Hydrogel drsg gel filler A6250 Skin seal protect moisturizr A6251 Absorpt drg <=16 sq in w/o b A6252 Absorpt drg >16 <=48 w/o bdr A6253 Absorpt drg > 48 sq in w/o b A6254 Absorpt drg <=16 sq in w/bdr A6255 Absorpt drg >16<=48 in w/bdr A6256 Absorpt drg > 48 sq in w/bdr A6257 Transparent film <= 16 sq in A6258 Transparent film >16<=48 in A6259 Transparent film > 48 sq in A6260 Wound cleanser any type/size A6261 Wound filler gel/paste /oz A6262 Wound filler dry form / gram A6263 Non-sterile elastic gauze/yd A6264 Non-sterile no elastic gauze A6265 Tape per 18 sq inches A6266 Impreg gauze no h20/sal/yard A6402 Sterile gauze <= 16 sq in A6403 Sterile gauze>16 <= 48 sq in A6404 Sterile gauze > 48 sq in A6405 Sterile elastic gauze /yd A6406 Sterile non-elastic gauze/yd A7000 Disposable canister for pump A7001 Nondisposable pump canister A7002 Tubing used w suction pump A7003 Nebulizer administration set A7004 Disposable nebulizer sml vol A7005 Nondisposable nebulizer set A7006 Filtered nebulizer admin set A7007 Lg vol nebulizer disposable A7008 Disposable nebulizer prefill A7009 Nebulizer reservoir bottle A7010 Disposable corrugated tubing A7011 Nondispos corrugated tubing A7012 Nebulizer water collec devic A7013 Disposable compressor filter A7014 Compressor nondispos filter A7015 Aerosol mask used w nebulize A7016 Nebulizer dome & mouthpiece A7017 Nebulizer not used w oxygen A7018 Water distilled w/nebulizer A7019 Saline solution dispenser A7020 Sterile H2O or NSS w lgv neb A7501 Tracheostoma valve w diaphra A7502 Replacement diaphragm/fplate A7503 HMES filter holder or cap A7504 Tracheostoma HMES filter A7505 HMES or trach valve housing

9A7506 HMES/trachvalve adhesivedisk A7507 Integrated filter & holder A7508 Housing & Integrated Adhesiv A7509 Heat & moisture exchange sys 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 A9502 Technetium TC99M tetrofosmin A9503 Technetium TC 99m medronate A9504 Technetium tc 99m apcitide A9505 Thallous chloride TL 201/mci A9507 Indium/111 capromab pendetid A9508 Iobenguane sulfate I-131 A9510 Technetium TC99m Disofenin A9600 Strontium-89 chloride A9605 Samarium sm153 lexidronamm A9700 Echocardiography Contrast A9900 Supply/accessory/service A9901 Delivery/set up/dispensing 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 cat1natural B4152 Enteral formulae category ii B4153 Enteral formulae categoryIII 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

10B4222 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 C1000 PERCLOSCLOSR PROSTARArtVas C1001 ACUNAV-DIAGNSTIC ULTRSND Ca C1003 Cath, ablation, Livewire TC C1004 Fast-Cath,Swartz,SAFL,CSTA C1006 ARRAY POST Chamb IOL C1007 AMS 700/Ambicor Prosthesis C1008 UROLUME-IMPLT URETHRAL Stnt C1009 PLASMA,CRYOPRECIPITATE-Reduc C1010 Blood, L/R, CMV-NEG C1011 Platelet, L/R CMV-NEG, UNIT C1012 PLATELET CONC, L/R, Irrad C1013 PLATELET CONC, L/R, Unit C1014 Platelet,Aph/Pher, L/R, unit C1016 BLOOD,L/R,FROZ/DEGLY/Washed C1017 Plt, APH/PHER,L/R,CMV-NEG C1018 Blood, L/R, IRRADIATED C1019 Plt, APH/PHER, L/R, IRRAD C1024 QUINOPRISTIN 10ml/DALFOPRIS C1025 Marinr CS Cath C1026 RF PERFRMR CATH 5F RF Marinr C1027 MAGIC X/SHORT RADIUS 14mm C1028 PRCIS TWST TRSNSVG ANCH Sys C1029 CRE GUIDED BALLOON DIL Cath C1030 CTHTR:MRSHAL,BLU MAX UTR Dmd C1031 MR COMP/MOD LEVEEN NED Elect C1033 SONICATH Mdl 37-410 C1034 SURPASS, LONG30 SURPASS-Cath C1035 Cath, Ultra ICE C1036 R PORT/RESERVOIR IMPL Dev C1037 VAXCELCHRONIC DIALYSIS Cath C1038 UltraCross Imaging Cath C1039 WALLSTENT, RP/Trach C1040 Wallstent, TIPS C1042 Wallstent, Biliary C1043 ATHERECTOMY SYS, Coronary C1045 I-131 Mibg(IOBEN-SULFATE)0.5 C1047 NOGA/NAVI-STAR Cath C1048 NEUROCYBERNETICPROS:Gen C1050 PROSORBA Column C1051 Oasis Thrombectomy Cath C1053 ENSITE 3000 Catheter

11C1054 Hydrolyser Thromb Cath 6/7F C1055 Transesoph 210, 210-S cath C1056 Thermachoice II Cath C1057 MICROMARK TISSUE Marker C1059 CARTICEL,AUTO CULT-CHNDR Cyt C1060 ACS MULTI-LINK TRISTAR Stent C1061 ACS VIKING GUIDING Cath C1063 ENDOTAK ENDURANCE EZ,RX Lead C1067 MEGALINK BILIARY Stent C1068 PULSAR DDD Pmkr C1069 DISCOVERY DR, Pmkr C1071 PULSAR MAX, PULSAR SR Pmkr C1072 GUIDANT:BLLN DIL Cath C1073 Morcellator C1074 RX/OTW VIATRAC-PERI DIL Cath C1075 GUIDANT:LEAD,Pmkr C1076 VENTAK MINI SC Defib C1077 VENTAK VR,PRIZM VR, SC Defib C1078 VENTAK:PRIZM,AV III DR Defib C1079 CO 57/58 0.5 Mci C1084 DENILEUKIN DIFTITOX, 300 Mcg C1086 TEMOZOLOMIDE, 5 mg C1087 I-123, per uCi, capsule C1088 LASER OPTIC TR Sys C1089 Co 57, 0.5 Mci C1090 INN I-111 CHLORIDE, PER mci C1091 INI111 OXYQUINOLINE,PER 5mci C1092 IN 111 PENETATE, PER 1.5 mci C1094 TC99M ALBUMIN AGGR, PER Vial C1095 TC 99M DEPREOTIDE, PER Vial C1096 TC 99M EXAMETAZIME, PER Dose C1097 TC 99M MEBROFENIN, PER Vial C1098 TC 99M PENTETATE, PER Vial C1099 TC 99M PYROPHOSPHATE,PER Via C1100 Medtronic AVE GT1 GUIDEWIRE C1101 MEDTRONIC AVE Zuma Guidecath C1102 SYNERGY NEUROSTIM Genrtr C1103 MICRO Jewel DEFIBRILLATOR C1104 RF Conductr Ablation Cath C1105 SIGMA 300VDD Pmkr C1106 SYNERGYEX Pt PROGRMR C1107 TORQR,SOLOIST Cath C1109 IMPLANTABLE ANCHOR:Ethicon C1110 STABLE MAPPER,Cath ELECTR C1111 ANEURXAORT-UNI-Iliac Stnt C1112 ANEURX STENT GRAFT/DEL Cath C1113 TLNT ENDO SPRNG STNT GRFT Sy C1114 TALNTSPRGSTNT+GRAF ENDO ProsC1115 5038S, 5038 5038L PACE Lead C1116 CAPSURESP PACING Lead C1117 Ancure Endograft Del Sys C1118 SIGMA300DR LEGIIDR, Pmkr

12C1119 SPRINT6932,6943 DEFIB Lead C1120 SPRINT6942,6945 DEFIB Lead C1121 Gem DEFIBRILLATOR C1122 Tc 99M ARCITUMOMAB PER VIAL C1123 Gem II VR DEFIBRILLATOR C1124 INTERSTIM TEST STIM Kit C1125 Kappa 400SR,TOPAZ II SR PMKR C1126 Kappa 700 DR, PMKR C1127 Kappa 700SR, SC PMKR C1128 Kappa 700D, RUBY IID PMKR C1129 Kappa 700VDD, PMKR C1130 Sigma200D, LGCY IID DC PMKR C1131 Sigma 200DR, PMKR C1132 Sigma 200 SR Leg II:SC PA C1133 Sigma SR, VITA SR, PMKR C1134 Sigma 300D PMKR C1135 Entity DR 5326L/R, DC, pmkr C1136 Affinity DR 5330L/R, DC, pmk C1137 CardioSeal IMPLANT SYS C1143 AddVent MOD 2060BL, VDD C1144 Afnty SP 5130,INTEGRITY SR C1145 Angio-SEAL 6FR,8FR C1146 Vett Tube C1147 Av PLUS DX 1368:LEAD C1148 Contour MD SC DEFIB C1149 Entity DC 5226R,PMKR C1151 PASSIVEPLUS DX LEAD, 10mdls C1152 LifeSite ACCESS SYSTEM C1153 REGENCY SC+2402L Pmkr C1154 SPL:SPO1,02,04-DEFIB Lead C1155 Repliform 8 SQ CM C1156 Tr1102TRSR+2260L,2264L,5131 C1157 Trilogy DCT 23/8L PMKR C1158 Tvl LEAD SV01,SV02,SV04 C1159 Tvl RV02, RV06,RV07:LEAD C1160 TVL-ADX 1559:Lead C1161 Tendril DX, 1388 PACING LEAD C1162 TempoDR TRILOGYDR+DC PMKR C1163 Tendril SDX, 1488T LEAD C1164 IODINE-125 Brachytx Seed C1166 CYTARABINE LIPOSOMAL, 10 mg C1167 EPIRUBICIN HCL, 2 mg C1170 ABBI DISP BIOPSY Device C1171 AUTOSUTURE SITE MARKER Stple C1172 SPACEMAKER DISSECT Balloon C1173 COR STNTS540,S670,O-WIRE Stn C1174 BARD BRACHYTX Needle C1175 MIBB disp biopsy device C1176 Mammotome HH Probe w/Vac Sys C1177 11-G Mammotome Probe C1178 BUSULFAN IV, 6 Mg C1179 14-G Mammotome Probe

13C1180 Vigor SR, SC, pmkr C1181 Meridian SSI, SC, pmkr C1182 Pulsar SSI, SC, pmkr C1183 Jade IIS, Sigma 300S, SC, pm C1184 Sigma 200S, SC, pmkr C1188 I-131, PER Uci C1200 TC 99M Sodium Glucoheptonat C1201 TC 99M SUCCIMER, PER Vial C1202 TC 99M SULFUR COLLOID, Vial C1203 VERTEPORFIN FOR Inj C1205 TC 99M DISOFENIN, PER Vial C1207 OCTREOTIDE ACETATE DEPOT 1mgC1300 HYPERBARIC Oxygen C1302 SQ01: Lead C1303 CapSure Fix 6940/4068-110 C1304 SONCATH Mdl 37-416,-418 C1305 Apligraf C1306 NEUROCYBERNETICPROS:Lead C1311 TRILOGY DR+/DAO Pmkr C1312 MAGIC WALLSTENT--Mini C1313 MAGIC MEDIUM,RADIUS 31mm C1314 MAGIC WALLSTENT--Long C1315 VIGOR DR, MERIDIAN DR Pmkr C1316 MERIDIAN DDD Pmkr C1317 DISCOVERY SR, Pmkr C1318 MERIDIAN SR Pmkr C1319 Wallstent: Enteral--60mm C1320 Wallstent: Iliac C1321 Palate/Base of Tongue electr C1322 Turbinate Somnoplasty electr C1323 VAPR/T disp electrode C1324 LIGASURE DISPOSABLE Electrod C1325 Palladium-103 Seed C1326 ANGIO-JET RHEOLYTIC Thromb C1328 ANS RENEW NS Trnsmtr C1329 Versapoint disp electrode C1333 PALMAZ CORINTHIAN BIL Stent C1334 CROWN,MINI-CROWN,CROSSLc C1335 MESH, Prolene C1336 CONSTANT Flow Imp Pump C1337 IsoMed 8472-20/35/60 C1348 I-131 PER MCI Solution C1350 PROSTASEED I-125, PER Source C1351 CAPSURE FIX Lead C1352 Gem II DR C1353 ITREL INTERSTM NEUROSTIM+Ext C1354 Kappa 400DR,DIAMOND II 820DR C1355 Kappa 600DR, VITA DR C1356 Profile MD V-186HV3 Sc DEFIB C1357 ANGSTROM MD V-190HV3 Sc DEF C1358 AFFINITY DC 5230R, Pmkr C1359 PULSAR,PULSAR MAX DR, Pmkr

14C1360 OCULAR PHOTODYNAMIC Tx C1361 REVEAL CARDIAC Recorder C1362 HERCULINK,OTW,SDS BIL Stnt C1363 Gem DR, DC, defib C1364 Photon DR V-230HV3 DC defib C1365 Guidewire, Hi-Torque14/18/35 C1366 Guidewire,PTCA,Hi-Torque C1367 Guide wire, Hi-TorqueCrossIt C1368 On-Q Pain Mgt Sys C1369 ANS Renew Stim Sys recvr C1370 Tension-Free Vaginal Tape C1371 Symp Nitinol Transhep Bil Sy C1372 Cordis Nitinol bil stent C1375 Stent, coronary, NIR C1376 ANS Renew Stim Sys lead C1377 Specify 3988 neuro lead C1378 InterStim Tx 3080/3886 lead C1379 Pisces-Quad 3887 lead C1420 StapleTac2 Bonew/Dermis C1421 stapletac2 bone wo Dermis C1450 ORTHOSPHERE Arthroplasty C1451 ORTHOSPHERE ARTHROPLASTY KitC1500 Atherectomy sys, peripheral C1700 Authen Mick TP brachy needle C1701 Medtec MT-BT-5201-25 needle C1702 WWMT Brachy Needle C1703 Mentor Prostate Brachy C1704 MT-Bt-5001-25/5051-25 C1705 Best Flexi Brachy Needle C1706 Indigo Prostate Seeding Ndl C1707 Varisource Implt Ndl C1708 UroMed Prostate Seed Ndl C1709 Remington Brachytx Needle C1710 US BIOPSY Prostate Needle C1711 MD TECH Brachytx Needle C1712 Imagyn brachytx needle C1790 Iridium 192 HDR C1791 OncoSeed, Rapid Strand I-125 C1792 UroMed I-125 Brachy seed C1793 Bard InterSource P-103 seed C1794 Bard IsoSeed P-103 seed C1795 Bard BrachySource I-125 C1796 SourceTech Med I-125 C1797 Draximage I-125 seed C1798 Syncor I-125 PharmaSeed C1799 I-Plant I-125 Brachytx seed C1800 Pd-103 brachytx seed C1801 IoGold I-125 brachytx seed C1802 Iridium 192 brachytx seeds C1803 Best Iodine 125 brachytx sds C1804 Best Palladium 103 seeds C1805 IsoStar Iodine-125 seeds

15C1806 Best Gold 198 brachytx seed C1810 D114S Dilatation Cath C1811 Sugical Dynamics Anchors C1812 OBL Anchors C1850 Repliform 14/21 sq cm C1851 Repliform 24/28 sq cm C1852 TransCyte, per 247 sq cm C1853 Suspend, per 8/14 sq cm C1854 Suspend, per 24/28 sq cm C1855 Suspend, per 36 sq cm C1856 Suspend, per 48 sq cm C1857 Suspend, per 84 sq cm C1858 DuraDerm, per 8/14 sq cm C1859 DuraDerm, per 21/24/28 sq cm C1860 DuraDerm, per 48 sq cm C1861 DuraDerm, per 36 sq cm C1862 DuraDerm, per 72 sq cm C1863 DuraDerm, per 84 sq cm C1864 SpermaTex, per 13.44 sq cm C1865 FasLata, per 8/14 sq cm C1866 FasLata, per 24/28 sq cm C1867 FasLata, per 36/48 sq cm C1868 FasLata, per 96 sq cm C1869 Gore Thyroplasty Device C1870 DermMatrix, per 16 sq cm C1871 DermMatrix, 32 or 64 sq cm C1872 Dermagraft, per 37.5 sq cm C1873 Bard 3DMax Mesh C1929 Maverick PTCA Cath C1930 Coyote Dil Cath, 20/30/40mm C1931 Talon Dil Cath C1932 SciMed Remedy Dil Cath C1933 Opti-Plast XL/Centurion Cath C1934 Ultraverse 3.5F Bal Dil Cath C1935 Workhorse PTA Bal Cath C1936 Uromax Ultra Bal Dil Cath C1937 Synergy/Explorer Cath C1938 UroForce Bal Dil Cath C1939 Raptur, Ninja PTCA Dil Cath C1940 PowerFlex,OPTA 5/LP Bal Cath C1941 Jupiter PTA Dil Cath C1942 Cordis Maxi LD PTA Bal Cath C1943 RXCrossSail OTW OpenSail C1944 Rapid Exchange Bil Dil Cath C1945 Savvy PTA Dil Cath C1946 R1s Rapid Dil Cath C1947 Gazelle Bal Dil Cath C1948 Oracle Megasonics Cath C1949 Oracle Megasonics Cath C1979 Visions PV/Avanar US Cath C1980 Atlantis SR Coronary Cath C1981 PTCA Catheters

16C2000 Orbiter ST Steerable Cath C2001 Constellation Diag Cath C2002 Irvine 5F Inquiry EP Cath C2003 Irvine 6F Inquiry EP Cath C2004 EP Cath--Octapolar C2005 EP Tip Cath--Hexapolar C2006 EP Cath--Decapolar C2007 Irvine 6F Luma-Cath EP Cath C2008 Luma-Cath Ep Cath 81910-15 C2009 Irvine 7F Luma-Cath EP Cath C2010 Fixed Curve EP Cath C2011 Deflectable Tip Cath--Quad C2012 Celsius Abln Cath C2013 Celsius Large Abln Cath C2014 Celsius II Asym Abln Cath C2015 Celsius II Sym Abln Cath C2016 Navi-Star DS, Navi-Star Ther C2017 Navi-Star Abln Cath C2018 Polaris T Ablation Cath C2019 EP Deflectable Cath C2020 Blazer II XP Abln Cath C2021 SilverFlex EP Cath C2022 CP Chilli Cooled Abln Cath C2023 Chilli Cld AblnCath-std,lg C2100 CP CS Reference Cath C2101 CP RV Reference Cath C2102 CP Radii 7F EP Cath C2103 CP Radii 7F EP Cath w/Track C2104 Lasso Deflectable Cath C2151 Veripath Guiding Cath C2152 Cordis Vista Brite Tip Cath C2153 Bard Viking Cath C2200 Arrow-Trerotola PTD Cath C2300 Varisource Stnd Cath C2597 Clinicath 16/18 sgl/dbl C2598 CliniCath 18/20/24G--single C2599 CliniCath 16/18 double C2600 Gold Probe Catheter C2601 Bard DL Ureteral Cath C2602 Vitesse Laser Cath 1.4/1.7mm C2603 Vitesse Laser Cath 2.0mm C2604 Vitesse E Laser Cath 2.0mm C2605 Extreme Laser Cath C2606 SpineCath XL Catheter C2607 SpineCath Intradiscal Cath C2608 SciMed 6F Wiseguide Catheter C2609 Flexima Bil Drainage Cath C2610 FlexTipPlus Intraspinal Cath C2611 AlgoLine Intraspinal Cath C2612 InDura Catheter C2676 Rsponse CV Catheter C2700 MycroPhylax Plus SC defib

17C2701 Phylax XM SC defib C2702 Ventak Prizm 2 VR Defib C2703 Ventak Prizm VR HE Defib C2704 Ventak Mini IV+ Defib C2801 Defender IV DR 612 DC defib C2802 Phylax AV C2803 Ventak Prizm DR HE Defib C2804 Ventak Prizm 2 DR Defib C2805 Jewel AF 7250 Defib C2806 Gem VR 7227 Defib C2807 Contak CD 1823 C2808 Contak TR 1241 C3001 Kainox SL/RV defib lead C3002 EasyTrak Defib Lead C3003 Endotak SQ Aray XP lead C3004 Intervene Defib Lead C3400 Siltex Spectrum,Contour Prof C3401 Saline-Filled Spectrum C3500 Alpha I Inf Pro C3510 AMS 800 URINARY Pros C3551 Choice/PT Graphix/Luge/Troop C3552 Hi-Torque Whisper C3553 Cordis guidewires C3554 Jindo guidewire C3555 Wholey Hi-Torque Plus GW C3556 Wave/FlowWire Guidewire C3557 HyTek guidewire C3800 SynchroMed EL Infusion Pump C3801 Arrow/MicroJect PCA Sys C3851 Elastic UV IOLAA-4203T/TF/TL C4000 Opus G 4621, 4624 SC pmkr C4001 Opus S 4121/4124 SC pmkr C4002 Talent 113 SC pmkr C4003 Kairos SR SC pmkr C4004 Actros SR, ActrosSR-B SC pmk C4005 Philos SR/SR-B SC pmkr C4006 Pulsar Max II SR pmkr C4007 Marathon SR pmkr C4008 Discovery II SSI pmkr C4009 Discovery II SR pmkr C4300 Integrity AFx DR 5342 pmkr C4301 Integrity AFx DR 5346 pmkr C4302 Affinity VDR 5430 pmkr C4303 Brio 112 DC pmkr C4304 Brio212,Talent213/223DCpmkr C4305 Brio 222 DC pmkr C4306 Brio 220 DC pmkr C4307 Kairos DR DC pmkr C4308 Inos2, Inos2+ DC pmkr C4309 Actros DR,D,DR-A,SLR DC pmkr C4310 Actros DR-B DC pmkr C4311 Philos DR/DR-B/SLR DC pmkr

18C4312 Pulsar Max II DR pmkr C4313 Marathon DR pmkr C4314 Momentum DR pmkr C4315 Selection AFm pmkr C4316 Discovery II DR C4317 Discovery II DDD C4600 Synox,Polyrox,Elox,Retrox C4601 Aescula LV pmkr lead C4602 Tendril SDX, 1488k pmkr lead C4603 Oscor/Flexion pmkr lead C4604 CrystallineActFix,CapsureFix C4605 CapSure Epi pmkr lead C4606 Flextend pmkr lead C4607 FinelineII/EZ, ThinlineII/EZ C5000 BX Velocity w/Hepacoat C5001 Memotherm Bil Stent, sm, med C5002 Memotherm Bil Stent, large C5003 Memotherm Bil Stent, x-large C5004 PalmazCorinthian IQ Bil Stnt C5005 PalmazCorinthian IQ Trans/Bi C5006 PalmazTrans Bil StentSys-Med C5007 PalmazTrans XL Bil St-40mm C5008 PalmazTrans XL Bil St-50mm C5009 VistaFlex Biliary Stent C5010 Rapid Exchange Bil Stent Sys C5011 IntraStent, IntraStent LP C5012 IntraStent DoubleStrut LD C5013 IntraStent DoubleStrut, XS C5014 AVE Bridge StentSys10/17/28 C5015 AVE/X3 Bridge Sys, 40-100 C5016 Biliary Stent Single Use Cov C5017 WallstentRP-Bil-20/40/60/68 C5018 WallstentRP Bil--80/94mm C5019 Flexima Bil Stent Sys C5020 Smart Nitinol Stent--20MM C5021 Smart Nitinol Stent--40/60MM C5022 Smart Nitinol Stent--80MM C5023 BX Velocity Stent--8/13mm C5024 BX Velocity Stent C5025 BX Velocity Stent--23mm C5026 BX Velocity Stent--28/33mm C5027 BX Velocity w/Hep--8/13mm C5028 BX Velocity w/Hep--18mm C5029 BX Velocity w/Hep--23mm C5030 Stent, coronary, S660 9/12mm C5031 Stent, coronary, S660 15/18 C5032 Stent,coronary, S660 24/30 C5033 Niroyal Stnt Sys, 9mm C5034 Niroyal Stent Sys, 12/15mm C5035 Niroyal Stent Sys, 18mm C5036 Niroyal Stent Sys, 25mm C5037 Niroyal Stent Sys, 31mm

19C5038 BX Velocity Stnt w/Raptor C5039 IntraCoil Perip Stent--40mm C5040 IntraCoil Periph Stent--60mm C5041 BeStent Over-the-Wire24/30mm C5042 BeStent Over-the-Wire 18mm C5043 BeStent Over-the-Wire 15mm C5044 BeStent Over-the-Wire 9/12mm C5045 Multilink Tetra Cor Stent Sy C5046 Radius 20mm cor stent C5047 Niroyal Elite Cor Stent Sys C5048 GR II Coronary Stent C5130 Wilson-Cook Z-stent C5131 Bard Colorectal Stent--60mm C5132 Bard Colorectal Stent--80mm C5133 Bard Colorectal Stent-100mm C5134 Enteral Wallstent--90mm C5279 Contour/Percuflex Stent C5280 Inlay Dbl Ureteral Stent C5281 Wallgraft Trach Sys 70mm C5282 Wallgraft Trach Sys 20/30/50 C5283 Wallstent/RP TIPS--80mm C5284 Wallstent TrachUltraFlex C5600 Closure dev, VasoSeal ES C5601 VasoSeal 1000 C6001 Composix Mesh 8/18 in C6002 Composix Mesh 32 in C6003 Composix Mesh 48 in C6004 Composix Mesh 80 in C6005 Composix Mesh 140 in C6006 Composix Mesh 144 in C6012 Pelvicol Collagen 8/14 sq cm C6013 Pelvicol Collagen 21/24/28 C6014 Pelvicol Collagen 40 sq cm C6015 Pelvicol Collagen 48 sq cm C6016 Pelvicol Collagen 96 sq cm C6017 Gore-Tex DualMesh 75/96 sqcm C6018 Gore-Tex DualMesh 150sqcm C6019 Gore-Tex DualMesh 285 sqcm C6020 Gore-Tex DualMesh 432sqcm C6021 Gore-Tex DualMesh 600 sqcm C6022 Gore-Tex DualMesh 884 sqcm C6023 Gore-TexPlus 1mm,75/96 sqcm C6024 Gore-TexPlus 1mm, 150 sq cm C6025 Gore-TexPlus 1mm, 285 sq cm C6026 Gore-TexPlus 1mm, 432 sqcm C6027 Gore-TexPlus 1mm, 600 sqcm C6028 Gore-TexPlus 1mm,884 sq cm C6029 Gore-TexPlus 2mm, 150 sq cm C6030 Gore-TexPlus 2mm, 285 sq cm C6031 Gore-TexPlus 2mm, 432 sq cm C6032 Gore-TexPlus 2mm, 600 sq cm C6033 Gore-TexPlus 2mm,884 sq cm

20C6034 Bard ePTFE: 150 sq cm-2mm C6035 Bard ePTFE150sqcm-1mm,75-2mm C6036 Bard ePTFE: 50/75sqcm-1,2mm C6037 Bard ePFTE: 300sq cm-1mm C6038 Bard ePTFE: 600sq cm-1mm C6039 Bard ePTFE: 884 cm--1mm C6040 Bard ePTFE: 600sq cm-2mm C6041 Bard ePTFE: 884sq cm-2mm C6050 Female Sling Sys w/wo Matrl C6051 Stratasis Sling, 20/40cm C6052 Stratasis Sling, 60cm C6053 Surgisis Soft Graft C6054 Surgisis Enchanced Graft C6055 Surgisis Enhanced Tissue C6056 Surgisis Soft Tissue Graft C6057 Surgisis Hernia Graft C6058 SurgiPro Hernia Plug,med/lg C6080 Male Sling Sys w/wo Matrl C6200 Exxcel Sft ePTFE vas graft C6201 Impra Venaflo-10/20cm C6202 Impra Venaflo-30/40cm C6203 Impra Venaflo-50cm/vt45 C6204 Impra Venaflo-stepped C6205 Impra Carboflo-10cm C6206 Impra Carboflo-20cm C6207 Impra Carboflo-30/34/40cm C6208 Impra Carboflo-40/50cm C6209 Impra Carboflo-ctrflex C6210 Exxcel ePTFE vas graft C6300 Vanguard III Endovas Graft C6500 Preface Guiding Sheath C6501 Soft Tip Sheaths C6525 Spectranetics Laser Sheath C6600 Micro Litho Flex Probes C6650 Fast-cath Guiding Introducer C6651 Seal-AwayGuiding Introducer C6652 Bard Excalibur Introducer C6700 Focal Seal-L C8099 Spectranetics Lead Lock Dev C8100 Adhesion barrier, ADCON-L C8102 SurgiVision Esoph Coil C8103 Capio Capturing Dev C8500 Atherocath-GTO C8501 Vigor SSI, SC, pmkr C8502 Livewire Steerable EP Cath C8503 SynchroMed Vas Cath C8504 VasoSeal Hemostasis Dev C8505 SynchroMed Infusion Pump C8506 Pmkr leads 4057M,4058M C8507 6721L/M/S,6939 lead C8508 CapSure 4965 defib lead C8509 Transvene 6933/6937 lead

21C8510 DP-3238 defib lead C8511 EndoTak DSP defib lead C8512 On-Point,Pisces-Quad lead C8513 Pisces,Resume II lead C8514 Dura II Penile Prosthesis C8516 Mentor Acu-Form/Mal Pros C8518 Vigor DDD DC pmkr C8519 Vista DDD C pmkr C8520 Legacy II S, SC, pmkr C8521 Medtronic Mattrix rcvr/trmr C8522 Palmaz Bal Stent C8523 Wallstent Trans Bil C8524 Wallstent Esop C8525 wallstent Esoph--double C8526 OptiPlast XT PTA Cath C8528 MS Classique Bl Dil Cath C8529 Crista Cath II Def 20-Pole C8530 Gel-Filled/Smooth Mammary Pr C8531 Wilson-Cook Esoph Z-Stent C8532 UltraFlex Esophageal Pros C8533 SynchroMed Vas Cath 8700A/V C8534 AMS 650 Penile Prosthesis C8535 Za/Spiral Z Bil Stent C8536 Esoph Z Metal Stent C8539 Quantum Dil Balloon C8540 Flex-EZ Bal Dilator C8541 Carson/Passprt Dil Cath C8542 UrethraMax Dil Cath C8543 Amplatz Renal Dil C8550 Livewire 5F, 7F EP Cath C8551 Livewire 7F Duo-Decapolar C8552 Santuro Fixed Curve Cath C8597 Wisdom ST guidewire C8598 SV Guidewire-5/8/14cm C8599 Stabilizer XS guidewire C8600 Shinobi Plus guidewire C8650 XL Check-Flo Introducer C8724 Octad neuro lead C8725 SymMix neuro lead C8748 Endotak SQ Patch defib lead C8749 Endotak SQ Array defib lead C8750 Unity VDDR dc pmkr C8775 2188 Cor pmkr lead C8776 Innomedica pmkr lead C8777 Unipass pmkr lead C8800 Lg Palmaz Bil Stent C8801 Gianturco Bil Z Stent C8802 Oasis Stent Intro Sys C8830 Gianturco-Roubin Cor Snt C8890 Perfluoron, 2ml C8891 Perfluoron, 5/7ml C9000 Na chromateCr51, per 0.25mCi

22C9001 Linezolid inj, 200mg C9002 Tenecteplase, 50mg/vial C9003 Palivizumab, per 50 mg C9004 Gemtuzumab ozogamicin inj,5m C9005 Reteplase inj, half-kit,18.8 C9006 Tacrolimus inj, per 5 mg C9007 Baclofen Intrathecal kit-1am C9008 Baclofen Refill Kit-500mcg C9009 Baclofen Refill Kit-2000mcg C9010 Baclofen Refill Kit--4000mcg C9011 Caffeine Citrate, inj, 1ml C9100 Iodinated I-131 Albumin C9102 51 Na Chromate, 50mCi C9103 Na Iothalamate I-125, 10 uCi C9104 Anti-thymocyte globulin,25mg C9105 Hep B imm glob, per 1 ml C9106 Sirolimus 1mg/ml C9107 Tinzaparin sodium, 2ml vial C9500 Platelets, irrad, ea unit C9501 Platelets, pheresis, ea unit C9502 Platelets, pher/irrad, ea un C9503 Fresh frozen plasma, ea unit C9504 RBC, deglycerolized, ea unit C9505 RBC, Irradiated, each unit C9700 Water Induced Thermo C9701 Stretta System C9702 Chkmate Intra Brachytx Sys 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 no wood E0116 Crutch underarm each no wood E0130 Walker rigid adjust/fixed ht E0135 Walker folding adjust/fixed E0141 Rigid walker wheeled wo seat E0142 Walker rigid wheeled with se E0143 Walker folding wheeled w/o s E0144 Enclosed walker w rear seat E0145 Walker whled seat/crutch att E0146 Folding walker wheels w seat E0147 Walker variable wheel resist E0148 Heavyduty walker no wheels E0149 Heavy duty wheeled walker E0153 Forearm crutch platform atta E0154 Walker platform attachment E0155 Walker wheel attachment,pair E0156 Walker seat attachment E0157 Walker crutch attachment E0158 Walker leg extenders set of4

23E0159 Brake for wheeled walker 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 E0168 Heavyduty/wide commode chair 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 E0217 Water circ heat pad w pump E0218 Water circ cold pad w pump E0220 Hot water bottle E0225 Hydrocollator unit E0230 Ice cap or collar E0235 Paraffin bath unit portable E0236 Pump for water circulating p 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

24E0249 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 Powered pres-redu air mattrs 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 E0298 Heavyduty/xtra wide hosp bed E0305 Rails bed side half length E0310 Rails bed side full length E0315 Bed accessory brd/tbl/supprt E0325 Urinal male jug-type E0326 Urinal female jug-type E0350 Control unit bowel system E0352 Disposable pack w/bowel syst E0370 Air elevator for heel E0371 Nonpower mattress overlay E0372 Powered air mattress overlay E0373 Nonpowered pressure mattress 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, gaseous E0442 Oxygen contents, liquid E0443 Portable 02 contents, gas E0444 Portable 02 contents, liquid E0450 Volume vent stationary/porta E0455 Oxygen tent excl croup/ped t

25E0457 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 E0571 Aerosol compressor for svneb E0572 Aerosol compressor adjust pr E0574 Ultrasonic generator w svneb E0575 Nebulizer ultrasonic E0580 Nebulizer for use w/ regulat E0585 Nebulizer w/ compressor & he E0590 Dispensing fee dme neb drug E0600 Suction pump portab hom modl E0601 Cont airway pressure device E0602 Breast pump 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 E0616 Cardiac event recorder E0617 Automatic ext defibrillator 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

26E0710 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 Elec osteogen stim not spine E0748 Elec osteogen stim spinal E0749 Elec osteogen stim implanted E0753 Neurostimulator electrodes E0755 Electronic salivary reflex s E0756 Implantable pulse generator E0757 Implantable RF receiver E0758 External RF transmitter E0760 Osteogen ultrasound stimltor E0765 Nerve stimulator for tx n&v E0776 Iv pole E0779 Amb infusion pump mechanical E0780 Mech amb infusion pump <8hrs E0781 External ambulatory infus pu E0782 Non-programble infusion pump E0783 Programmable infusion pump E0784 Ext amb infusn pump insulin E0785 Replacement impl pump cathet E0786 Implantable pump replacement E0791 Parenteral infusion pump sta E0830 Ambulatory traction device E0840 Tract frame attach headboard E0850 Traction stand free standing E0855 Cervical traction equipment 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

27E0952 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 E1035 Patient transfer system 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

28E1090 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 E1340 Repair for DME, per 15 min E1353 Oxygen supplies regulator E1355 Oxygen supplies stand/rack E1372 Oxy suppl heater for nebuliz E1390 Oxygen concentrator E1399 Durable medical equipment mi E1405 O2/water vapor enrich w/heat E1406 O2/water vapor enrich w/o he

29E1510 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 E1900 Speech communication 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

30G0034 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 G0101 CA screen;pelvic/breast exam G0102 Prostate ca screening; dre G0103 Psa, total screening G0104 CA screen;flexi sigmoidscope G0105 Colorectal scrn; hi risk ind G0106 Colon CA screen;barium enema G0107 CA screen; fecal blood test G0108 Diab manage trn per indiv G0109 Diab manage trn ind/group G0110 Nett pulm-rehab educ; ind G0111 Nett pulm-rehab educ; group G0112 Nett;nutrition guid, initial G0113 Nett;nutrition guid,subseqnt G0114 Nett; psychosocial consult G0115 Nett; psychological testing G0116 Nett; psychosocial counsel G0120 Colon ca scrn; barium enema G0121 Colon ca scrn not hi rsk ind G0122 Colon ca scrn; barium enema G0123 Screen cerv/vag thin layer G0124 Screen c/v thin layer by MD G0125 Lung image (PET) G0126 Lung image (PET) staging G0127 Trim nail(s) G0128 CORF skilled nursing service G0129 Partial hosp prog service G0130 Single energy x-ray study G0131 CT scan, bone density study G0132 CT scan, bone density study G0141 Scr c/v cyto,autosys and md G0143 Scr c/v cyto,thinlayer,rescr G0144 Scr c/v cyto,thinlayer,rescr G0145 Scr c/v cyto,thinlayer,rescr G0147 Scr c/v cyto, automated sys G0148 Scr c/v cyto, autosys, rescr G0151 HHCP-serv of pt,ea 15 min G0152 HHCP-serv of ot,ea 15 min

31G0153 HHCP-svs of s/l path,ea 15mn G0154 HHCP-svs of rn,ea 15 min G0155 HHCP-svs of csw,ea 15 min G0156 HHCP-svs of aide,ea 15 min G0163 Pet for rec of colorectal ca G0164 Pet for lymphoma staging G0165 Pet,rec of melanoma/met ca G0166 Extrnl counterpulse, per tx G0167 Hyperbaric oz tx;no md reqrd G0168 Wound closure by adhesive G0173 Stereo radoisurgery,complete G0174 Intensitymodulatedradiation G0175 OPPS Service,sched team conf G0176 OPPS/PHP;activity therapy G0177 OPPS/PHP; train & educ serv G0178 Intensitymodulatedradiation G0179 Intensitymodulatedradiation G0180 MD certification HHA patient G0181 Home health care supervision G0182 Hospice care supervision G0183 Ocular photodynamic therapy G0184 Ocular photocoagulation G0185 Transpuppillary thermotx G0186 Dstry eye lesn,fdr vssl tech G0187 Dstry mclr drusen,photocoag G0188 Xray lwr extrmty-full lngth G0190 Immunization administration G0191 Immunization admin,each add G0192 Immunization oral/intranasal G0193 Endoscopicstudyswallowfunctn G0194 Sensorytestingendoscopicstud G0195 Clinicalevalswallowingfunct G0196 Evalofswallowingwithradioopa G0197 Evalofptforprescipspeechdevi G0198 Patientadapation&trainforspe G0199 Reevaluationofpatientusespec G0200 Evalofpatientprescipofvoicep G0201 Modifortraininginusevoicepro G9001 MCCD, initial rate G9002 MCCD,maintenance rate G9003 MCCD, risk adj hi, initial G9004 MCCD, risk adj lo, initial G9005 MCCD, risk adj, maintenance G9006 MCCD, Home monitoring G9007 MCCD, sch team conf G9008 Mccd,phys coor-care ovrsght G9016 Demo-smoking cessation coun H0001 Alcohol and/or drug assess H0002 Alcohol and/or drug screenin H0003 Alcohol and/or drug screenin H0004 Alcohol and/or drug services H0005 Alcohol and/or drug services

32H0006 Alcohol and/or drug services H0007 Alcohol and/or drug services H0008 Alcohol and/or drug services H0009 Alcohol and/or drug services H0010 Alcohol and/or drug services H0011 Alcohol and/or drug services H0012 Alcohol and/or drug services H0013 Alcohol and/or drug services H0014 Alcohol and/or drug services H0015 Alcohol and/or drug services H0016 Alcohol and/or drug services H0017 Alcohol and/or drug services H0018 Alcohol and/or drug services H0019 Alcohol and/or drug services H0020 Alcohol and/or drug services H0021 Alcohol and/or drug training H0022 Alcohol and/or drug interven H0023 Alcohol and/or drug outreach H0024 Alcohol and/or drug preventi H0025 Alcohol and/or drug preventi H0026 Alcohol and/or drug preventi H0027 Alcohol and/or drug preventi H0028 Alcohol and/or drug preventi H0029 Alcohol and/or drug preventi H0030 Alcohol and/or drug hotline J0120 Tetracyclin injection J0130 Abciximab injection J0150 Injection adenosine 6 MG J0151 Adenosine injection J0170 Adrenalin epinephrin inject J0190 Inj biperiden lactate/5 mg J0200 Alatrofloxacin mesylate J0205 Alglucerase injection J0207 Amifostine J0210 Methyldopate hcl injection J0256 Alpha 1 proteinase inhibitor J0270 Alprostadil for injection J0275 Alprostadil urethral suppos J0280 Aminophyllin 250 MG inj J0282 Amiodarone HCl J0285 Amphotericin B J0286 Amphotericin B lipid complex 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 J0395 Arbutamine HCl injection

33J0400 Inj trimethaphan camsylate J0456 Azithromycin J0460 Atropine sulfate injection J0470 Dimecaprol injection J0475 Baclofen 10 MG injection J0476 Baclofen intrathecal trial 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 unit 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 J0735 Clonidine hydrochloride J0740 Cidofovir injection 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

34J0945 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 Dexamethasone sodium phos J1110 Inj dihydroergotamine mesylt J1120 Acetazolamid sodium injectio J1160 Digoxin injection J1165 Phenytoin sodium injection J1170 Hydromorphone injection J1180 Dyphylline injection J1190 Dexrazoxane HCl 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 J1260 Dolasetron mesylate J1320 Amitriptyline injection J1325 Epoprostenol injection J1327 Eptifibatide 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 J1438 Etanercept injection J1440 Filgrastim 300 mcg injeciton J1441 Filgrastim 480 mcg injection J1450 Fluconazole J1452 Intraocular Fomivirsen na 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

35J1520 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 500 mg J1563 IV immune globulin J1565 RSV-ivig J1570 Ganciclovir sodium injection J1580 Garamycin gentamicin inj J1600 Gold sodium thiomaleate inj J1610 Glucagon hydrochloride/1 MG J1620 Gonadorelin hydroch/ 100 mcg J1626 Granisetron HCl injection J1630 Haloperidol injection J1631 Haloperidol decanoate inj J1642 Inj heparin sodium per 10 u J1644 Inj heparin sodium per 1000u J1645 Dalteparin sodium J1650 Inj enoxaparin sodium 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 J1742 Ibutilide fumarate injection J1745 Infliximab injection J1750 Iron dextran J1785 Injection imiglucerase /unit J1790 Droperidol injection J1800 Propranolol injection J1810 Droperidol/fentanyl inj J1820 Insulin injection J1825 Interferon beta-1a 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 J1956 Levofloxacin injection J1960 Levorphanol tartrate inj J1970 Methotrimeprazine injection J1980 Hyoscyamine sulfate inj J1990 Chlordiazepoxide injection

36J2000 Lidocaine injection J2010 Lincomycin 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 J2271 Morphine so4 injection 100mg 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 J2352 Octreotide acetate injection J2355 Oprelvekin 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 J2500 Paricalcitol J2510 Penicillin g procaine inj J2512 Inj pentagastrin per 2 ML J2515 Pentobarbital sodium inj J2540 Penicillin g potassium inj J2543 Piperacillin/tazobactam 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

37J2730 Pralidoxime chloride inj J2760 Phentolaine mesylate inj J2765 Metoclopramide hcl injection J2770 Quinupristin/dalfopristin J2780 Ranitidine hydrochloride inj J2790 Rho d immune globulin inj J2792 Rho(D) immune globulin h, sd J2795 Ropivacaine HCl injection J2800 Methocarbamol injection J2810 Inj theophylline per 40 MG J2820 Sargramostim injection J2860 Secobarbital sodium inj J2910 Aurothioglucose injeciton J2912 Sodium chloride injection J2915 NA Ferric Gluconate Complex J2920 Methylprednisolone injection J2930 Methylprednisolone injection J2950 Promazine hcl injeciton J2970 Methicillin sodium injection J2993 Reteplase injection J2995 Inj streptokinase /250000 IU J2997 Alteplase recombinant J3000 Streptomycin injection 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 J3245 Tirofiban hydrochloride 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

38J3400 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 J3485 Zidovudine 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 J7190 Factor viii J7191 Factor VIII (porcine) J7192 Factor viii recombinant J7194 Factor ix complex J7197 Antithrombin iii injection J7198 Anti-inhibitor J7199 Hemophilia clot factor noc J7300 Intraut copper contraceptive J7310 Ganciclovir long act implant J7315 Sodium hyaluronate injection J7320 Hylan G-F 20 injection J7330 Cultured chondrocytes implnt J7500 Azathioprine oral 50mg J7501 Azathioprine parenteral J7502 Cyclosporine oral 100 mg J7504 Lymphocyte immune globulin J7505 Monoclonal antibodies J7506 Prednisone oral J7507 Tacrolimus oral per 1 MG J7508 Tacrolimus oral per 5 MG J7509 Methylprednisolone oral J7510 Prednisolone oral per 5 mg J7513 Daclizumab, parenteral J7515 Cyclosporine oral 25 mg J7516 Cyclosporin parenteral 250mg J7517 Mycophenolate mofetil oral J7520 Sirolimus, oral

39J7525 Tacrolimus injection J7599 Immunosuppressive drug noc J7608 Acetylcysteine inh sol u d J7618 Albuterol inh sol con J7619 Albuterol inh sol u d J7628 Bitolterol mes inhal sol con J7629 Bitolterol mes inh sol u d J7631 Cromolyn sodium inh sol u d J7635 Atropine inhal sol con J7636 Atropine inhal sol unit dose J7637 Dexamethasone inhal sol con J7638 Dexamethasone inhal sol u d J7639 Dornase alpha inhal sol u d J7642 Glycopyrrolate inhal sol con J7643 Glycopyrrolate inhal sol u d J7644 Ipratropium brom inh sol u d J7648 Isoetharine hcl inh sol con J7649 Isoetharine hcl inh sol u d J7658 Isoproterenolhcl inh sol con J7659 Isoproterenol hcl inh sol ud J7668 Metaproterenol inh sol con J7669 Metaproterenol inh sol u d J7680 Terbutaline so4 inh sol con J7681 Terbutaline so4 inh sol u d J7682 Tobramycin inhalation sol J7683 Triamcinolone inh sol con J7684 Triamcinolone inh sol u d J7699 Inhalation solution for DME J7799 Non-inhalation drug for DME J8499 Oral prescrip drug non chemo J8510 Oral busulfan J8520 Capecitabine, oral, 150 mg J8521 Capecitabine, oral, 500 mg J8530 Cyclophosphamide oral 25 MG J8560 Etoposide oral 50 MG J8600 Melphalan oral 2 MG J8610 Methotrexate oral 2.5 MG J8700 Temozolmide J8999 Oral prescription drug chemo J9000 Doxorubic hcl 10 MG vl chemo J9001 Doxorubicin hcl liposome 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

40J9090 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 J9151 Daunorubicin citrate liposom J9160 Denileukin diftitox, 300 mcg J9165 Diethylstilbestrol injection J9170 Docetaxel J9180 Epirubicin HCl injection J9181 Etoposide 10 MG inj J9182 Etoposide 100 MG inj J9185 Fludarabine phosphate inj J9190 Fluorouracil injection J9200 Floxuridine injection J9201 Gemcitabine HCl J9202 Goserelin acetate implant J9206 Irinotecan injection J9208 Ifosfomide injection J9209 Mesna injection J9211 Idarubicin hcl injeciton J9212 Interferon alfacon-1 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 J9219 Leuprolide acetate implant 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 J9310 Rituximab cancer treatment J9320 Streptozocin injection

41J9340 Thiotepa injection J9350 Topotecan J9355 Trastuzumab J9357 Valrubicin, 200 mg 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 J9600 Porfimer sodium 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 Manual 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

42K0042 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

43K0094 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 Pwr wheelchair front caster 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 W/c component-accessory NOS 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 K0183 Nasal application device K0184 Nasal pillows/seals pair K0185 Pos airway pressure headgear K0186 Pos airway prssure chinstrap K0187 Pos airway pressure tubing K0188 Pos airway pressure filter K0189 Filter nondisposable w PAP K0195 Elevating whlchair leg rests K0268 Humidifier nonheated w PAP K0415 RX antiemetic drg, oral NOS K0416 Rx antiemetic drg,rectal NOS K0452 Wheelchair bearings K0455 Pump uninterrupted infusion K0460 WC power add-on joystick K0461 WC power add-on tiller cntrl K0462 Temporary replacement eqpmnt K0531 Heated humidifier used w pap K0532 Noninvasive assist wo backup K0533 Noninvasive assist w backup K0534 Invasive assist w backup K0538 Neg pressure wnd thrpy pump K0539 Neg pres wnd thrpy dsg set K0540 Neg pres wnd thrp canister K0541 Speech generating device K0542 Speech generating device K0543 Speech generating device K0544 Speech generating device K0545 Speech generating software K0546 Accessory for sgd,mntng syst K0547 Accessory for sgd,not clasfd L0100 Cerv craniosten helmet mold L0110 Cerv craniostenosis hel non-

44L0120 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 TLSO flex surgical support 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 flex surgical support 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 flex surg support 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 Torso/ptosis support L0910 Torso & ptosis supp custm fa L0920 Torso/pendulous abd support L0930 Pendulous abdomen supp custm

45L0940 Torso/postsurgical support 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 L0999 Add to spinal orthosis NOS 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 Spinal orthosis NOS 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 HO abduction hip adjustable L1660 HO abduction static plastic L1680 Pelvic & hip control thigh c L1685 Post-op hip abduct custom fa

46L1686 HO post-op hip abduction L1690 Combination bilateral HO 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 jnt pos rigid support L1834 Ko w/0 joint rigid molded to L1840 Ko derot ant cruciate custom L1843 KO single upright custom fit L1844 Ko w/adj jt rot cntrl molded L1845 Ko w/ adj flex/ext rotat cus L1846 Ko w adj flex/ext rotat mold L1847 KO adjustable w air chambers 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 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 L2035 KAFO plastic pediatric size L2036 Kafo plas doub free knee mol L2037 Kafo plas sing free knee mol L2038 Kafo w/o joint multi-axis an L2039 KAFO,plstic,medlat rotat con

47L2040 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 tibial fracture soft L2114 Afo tib fx semi-rigid L2116 Afo tibial fracture rigid 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 femoral fx cast soft L2134 Kafo fem fx cast semi-rigid L2136 Kafo femoral fx cast rigid 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

48L2397 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 L2430 Knee jnt ratchet lock ea jnt 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 L2755 Carbon graphite lamination 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 Lower extremity orthosis NOS 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

49L3040 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

50L3370 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 Ortho shoe add leather insol L3510 Orthopedic shoe add rub insl L3520 O shoe add felt w leath insl L3530 Ortho shoe add half sole L3540 Ortho shoe add full sole L3550 O shoe add standard toe tap L3560 O shoe add horseshoe toe tap L3570 O shoe add instep extension L3580 O shoe add instep velcro clo L3590 O shoe convert to sof counte L3595 Ortho shoe add march bar 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 Orthopedic shoe modifica NOS L3650 Shlder fig 8 abduct restrain L3660 Abduct restrainer canvas&web L3670 Acromio/clavicular canvas&we L3675 Canvas vest SO 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 L3760 EO withjoint, Prefabricated L3800 Whfo short opponen no attach L3805 Whfo long opponens no attach L3807 WHFO,no joint, prefabricated 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

51L3845 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 L3923 HFO, no joint, prefabricated 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 L3956 Add joint upper ext orthosis L3960 Sewho airplan desig abdu pos L3962 Sewho erbs palsey design abd L3963 Molded w/ articulating elbow L3964 Seo mobile arm sup att to wc L3965 Arm supp att to wc rancho ty L3966 Mobile arm supports reclinin L3968 Friction dampening arm supp 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

52L3986 Humeral rad/ulna wrist fx or L3995 Sock fracture or equal each L3999 Upper limb orthosis NOS 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 L4205 Ortho dvc repair per 15 min L4210 Orth dev repair/repl minor p L4350 Pneumatic ankle cntrl splint L4360 Pneumatic walking splint L4370 Pneumatic full leg splint L4380 Pneumatic knee splint L4392 Replace AFO soft interface L4394 Replace foot drop spint L4396 Static AFO L4398 Foot drop splint recumbent 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

53L5430 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

54L5655 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 suspension sleeve L5675 Bk heavy duty susp sleeve 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

55L5790 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 L5814 Endo knee-shin hydral swg ph 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 L5826 Miniature knee joint 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 L5968 Multiaxial ankle w dorsiflex L5970 Foot external keel sach foot L5972 Flexible keel foot L5974 Foot single axis ankle/foot L5975 Combo ankle/foot prosthesis 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 L5987 Shank ft w vert load pylon L5988 Vertical shock reducing pylo L5999 Lowr extremity prosthes NOS 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

56L6120 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

57L6676 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 L6693 Lockingelbow forearm cntrbal 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 or equal L6807 Term device grip1/2 or equal L6808 Term device infant or child 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

58L6880 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 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 Upper extremity prosthes NOS L7500 Prosthetic dvc repair hourly L7510 Prosthetic device repair rep L7520 Repair prosthesis per 15 min L7900 Vacuum erection system L8000 Mastectomy bra L8010 Mastectomy sleeve L8015 Ext breastprosthesis garment L8020 Mastectomy form L8030 Breast prosthesis silicone/e

59L8035 Custom breast prosthesis L8039 Breast prosthesis NOS L8040 Nasal prosthesis L8041 Midfacial prosthesis L8042 Orbital prosthesis L8043 Upper facial prosthesis L8044 Hemi-facial prosthesis L8045 Auricular prosthesis L8046 Partial facial prosthesis L8047 Nasal septal prosthesis L8048 Unspec maxillofacial prosth L8049 Repair maxillofacial prosth L8100 Compression stocking BK18-30 L8110 Compression stocking BK30-40 L8120 Compression stocking BK40-50 L8130 Gc stocking thighlngth 18-30 L8140 Gc stocking thighlngth 30-40 L8150 Gc stocking thighlngth 40-50 L8160 Gc stocking full lngth 18-30 L8170 Gc stocking full lngth 30-40 L8180 Gc stocking full lngth 40-50 L8190 Gc stocking waistlngth 18-30 L8195 Gc stocking waistlngth 30-40 L8200 Gc stocking waistlngth 40-50 L8210 Gc stocking custom made L8220 Gc stocking lymphedema L8230 Gc stocking garter belt L8239 G compression stocking NOS 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 L8417 Pros sheath/sock w gel cushn L8420 Prosthetic sock multi ply BK L8430 Prosthetic sock multi ply AK L8435 Pros sock multi ply upper lm L8440 Shrinker below knee L8460 Shrinker above knee L8465 Shrinker upper limb L8470 Pros sock single ply BK L8480 Pros sock single ply AK L8485 Pros sock single ply upper l 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 ml L8606 Synthetic implnt urinary 1ml

60L8610 Ocular implant L8612 Aqueous shunt prosthesis L8613 Ossicular implant L8614 Cochlear device/system L8619 Replace cochlear processor L8630 Metacarpophalangeal implant L8641 Metatarsal joint implant L8642 Hallux implant L8658 Interphalangeal joint implnt L8670 Vascular graft, synthetic L8699 Prosthetic implant NOS L9900 O&P supply/accessory/service M0064 Visit for drug monitoring M0075 Cellular therapy M0076 Prolotherapy M0100 Intragastric hypothermia 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 P9016 RBC leukocytes reduced P9017 One donor fresh frozn plasma P9019 Platelets, each unit P9020 Plaelet rich plasma unit P9021 Red blood cells unit P9022 Washed red blood cells unit P9023 Frozen plasma, pooled, sd P9031 Platelets leukocytes reduced P9032 Platelets, irradiated P9033 Platelets leukoreduced irrad P9034 Platelets, pheresis P9035 Platelet pheres leukoreduced P9036 Platelet pheresis irradiated P9037 Plate pheres leukoredu irrad P9038 RBC irradiated P9039 RBC deglycerolized P9040 RBC leukoreduced irradiated P9041 Albumin(human), 5% P9042 Albumin (human), 25% P9043 Plasma protein fraction P9044 Cryoprecipitatereducedplasma P9603 One-way allow prorated miles

61P9604 One-way allow prorated trip P9612 Catheterize for urine spec P9615 Urine specimen collect mult Q0035 Cardiokymography Q0081 Infusion ther other than che 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 Q0111 Wet mounts/ w preparations Q0112 Potassium hydroxide preps Q0113 Pinworm examinations Q0114 Fern test Q0115 Post-coital mucous exam Q0136 Non esrd epoetin alpha inj Q0144 Azithromycin dihydrate, oral Q0160 Factor IX non-recombinant Q0161 Factor IX recombinant Q0163 Diphenhydramine HCl 50mg Q0164 Prochlorperazine maleate 5mg Q0165 Prochlorperazine maleate10mg Q0166 Granisetron HCl 1 mg oral Q0167 Dronabinol 2.5mg oral Q0168 Dronabinol 5mg oral Q0169 Promethazine HCl 12.5mg oral Q0170 Promethazine HCl 25 mg oral Q0171 Chlorpromazine HCl 10mg oral Q0172 Chlorpromazine HCl 25mg oral Q0173 Trimethobenzamide HCl 250mg Q0174 Thiethylperazine maleate10mg Q0175 Perphenazine 4mg oral Q0176 Perphenazine 8mg oral Q0177 Hydroxyzine pamoate 25mg Q0178 Hydroxyzine pamoate 50mg Q0179 Ondansetron HCl 8mg oral Q0180 Dolasetron mesylate oral Q0181 Unspecified oral anti-emetic Q0183 Nonmetabolic active tissue Q0184 Metabolically active tissue Q0185 Metabolic active D/E tissue Q0187 Factor viia recombinant Q1001 Ntiol category 1 Q1002 Ntiol category 2 Q1003 Ntiol category 3 Q1004 Ntiol category 4 Q1005 Ntiol category 5 Q2001 Oral cabergoline 0.5 mg Q2002 Elliotts b solution per ml Q2003 Aprotinin, 10,000 kiu Q2004 Bladder calculi irrig sol

62Q2005 Corticorelin ovine triflutat Q2006 Digoxin immune fab (ovine) Q2007 Ethanolamine oleate 100 mg Q2008 Fomepizole, 1.5 mg Q2009 Fosphenytoin, 50 mg Q2010 Glatiramer acetate, per dose Q2011 Hemin, per 1 mg Q2012 Pegademase bovine, 25 iu Q2013 Pentastarch 10% solution Q2014 Sermorelin acetate, 0.5 mg Q2015 Somatrem, 5 mg Q2016 Somatropin, 1 mg Q2017 Teniposide, 50 mg Q2018 Urofollitropin, 75 iu Q2019 Basiliximab Q2020 Histrelin acetate Q2021 Lepirudin Q2022 VonWillebrandFactrCmplxperIU Q3001 Brachytherapy Radioelements Q3002 Gallium ga 67 Q3003 Technetium tc99m bicisate Q3004 Xenon xe 133 Q3005 Technetium tc99m mertiatide Q3006 Technetium tc99m glucepatate Q3007 Sodium phosphate p32 Q3008 Indium 111-in pentetreotide Q3009 Technetium tc99m oxidronate Q3010 Technetium tc99mlabeledrbcs Q3011 Chromic phosphate p32 Q3012 Cyanocobalamin cobalt co57 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

63R0075 Transport port x-ray multipl R0076 Transport portable EKG S0009 Injection, butorphanol tartr S0012 Butorphanol tartrate, nasal S0014 Tacrine hydrochloride, 10 mg S0016 Injection, amikacin sulfate S0017 Injection, aminocaproic acid S0020 Injection, bupivicaine hydro S0021 Injection, cefoperazone sod S0023 Injection, cimetidine hydroc S0024 Injection, ciprofloxacin S0028 Injection, famotidine, 20 mg S0029 Injection, fluconazole S0030 Injection, metronidazole S0032 Injection, nafcillin sodium S0034 Injection, ofloxacin, 400 mg S0039 Injection, sulfamethoxazole S0040 Injection, ticarcillin disod S0071 Injection, acyclovir sodium S0072 Injection, amikacin sulfate S0073 Injection, aztreonam, 500 mg S0074 Injection, cefotetan disodiu S0077 Injection, clindamycin phosp S0078 Injection, fosphenytoin sodi S0080 Injection, pentamidine iseth S0081 Injection, piperacillin sodi S0085 injection, gatifloxacin S0086 Injection, verteporfin, 15mg S0090 Sildenafil citrate, 25 mg S0096 Injection, itraconazole, 200 S0156 Exemestane, 25 mg S0157 Becaplermin gel 1%, 0.5 gm S0220 Medical conference by physic S0221 Medical conference, 60 min S0601 Screening proctoscopy S0605 Digital rectal examination, S0610 Annual gynecological examina S0612 Annual gynecological examina S0620 Routine ophthalmological exa S0621 Routine ophthalmological exa S0630 Removal of sutures S0800 Laser in situ keratomileusis S0810 Photorefractive keratectomy S0820 Computerized corneal topogra S0830 Ultrasound pachymetry S1015 IV tubing extension set S1016 Non-pvc intravenous administ S2052 Transplantation of small int S2053 Transplantation of small int S2054 Transplantation of multivisc S2055 Harvesting of donor multivis S2060 Lobar lung transplantation

64S2061 Donor lobectomy (lung) S2102 Islet cell tissue transplant S2103 Adrenal tissue transplant S2120 Low density lipoprotein(LDL) S2140 Cord blood harvesting S2142 Cord blood-derived stem-cell S2180 Donor leukocyte infusion S2202 Echosclerotherapy S2205 Minimally invasive direct co S2206 Minimally invasive direct co S2207 Minimally invasive direct co S2208 Minimally invasive direct co S2209 Minimally invasive direct co S2210 Cryosurgical ablation (in si S2220 Thrombectomy, coronary S2300 Arthroscopy, shoulder, surgi S2340 Chemodenervation of abductor S2350 Diskectomy, anterior, with d S2351 Diskectomy, anterior, with d S2370 Intradiscal electrothermal S2371 Each additional interspace S3620 Newborn metabolic screening S3645 HIV-1 antibody testing of or S3650 Saliva test, hormone level; S3652 Saliva test, hormone level; S3700 Bladder tumor-associated S3708 Gastrointestinal fat absorpt S3902 Ballistocardiogram S3904 Masters two step S3906 Transfusion, direct, blood S5000 Prescription drug, generic S5001 Prescription drug,brand name S5002 Fat emulsion 10% in 250 ml S5003 Fat emulsion 20% in 250 ml S5010 5% dextrose and 45% saline S5011 5% dextrose in lactated ring S5012 5% dextrose with potassium S5013 5% dextrose/45%saline,1000ml S5014 5% dextrose/45%saline,1500ml S5016 Antibiotic admin supplies w/ S5017 Antibiotic adminsupplies w/o S5018 Pain therapy admin supplies S5019 Chemotherapy admin supplies S5020 Chemotherapy admin supplies S5021 Hydration therapy admin supp S5022 Growth hormone therapy S5025 Infusion pump rental,perdiem S5503 Maintenance of implanted vas S8001 Radiofrequency stimulation S8035 Magnetic source imaging S8040 Topographic brain mapping S8049 Intraoperative radiation the

65S8080 Scintimammography S8085 Fluorine-18 fluorodeoxygluco S8092 Electron beam computed tomog S8095 Wig (for medically-induced h S8096 Portable peak flow meter S8105 Oximeter for measuring blood S8110 Peak expiratory flow rate (p S8200 Chest compression vest S8205 Chest compression system gen S8210 Mucus trap S8260 Oral orthotic for treatment S8400 Incontinence pants, each S8402 Diapers, each S8405 Incontinence liners, each S8950 Complex lymphedema therapy, S8999 Resuscitation bag S9001 Home uterine monitor with or S9007 Ultrafiltration monitor S9015 Automated EEG monitoring S9022 Digital subtraction angiogra S9023 Xenon regional cerebral bloo S9024 Paranasal sinus ultrasound S9025 Omnicardiogram/cardiointegra S9035 Medical equipment or supplie S9055 Procuren or other growth fac S9056 Coma stimulation per diem S9061 Medical supplies and equipme S9075 Smoking cessation treatment S9085 Meniscal allograft transplan S9088 Services provided in urgent S9090 Vertebral axial decompressio S9122 Home health aide or certifie S9123 Nursing care, in the home; b S9124 Nursing care, in the home; b S9125 Respite care, in the home, p S9126 Hospice care, in the home, p S9127 Social work visit, in the ho S9128 Speech therapy, in the home, S9129 Occupational therapy, in the S9140 Diabetic Management Program, S9141 Diabetic Management Program, S9200 Nursing services and all nec S9210 Nursing services and all nec S9220 Nursing services and all nec S9225 Nursing services and all nec S9230 Nursing services and all nec S9300 Nursing services and all nec S9308 Nursing services and all nec S9310 Nursing services and all nec S9395 Nursing services and all nec S9420 Nursing services and all nec S9423 Nursing services, patient as

66S9425 Nursing services and all nec S9435 Medical foods for inborn err S9455 Diabetic Management Program, S9460 Diabetic Management Program, S9465 Diabetic Management Program, S9470 Nutritional counseling, diet S9472 Cardiac rehabilitation progr S9473 Pulmonary rehabilitation pro S9474 Enterostomal therapy by a re S9475 Ambulatory setting substance S9480 Intensive outpatient psychia S9485 Crisis intervention mental h S9524 Nursing services related to S9526 Skilled nursing visits for S9527 Insertion of a peripherally S9528 Insertion of midline central S9533 Pain management, intravenous S9535 Administration of hematopoie S9539 Administration of antibiotic S9543 Administration of medication S9545 Administration of immune glo S9550 Home IV therapy, hydration S9555 Additional home infusion S9990 Services provided as part of S9991 Services provided as part of S9992 Transportation costs to and S9994 Lodging costs (e.g. hotel ch S9996 Meals for clinical trial par S9999 Sales tax 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

67V2201 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

68V2512 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 Hearing aid monaural in ear V5060 Behind ear hearing aid V5070 Glasses air conduction V5080 Glasses bone conduction

69V5090 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 V5299 Hearing service V5336 Repair communication device V5362 Speech screening V5363 Language screening V5364 Dysphagia screening